A person cannot rely on symptoms alone to determine an HIV status. Symptoms vary according the phase of infection (the weakening of the immune system due to destroyed CD4 cells and the physical effects this has on the body). The only sure way to know if a person has an infection is through testing.
Signs and symptoms according to HIV infection stage
An HIV infection progresses through three stages, each presenting different sets of symptoms and complications. Not all HIV positive individuals will progress through all three stages. Some never develop full-blown AIDS. An HIV infection, however, lasts the remainder of a person’s life once contracted and cannot be cured. The three stages and their associated symptoms are:
- Acute HIV (the primary infection stage): Once the virus has entered the body, initial symptoms may show up within two to four weeks or up to a month or two (when the body’s immune system kicks into gear to fend off signs of infection). The acute stage typically shows up flu-like symptoms which can linger for a few days or up to several weeks. Common symptoms include headache, fever, nausea and vomiting, joint pain, muscle aches, body chills, a sore throat, swollen lymph nodes (in the neck), mouth ulcers and a red (inflamed) rash. Symptoms range from mild to severe and depend on the amount of the virus present in the bloodstream (the viral load). Symptoms such as these can also appear due to other infections in the body. The virus is more easily spread during this stage of infection, especially if the viral load (amount of virus in the bloodstream) is particularly high. Even if a person does not display obvious symptoms at this stage, they can still easily transmit the disease through relevant spreading behaviours.
- Chronic HIV (the clinical latent or asymptomatic infection stage): During this stage, there are no specific signs and symptoms of the virus, but many can experience persistently swollen lymph nodes. The virus remains in the infected white blood cells for up to 10 years without treatment before progressing to the next stage. With treatment, this stage can last several decades as the virus slowly progresses by multiplying and destroying cells and although the virus is still very much active at this stage, it reproduces (copies itself) at a lower rate than the previous stage. Transmission of the virus is still very much possible during this stage even if ART treatment is being administered. Treatment can help an infected person’s body to suppress the virus (i.e. there will be low levels of the virus in the bloodstream), but spreading of the disease is still very much possible.
- Progression to AIDS: As the disease progresses, a person may develop a range of mild infections and other chronic ailments (and associated symptoms). These can include persistent or frequent fevers, fatigue, diarrhoea, swollen lymph nodes (in the neck, armpits and groin), rapid weight loss, thrush (oral yeast infections), sores (in the mouth, genitals and anus) or shingles (herpes zoster). Once the disease has progressed to this advanced stage, the body’s immune system has been severely compromised (damaged). A person is at their most vulnerable to opportunistic infections (i.e. other infections mild enough that a normally healthy individual is able to fend off naturally or with very little medical intervention) and thus experiences associated symptoms such as persistent fever, soaking night sweats, chronic diarrhoea, unexplained or persistent fatigue, weight loss, unexplained bruising (sometimes this can include bleeding), skin rashes or bumps, white spots and unusual lesions that are red, brown, purplish or pink in colour (particularly on the eyelids, or in the nose, in the mouth and on the tongue). During this stage, an infected person is also prone to bouts of pneumonia, neurological disorders, memory loss and even depression. The most severe symptoms typically are as a result of opportunistic infections due to immune system damage and can be life-threatening. Diagnosis of AIDS usually happens when a person’s CD4 cell count drops below 200 or if it becomes apparent that an ‘AIDS-defining illness’ has developed, such as a form of skin cancer, known as Kaposi’s sarcoma or lung condition such as pneumonia (pneumocystis jiroveci pneumonia).