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Late Stage HIV Infection (AIDS)

An individual progresses from acute infection when they are first infected, to clinical latency where HIV slowly replicates in their body. Clinical latency can last anywhere from two to fifteen years without treatment, and for much longer with consistent treatment (called ART, antiretroviral therapy). Eventually, the slowly replicating HIV in a person’s body will lead to a significant decrease in their CD4 cell count.1-5

CD4 cells are cells that are part of the immune system and help our bodies fight off infections and other foreign invaders. A normal CD4 count in a healthy individual can be anywhere from 500-1,500 cells/microliter. When an individual has late-stage HIV, also called AIDS (acquired immunodeficiency syndrome), their CD4 count is below 200 cells/microliter (also referred to as a CD4 count of 200) or they have one of the many AIDS-defining illnesses (some of which are listed below). When an individual’s CD4 count gets very low, such as below 50, their HIV is thought to be very advanced.1

The effect of low CD4 counts

As mentioned, CD4 cells help protect our bodies from infection and regulate our immune systems. Without them, we are much more susceptible to illnesses, foreign invaders, and cancers. One thing that is of particular importance for individuals with late-stage HIV is opportunistic infections. An opportunistic infection is one that normally wouldn’t affect an individual with a healthy immune system, but can greatly affect someone with HIV. We are exposed to possibly infectious agents every day; however, our bodies are able to fight them off. If our immune system is damaged by HIV, we are unable to fight off these common invaders like we used to. These infections can take over our bodies and be potentially life-threatening.1-5

The symptoms of these infections and other issues related to a weakened immune system are symptoms often associated with AIDS. Several of these include, but are not limited to:

  • Recurring fever
  • Extreme tiredness
  • Rapid weight loss
  • Recurring night sweats
  • Long-term diarrhea
  • Pneumonia
  • Persistent cough
  • Long-term swelling of lymph nodes in the neck, groin, or armpits
  • Neurological issues such as depression or memory loss
  • Sores in or around the mouth, genitals, or anus
  • Purple, brown, red, or pink blotches inside the mouth or nose, under or on the skin, or around the eyelids1-5

AIDS-defining illnesses

Regardless of an individual’s CD4 count, they can be diagnosed with AIDS at any time if they are HIV-positive and have one or more AIDS-defining illnesses. Many of these illnesses are opportunistic infections or occur as the result of long-term HIV infection. There are many AIDS-defining illnesses. Several of these include, but are not limited to, the following:

  • Multiple or recurrent bacterial infections
  • Candidiasis (yeast infection) of the mouth, trachea, lungs, or esophagus
  • Fungal infections throughout the body caused by species including coccidiodes, cryptococcus, or histoplasma
  • Invasive cervical cancer
  • Kaposi sarcoma
  • Immunoblastic, Burkitt, or brain lymphoma
  • Cytomegalovirus (CMV) retinitis with loss of vision
  • HIV encephalopathy (brain infection that causes damage, also called the AIDS dementia complex)
  • Herpes simplex virus with chronic ulcers lasting longer than a month
  • Tuberculosis
  • Pneumocystis jirovecii pneumonia
  • Recurrent salmonella infection in the blood
  • Toxoplasmosis (brain infection from a parasite)
  • HIV wasting syndrome (unwanted weight loss of greater than 10 percent of a person’s body weight within a month)1,6

Prognosis of AIDS

It’s important to note that when an individual who has AIDS has an AIDS-related death, they are not dying because of AIDS. Rather, they are dying as a result of an AIDS-related complication, specifically, having a weakened immune system that allows them to be more susceptible to serious medical conditions. The median survival for someone diagnosed with AIDS is about 12 months to three years if the individual is not taking ART.1-5

However, it’s possible for most individuals to undergo immune reconstitution if they take ART regularly, even after being diagnosed with AIDS. When this happens, the body is able to respond to ART, suppress HIV, and increase the number of CD4 counts past the 200 cell count mark. If an individual passes this mark, and has no AIDS-defining conditions, they are considered to have moved backwards into the clinical latency or chronic HIV infection stage. They no longer have AIDS.1

Written by: Casey Hribar | Last reviewed: September 2019
  1. Sax PE. The Natural History and Clinical Features of HIV Infection in Adults and Adolescents. UpToDate. https://www.uptodate.com/contents/the-natural-history-and-clinical-features-of-hiv-infection-in-adults-and-adolescents. Published July 24, 2018. Accessed June 25, 2019.
  2. How Can You Tell if You Have HIV? U.S. Department of Health and Human Services: HIV.gov. https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv. Published June 21, 2019. Accessed June 25, 2019.
  3. Symptoms and Stages of HIV Infection. Avert: Global Information and Education on HIV and AIDS. https://www.avert.org/about-hiv-aids/symptoms-stages. Published September 28, 2018. Accessed June 25, 2019.
  4. Stages of HIV Infection. Centers for Disease Control and Prevention: HIV Risk Reduction Tool. https://wwwn.cdc.gov/hivrisk/what_is/stages_hiv_infection.html. Accessed June 25, 2019.
  5. Hare CB. Clinical Overview of HIV Disease. HIVInSite: University of California San Francisco. http://hivinsite.ucsf.edu/InSite?page=kb-00&doc=kb-03-01-01. Published December 8, 2009. Accessed June 25, 2019.
  6. HIV and Dementia. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/hiv-and-aids/hiv-and-dementia. Accessed June 25, 2019.