Reviewed By: Dr. Kurt Kloss, MD
Last Reviewed Date: Jan 04, 2019
Last Modified Date: Jan 04, 2019
Published Date: Dec 13, 2018
TABLE OF CONTENTS
Human immunodeficiency virus, or HIV, is a virus that attacks the body's immune system, making it dangerously susceptible to infections. HIV compromises the CD4 cells that are responsible for fighting off infections and infection-related cancers. If HIV progresses to the point in which the body has so few CD4 cells that it can no longer fight off diseases and infections, the patient will develop AIDS, which is the final stage of this infection.
HIV/AIDS: The Basics
HIV is transmitted through the exchange of bodily fluids with an infected individual, most frequently via unprotected sex or through needle or syringe use. Left untreated, this viral infection can lead to the development of AIDS, or acquired immunodeficiency syndrome, which is a life-threatening disease. That makes it very important that HIV infection is diagnosed and treated early and getting tested regularly and being well-informed about HIV is the best way to make sure that happens. So, what do you need to know about HIV Symptoms in men?
There's no cure for HIV, but you can control it with antiretroviral therapy (ART). This is a daily medication that lowers the patient's chance of transmitting HIV and helps to keep him or her healthy. The sooner you diagnose HIV, the better your chances of successfully controlling it and enjoying a long lifespan.
When it comes to Human Immunodeficiency Virus (HIV) infection, early detection is essential to ensure the prompt treatment necessary to control the virus. With early treatment, progression from HIV infection to Acquired Immunodeficiency Syndrome (AIDS) can be slowed significantly, improving a person's prognosis and quality of life dramatically. Given the importance of early diagnosis and treatment, knowing the symptoms of HIV is important for everyone, increasing chances that the infection will be recognized in its earliest, most treatable stages.
HIV and AIDS
Human Immunodeficiency Virus (HIV) weakens the immune system in infected individuals leaving them open to contracting AIDS. The primary means by which it is transmitted is through sexual contact, but the virus may also be contracted through exposure to infected blood and can be transmitted by a mother to her child during pregnancy, childbirth or breastfeeding.
Left untreated, the progressive damage to the immune system almost always leads to the development of AIDS although the time frame varies. AIDS is a chronic condition in which a severely compromised immune system makes the body vulnerable to opportunistic infections, many of which are life threatening.
There is no cure for HIV, but treatments have been developed that are very effective in slowing the progression of the disease. These treatments have allowed many HIV positive individuals to live long, full lives by delaying or even preventing the onset of AIDS, as well as significantly reducing the number of AIDS deaths. However, earlier is better when it comes to effective HIV treatment, so knowing the early symptoms of HIV and getting tested at any sign of them is essential.
Who is at Risk?
Anyone who is sexually active is at risk for contracting HIV. That being said, there are certain factors that place individuals at greater than average risk. Among the most important of these is:
- Unprotected vaginal, anal or oral sex
- Multiple sex partners
- Use of intravenous drugs, particularly when syringes and other equipment is shared
- Infection with other sexually transmitted diseases
- Infection with hepatitis, tuberculosis or malaria
- Sexual activity with individuals with any of the above risk factors
Primary or Acute HIV Infection: The Source of the Early Symptoms of HIV Primary or acute HIV infection are terms used to describe the early stages of HIV infection, when an individual is newly infected with the virus, also known as acute retroviral syndrome (ARS). This phase of HIV infection typically develops within 2 to 4 weeks of initial HIV infection; but, may appear three months after contraction of the virus. Between 50 and 90 percent of patients will present symptoms of HIV during this phase, as their immune system will begin reacting to the invasion of the HIV virus. Symptoms, which are typically flu-like, last an average of 14 days, but may persist for several months in some cases. Most commonly reported early symptoms of HIV infection include:
- Night sweats
- Muscle aches
- Sore throat
- Swollen lymph nodes
- Mouth sores
Individuals who experience these symptoms of HIV should be tested for infection, especially if known risk factors for HIV exposure are present. Since the immune system has not yet produced antibodies against HIV at this phase, standard tests, which detect those antibodies, will produce a negative result in primary HIV infection cases. HIV test that look for the virus itself, such as HIV-1, Qualitative, RNA tests, are necessary for an accurate diagnosis. Recognizing these early symptoms of HIV infection is essential to early detection, since once they disappear, most HIV infected individuals will show no further telltale signs that might prompt them to seek testing for up to 10 years.
This high-impact virus can have the following symptoms.
Fever and Chills
A fever is often one of the first symptoms an individual having HIV experiences. Any temperature over 100.4 is considered a significant fever. Fevers with HIV may climb up to 102. Fevers typically show up two to four weeks after the patient contracts HIV. This is known as the acute stage of the infection. Such fever is often accompanied by other flu-like symptoms, such as fatigue, sore throat, and even swollen lymph nodes.
Fevers typically accompany a viral infection; and, may be due to a variety of viruses one might pick up. A persistent fever in someone with stage-3 HIV is often the sign of an opportunistic infection. This type of infection takes hold because the immune system is too weak to fight it off as it would in a healthy person. Opportunistic infections include pneumonia, herpes simplex, tuberculosis, and bronchitis, among others.
Headaches are a common occurrence for some people, and may not be a cause for major concern. If you've been diagnosed with migraines; or, develop headaches through known triggers such as alcohol, dehydration, or stress, then you can typically treat these using pain medication. There are, however, some headaches that require more attention.
If you're experiencing frequent, prolonged headaches, you should speak to your healthcare provider as soon as possible. You should also call your doctor if you're battling a headache that's unusually severe. This type of headache may indicate a more severe underlying problem such as an HIV-related systemic disease. Patients with diagnosed HIV might experience headaches as a side effect of some ART medications. Don't let worrisome headaches go undiagnosed, as this may offer an early indicator of a bigger problem.
HIV can result in brain deficiencies as it progresses. Though ART can dramatically reduce the levels of the virus in the body, HIV may continue to cause damage to the brain. Roughly half of the patients with HIV experience brain-related symptoms from HIV-associated neurocognitive disorder. The earlier you start HIV treatment, the lower your risk of suffering from damage to the brain cells.
Trouble concentrating is a advanced symptom of HIV. It's most commonly seen in patients who have had the virus undiagnosed for a long time. If HIV goes unnoticed, it can cause cognitive difficulties including trouble concentrating, memory loss, and confusion. If HIV is left untreated, this can progress to HIV-associated dementia. At this point, the patient may have trouble with reasoning and experience notable personality changes. Neurological symptoms should never be ignored. If you can't focus or concentrate as you used to, see a doctor as soon as possible.
Night sweats are just what they sound like. Patients wake up drenched in excessive perspiration for no apparent reason. The sweating is often so profuse that the individual has to change their sleepwear or bedding. There are many conditions that can cause night sweats including diabetes, menopause, pregnancy, and sleep disorders.
In HIV patients, night sweats typically occur either at a very early stage of the disease; or, very late. During the acute stage of HIV, night sweats may accompany other symptoms such as muscle aches, fever, and headaches. Patients with later-stage HIV may experience night sweats when in conjunction with a serious infection such as tuberculosis or cytomegalovirus. If you're experiencing frequent night sweats, it's best to discuss these with your doctor so you can uncover the underlying cause of this uncomfortable symptom.
HIV can lead to a number of infections that cause skin conditions. Rashes are extremely common among HIV patients, with roughly 90 percent exhibiting a rash at some point in the course of the disease. These rashes may appear as generalized dermatitis, an infection, or possibly a skin lesion.
There are also several classes of antiretroviral drugs that can cause skin rashes. These typically exhibit as small, flat red bumps on the body that are very itchy.
If you haven't been diagnosed with HIV, a skin rash might be an early indicator of the acute stage of HIV. As the virus multiplies rapidly, it can cause a range of flu-like symptoms accompanied by a rash. Rashes are uncommon during the second stage, known as clinical latency. They may reappear in stage-3 of the virus, when HIV progresses to AIDS.
Changes in Your Nails
Changes in the nails are a subtle but distinctive indication of HIV. Most nail problems associated with HIV are the result of a fungal infection like onychomycosis. You might notice that the nails are thickening, splitting, or curving.
Discoloration of the nails is another sign you should pay attention to. You might notice dark black or brown lines running either vertically or horizontally. While some nail discolorations are harmless, it's important to discuss these nail changes with your healthcare provider. Don't simply cover the markings with nail polish and move on. Sudden unexplained nail changes often indicate a deeper problem that you need to address immediately.
A sore throat is a common symptom of HIV that's easy to overlook. The sore throat is typically accompanied by a headache, muscle aches, and fever. You might attribute these to a cold or flu; and, put them out of your mind. However, if these symptoms persist, they may indicate something more serious.
If you've engaged in risky behaviors such as unprotected sex, you should speak to your healthcare provider about any subsequent illness as soon as possible. Though it can take weeks or months for HIV to show up in a blood test, you can request a test that detects viral RNA to help you identify exposure to HIV sooner. These tests are accurate in just nine days of infection.
Sore throats aren't exclusive to the acute stage of HIV. HIV patients often experience recurring sore throats. In many cases, these are caused by thrush, a secondary infection that can take hold more easily in an individual with a compromised immune system. If you have thrush, your sore throat may be accompanied by a difficulty in swallowing.
Patients with HIV have a compromised immune system, that makes them more susceptible to other conditions, such as pneumonia. Pneumonia is an infection causing inflammation of the lungs. Symptoms of pneumonia include chills, coughing, fatigue, low appetite, high fever, rapid breathing and heartbeat, and stabbing chest pain.
If you believe you may have pneumonia, you should always see a healthcare provider. In extreme cases, pneumonia is fatal. If you've experienced other common signs and symptoms of HIV or you've engaged in risky behavior that may have exposed you to the disease, speak with your doctor about getting tested for HIV as well.
In the acute stage of HIV, the virus reproduces rapidly. As your immune system produces its inflammatory response, you're likely to feel fatigued as a result. Though you can't see it, your body is waging a strenuous war inside. This can take all the energy out of you and leave you feeling like you need nothing more than to lay down and stay in bed for days.
HIV-related fatigue may exhibit itself in many ways. You might find that you're unusually winded after climbing a flight of stairs, or you're suddenly out of breath though you're not sure why. Perhaps you simply can't summon the energy for common tasks and activities like doing chores or going out with friends. Fatigue generally lets up some during stage 2 of HIV but will return again later as the virus progresses.
You may also experience fatigue with HIV that's an indirect, rather than direct, cause of the virus. HIV patients often struggle with depression or insomnia as a result of their diagnosis that may cause persistent fatigue as a result.
Nausea, Vomiting, or Diarrhea
Patients with HIV often experience a variety of stomach problems. These usually occur in later stages of the disease, as a result of opportunistic infections that take hold. Nausea, vomiting, and diarrhea are common side effects with some antiretroviral medications as well.
If you're struggling with ongoing nausea, diarrhea, or vomiting, you should talk to your doctor to determine the underlying cause. In some cases, nausea is the result of something less serious, such as anxiety. In other cases, it can be a manifestation of a potentially serious virus.
If you're dealing with ongoing stomach problems with HIV, try switching to a bland diet. Avoid excessively hot or cold foods and stay away from anything spicy, greasy, or acidic. Eating smaller snacks throughout the day rather than three large meals may help as well.
HIV can cause muscle aches throughout the body. This symptom may also be the result of another virus or bacteria that was able to take hold because of the body's weakened immune system. Muscle pain with HIV can be mild in the early stages, feeling very much like the flu. This is particularly common in the acute stage.
HIV can also cause more severe muscle pain. This can be the result of HIV itself or a side effect of medications. This type of pain is also associated with high cholesterol or hepatitis. If you have achy muscles for no reason, speak with your doctor to find out the underlying cause of this discomfort.
Viral infections may cause painful joints. These infections cause the joints to become swollen and warm on the touch. HIV patients often develop HIV-related arthritis, which can cause bone and joint pain. This pain usually starts in the feet and ankles, though it can later progress to other joints in the body. HIV-associated reactive arthritis causes pain and swelling in the fingers and toes.
Swollen Lymph Nodes
The lymph nodes are a key part of your body's immune system, which is why they're so frequently affected by HIV. Your lymph nodes assist the body in getting rid of viruses and bacteria when they're functioning properly. If there's an infection, the lymph nodes become inflamed in response.
You have lymph nodes in your neck, groin, and armpits. You may have felt these swell and become tender with other viruses. Doctors will frequently feel your lymph nodes when diagnosing you with an illness. If your lymph nodes are enlarged and painful, this is a sure sign that your body is battling something. HIV could be at the root of the problem. If you have painful lymph nodes for an extended period of time, you should call your doctor.
A dry, persistent cough is a common symptom in patients with late-stage HIV. This type of cough doesn't resolve with inhalers, allergy medication, or antibiotics and continues for an extended period of time. Patients may initially believe the cough is simply caused by a cold. Seasonally, it may seem like a symptom of allergies.
A cough related to HIV will outlive other common coughs. If you're still experiencing a dry hacking cough weeks after its initial onset, you should discuss the symptom with your doctor. This is an indicator of a more serious problem. If the cough is associated with HIV, it's a clue that you're very ill and should seek treatment as soon as possible.
Frequent Yeast Infections
Although they may seem innocent, too many yeast infections can indicate the presence of HIV. Symptoms of a vaginal yeast infection include persistent itching, a white discharge, and vaginal discomfort. Most women will experience one or more yeast infections in their lifetimes, as they're extremely common.
This fungal infection is caused by an overgrowth of yeast. Maintaining the right balance of bacteria and fungi in the body is particularly difficult for patients with HIV, as their immune systems are compromised. Yeast infections are particularly common in women with a CD4 count below 350 cells/mL. At this point, yeast infections are not only more frequent, they're also more severe and difficult to get rid of.
If you haven't been diagnosed with HIV but you're struggling with yeast infections that won't go away or persistently reoccur, discuss the problem with your healthcare provider as soon as you can.
One-third of all people with HIV develop mouth sores at some point. This is a direct result of the weakened immune system. It's important to address mouth sores with your doctor as soon as possible. Open sores make you more susceptible to infection. They can interfere with your medications and make eating difficult and painful.
Many HIV patients also suffer from herpes simplex, which will cause red mouth sores. These can look more like blisters when they appear outside the mouth. An oral herpes outbreak is treatable with medication, but patients with HIV may have more difficulty healing such sores. It's not uncommon for a herpes outbreak to last longer and be more severe in a patient with HIV.
There's a strong connection between genital herpes and HIV. People with sores from genital herpes are more likely to contract HIV from intercourse. These sores are a magnet for immune system cells, which attempt to heal them. HIV is drawn directly to these cells, so any infected bodily fluids that come into contact with herpes sores present an extremely high risk of infection.
An active herpes virus also allows HIV to replicate more quickly once the patient is infected. Individuals with HIV will have more outbreaks of genital herpes. These are often longer and more severe than they would be in a patient without HIV. If you have genital herpes, it's important to be particularly mindful of the increased risk for HIV infection. A sharp increase in the frequency and severity of herpes outbreaks could be an indicator of HIV for a patient who isn't yet aware of the virus.
Unexplained Weight Loss
Unexplained weight loss may be a concern when you lose 10 pounds, or five percent of your body weight, over a period of six to 12 months without cause. Weight loss is a common problem for patients with advanced HIV. Weight loss and/or wasting frequently happen as CD4 cell counts drop. Weight loss is even an independent predictor of mortality for patients with HIV.
Since weight loss happens so late in the progression of HIV, patients typically know that they have the virus by that point. Any unexplained weight loss should be addressed with your healthcare provider, regardless of the cause. If you have HIV, weight loss is particularly concerning because it will further hinder your body's ability to fight infection.
Changes in one's menstrual cycle can be an indicator of HIV in women. Changes to your immune system caused by HIV will affect the hormone levels in your body. This, in turn, can have a noticeable impact on your menstrual cycle. If estrogen, testosterone, and progesterone levels change significantly, your period can adjust in many ways.
Though the timing, length, and heaviness of a woman's period can vary from person to person, most women know what's familiar to them. If you notice that your periods are occurring more or less frequently, the duration has changed, or you're spotting between cycles, you should address the issue. You should also speak with your doctor about periods that are lighter or heavier than usual, particularly if these types of changes persist past a single cycle.
Women who are on an anti-HIV medication are less likely to experience these issues. Therefore, menstrual irregularities are most pronounced in women with HIV that has not been diagnosed.
Numbness and Tingling
In later stages of HIV, patients may have damage to the nerves in the spinal column and brain. This chronic inflammatory polyneuropathy causes a feeling of numbness and tingling in the extremities. This is usually experienced in the fingers and toes. As the condition progresses, the sensation may extend into the arms and legs.
HIV neuropathy may also cause severe aching or burning sensations in the arms, fingers, legs, and toes. Weakness in the extremities may occur as well. This is one of the more difficult effects of HIV neuropathy as it can greatly interfere with daily activities. If you have a known HIV infection, you should address numbness and tingling with your doctor as soon as possible. If you haven't been diagnosed with HIV, these symptoms may indicate the need to get tested.
Depression and other neurological symptoms are a common sign of HIV. However, patients who are already diagnosed with HIV may also suffer from depression as a result. Following this diagnosis, individuals often experience feelings of sadness and grief. If these emotions worsen into a case of serious clinical depression, this should be addressed so patients can manage both their HIV and their depression to live a healthy life.
HIV-positive women are more likely to suffer from depression than HIV-positive men. Those in rural America are also at a higher risk because they may have access to less information, not realizing the improved outcomes that are now possible for people who have the virus. Anyone with HIV should receive regular mental health screenings.
Though most symptoms of HIV are also attributable to other causes, noting long-lasting or recurring symptoms may tip you off to a bigger concern. If you suffer from several of these symptoms or have troublesome symptoms on a frequent basis, speak with your doctor about whether HIV blood testing is an appropriate move.
HIV and Men
Perhaps, the most important thing to know about HIV symptoms in men is that many men do not experience clear symptoms at all. They are often feeling perfectly healthy for up to ten years after contracting the virus. So, if you suspect that you may have been exposed to HIV, do not wait for symptoms to confirm an infection – get an HIV test.
Many men experience symptoms shortly after becoming infected, generally within one to eight weeks after contracting the virus. These may include:
Fever: This is often one of the first signs of HIV infection; and, happens as the virus moves into the bloodstream and begins to reproduce itself. This progress causes an inflammatory reaction in the body as the immune system works to combat the virus.
Fatigue: That same inflammatory response can make you feel very tired and/or easily tired and winded from exercise.
Headache: Frequent and/or persistent headaches are a common symptom in the early stages of an HIV infection.
Swollen Lymph Nodes: Lymph nodes are part of the body’s immune system. They can swell and become tender in response to the presence of the HIV virus.
Muscle Aches - Joint Pain: Aches and pains are common, especially in areas like the neck, groin, and/or arm pits, where lymph nodes are located.
Skin Rash: The HIV rash may appear in small areas of the body or all over, including the palms of the hands, and soles of the feet. It often resembles boils, which may be surrounded by reddened, itchy skin.
Digestive System Problems: This is a very common early HIV symptom and can include nausea, vomiting and diarrhea.
Sore Throat and Dry Cough: This may be short-lived, lasting a few days or weeks; or, persistent, lasting for months.
Night Sweats: This is profuse sweating during sleep that occurs even in cool temperatures.
Ulcers in Mouth or Penis: These are open sores that can appear with early infection in men, most frequently in the mouth; but, also, on the penis or anus.
Hypogonadism - Poor Testosterone Production: This can occur as the HIV virus builds in the system and can cause low testosterone levels, which can lead to erectile dysfunction.
These early symptoms are collectively known as the acute illness phase of HIV infection. Many people never experience any of them, while those that do develop some or all of them may discount them as a case of the flu or another common ailment. Mistaking them for a simple, common and temporary illness is made easy due to their similarity to flu symptoms, and to the fact that they tend to disappear after a week or two – even though the virus is still very much present in the body. It is important to note that this period, when the virus has just been introduced to the body and is multiplying, is an extremely contagious phase of the disease – whether the infected experiences symptoms or not.
The Asymptomatic Stage of HIV Infection
The acute illness phase is typically followed by a long period where no symptoms are exacerbated. Men may be in this asymptomatic phase for a period of months or even years, often as long as 10 years; and, do not feel or look sick. However, the virus will still be active during this time, quietly lingering in the system, reproducing continually and beginning to gradually weaken the immune system. It will also still be contagious, which means that it can be passed to others.
Late-Stage HIV Symptoms in Men
Left untreated, the HIV virus will generally break down the body’s immune system. When this happens, it is typically referred to as late-stage HIV, advanced HIV, stage 3 HIV or AIDS. Men who reach this stage of HIV infection have severe damage to their immune system, making them easy targets for a variety of opportunistic infections. These are infections that a healthy immune system would usually fight off. Symptoms that may occur in men during this stage of infection include:
- Frequent colds, flu, fungal infections and other ailments
- Rapid weight loss
- Frequent nausea and vomiting
- Chronic diarrhea
- Chronic fatigue
- Chronic cough and shortness of breath
- Recurring fever, chills, night sweats
- Chronic inflammation of the lymph nodes
- Rashes, sores or lesions on the skin, in the mouth or nose and/or on the penis, testicles or anus
- Memory problems, neurological problems or confusion
Researchers in Canada determine that oral HIV test used for rapid STD testing can be done by swabbing the gums. It is 97% accurate in populations considered to be at low risk for HIV; and, 99% accurate in high risk populations. Results from the oral HIV test are quick and appear in as little as thirty minutes.
However, these rapid tests are still considerably less accurate than a standard laboratory HIV blood test. The benefit of the oral swab test is that it makes HIV accessible and convenient. Blood tests have been less accessible due to the stigma and the necessity of having a doctor's order.
Today, private HIV blood testing is available conveniently from companies such as Health Testing Centers without needing to personally go to a doctor. Results are private, fast (generally within 24 to 48 hours), and accurate.
There is a worldwide focus on prevention of HIV and unfortunately testing has not been in the forefront of the strategies resorted to in order to slow the growth of HIV. The main complaint is that HIV testing is inconvenient. Oral testing makes testing easier with nearly instantaneous results. But, the results show that such an instant testing method is still less accurate.
In areas where less than 1 percent of the population has HIV, the positive predictive value (PPV) was 89% for oral testing compared to 99% for blood testing. Correspondingly, as the percentage of the population with HIV increases, the false positive percentage decreases. Despite the increased false positives, the oral HIV tests were just 2% less sensitive than blood rapid HIV tests.
A main reason for the poorer performance of oral testing is that there are lower concentrations of HIV antibodies orally than there is in the blood. The results are particularly affected if testing HIV was done after a potential recent exposure, when antibodies would especially be low in oral fluid; but, could be accurately measured in the blood (Viral STD test package).
Antiretroviral therapy (ART) is the primary approach used in the treatment of HIV. ART uses a combination of drugs, to slow progression of the disease by inhibiting the ability of the virus to replicate. This decreases a patient's viral load to less damaging levels. In many cases, viral load can be reduced to undetectable levels. However, it is important to remember that individuals with undetectable HIV levels, and no symptoms of HIV, are still infected with the virus and can transmit the infection to others. Treatment, in most cases, will be long-term or even lifelong.
HIV: Regular Testing
While there is no cure for HIV infection, there are very effective treatments. With the use of medications and a treatment called antiretroviral therapy, the virus can be suppressed, stopping it from reproducing itself in the body. This can keep the viral load, that is the amount of HIV virus present in the body, low while limiting the damage it causes to the immune system. This can help prevent the disease from advancing to the more harmful late stage phase. This type of treatment is most effective when started early. Also, regular testing is your best means of ensuring an early diagnosis, followed by effective, rigorous treatment at the earliest possible stages.
Regular testing is also important to helping you ensure that you are not passing an undetected infection to others. So, how often should you be tested? The CDC recommends testing for all men ages 13 to 64, at least once. Men who are gay or bisexual should be tested every 3 to 6 months, as should all men who are sexually active and have more than one partner. Men who have unprotected sex should be tested every year, as should anyone who shares injection drug devices with others.
U.S. Department of Health & Human Services. HIV Basics. Retrieved from: https://www.hiv.gov/hiv-basics
The Centers for Disease Control and Prevention. About HIV/AIDS. (2018). Retrieved from: www.cdc.gov/hiv/basics/whatishiv.html
The Antiretroviral Therapy Cohort Collaboration. (2017). Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. DOI: 10.1016/S2352-3018(17)30066-8
The Centers for Disease Control and Prevention. HIV basics: Testing. (2018). Retrieved from: www.cdc.gov/hiv/basics/testing.html