Signs and Symptoms of HIV Infection

The general course and presentation of HIV infection makes it tricky to describe the signs and symptoms of infection in the way you might with another infectious disease. The signs and symptoms of initial, acute infection mimic the flu so closely that testing and diagnosis are often missed. Then, HIV can progress in the body undiagnosed for years on end until a significant opportunistic infection arises and manifests with its own signs and symptoms. Once HIV infection has progressed to AIDS, the signs and symptoms are simply the signs and symptoms of the various opportunistic infections and cancers that occur.

Nevertheless, some signs and symptoms are associated with each stage of infection, and I've listed them here, for adults, based on WHO's clinical criteria for staging and reporting.

Primary HIV Infection (2-4 weeks post exposure)

Signs

Elevated viral load (rises quickly, then returns to baseline)

Low CD4+ T cell count (falls quickly, then returns to baseline)

Fever

Lymphadenopathy

Orogenital ulcers

Diffuse rash
Meningoencephalitis

Symptoms

"Feels like the flu"

Sore throat

Clinical stage 1: Asymptomatic

Signs

Low viral load

CD4+ T cell count >500

Persistent generalized lymphadenopathy

Symptoms
Generally asymptomatic

(This is an especially dangerous time--due to mildness (or even absence) of symptoms, the person is essentially asymptomatic and unlikely to seek out testing and treatment. They are at risk for uncontrolled progression as well as for spreading the disease to others.)

Clinical Stage 2: Mild Symptoms

Signs

Increased viral load

CD4+ T cell count between 350 and 499

Stage 2 Conditions
Moderate unexplained weight loss (<10% of normal body weight)
Recurrent respiratory tract infections (sinusitis, tonsilitis, otitis media, pharyngitis)
Herpes zoster (shingles)
Angular cheilitis (lesion at the corner of the mouth)
Recurrent oral ulceration
Rash
Seborrhoeic dermatitis (eczema-like)
Fungal nail infections

Clinical Stage 3: Moderate Symptoms

Signs

CD4+ T cell count 200-349

Stage 3 Conditions
Unexplained severe weight loss (>10% of normal body weight)
Unexplained chronic diarrhea > 1 month
Unexplained persistent fever > 1 month
Persistent oral candidiasis (thrush)
Oral hairy leukoplakia
Pulmonary tuberculosis
Severe bacterial infections (e.g. pneumonia, meningitis, bacteremia)
Acute necrotizing ulcerative stomatitis, gingivitis, or periodontitis
Unexplained anemia, neutropenia, or chronic thrombocytopenia

Clinical Stage 4: Severe Symptoms, AIDS
Signs
Presumptive or definitive clinical diagnosis of any stage 4 condition AND confirmed HIV infection OR CD4+ T cell count<200

Stage 4 Conditions

HIV wasting syndrome
Pneumocystis pneumonia
Recurrent severe bacterial pneumonia
Chronic herpes simplex infection
Candidiasis of esophagus, trachea, bronchi, or lungs
Extrapulmonary tuberculosis
Kaposi's sarcoma
Cytomegalovirus infection
Central nervous system toxoplasmosis
HIV encephalopathy
Extrapulmonary cryptococcosis (e.g. meningitis)
Disseminated non-tuberculosis mycobacterial infection
Progressive multifocal leukoencephalopathy
Chronic cryptosporidiosis with diarrhea
Chronic isosporiasis
Disseminated mycosis (coccidiomycosis or histoplasmosis)
Recurrent non-typhoidal Salmonella bacteremia
Lymphoma (cerebral or B-cell non-Hodgkin) or other solid HIV-associated tumors
Invasive cervical carcinoma
Atypical disseminated leishmaniasis
Symptomatic HIV-associated neuropathy or symptomatic HIV-associated cardiomyopathy

Resources
I found it interesting that information about signs/symptoms of HIV is not especially well-disseminated via the websites for WHO or the CDC. (WHO's main HIV information: http://www.who.int/features/qa/71/en/index.html. CDC's: http://www.cdc.gov/hiv/topics/basic/index.htm.)

I think this has to do with two things: first, that there is a move to "opt-out" testing, where everyone is tested routinely, rather than testing by signs/symptoms. Second, we know that the signs and symptoms of primary HIV infection mimic the flu.

Closer to home, WebMD publishes a list of signs and symptoms (http://www.webmd.com/hiv-aids/guide/hiv-symptoms) which seems a bit oversimplified/alarmist. Proceed with caution!

References

Lewis, Heitkemper, Dirksen, O'Brien, & Bucher. Human immunodeficiency virus infection. Medical-Surgical Nursing: Assessment and Management of Clinical Problems. Mosby, 2007.

World Health Organization (2007). WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV-related disease in adults and children. Retrieved October, 2011 from: www.who.int/hiv/pub/guidelines/HIVstaging150307.pdf