A Timeline of HIV Symptoms

The signs and symptoms of an HIV infection (from the human immunodeficiency virus) can vary from person to person — and many people won’t know they’ve been infected until years after they were first exposed to the virus.

HIV infection is a progressive disease, meaning that it typically worsens over time. In the early stages, the symptoms may be mild and easily mistaken for an illness like the flu. However, as the disease advances and breaks down the immune system, other, more serious symptoms can develop.

It’s important, therefore, to recognize the signs of HIV at different stages of the infection. By doing so, you can be tested and begin taking HIV treatment, which can allow you to live a healthy life.

“Even if you don’t have symptoms, early testing and treatment confers far better health and near-normal life expectancy,” says Linda-Gail Bekker, MD, an infectious disease specialist who is the deputy director of the Desmond Tutu HIV Centre based in South Africa and the former president of the International AIDS Society.

Here’s a list of HIV symptoms along with the stage of the infection in which they likely appear:

2 to 4 Weeks After Exposure

Known as acute retroviral syndrome, or ARS, the acute stage occurs immediately after being infected, when the immune system has yet to control the virus. During this time, about two-thirds of people will experience mild to moderate flu-like symptoms, whereas the rest won’t experience any symptoms at all, notes HIV.gov.

Although these signs typically appear within two to four weeks of exposure, they can also occur within as little as three days. Around 30 percent of people with ARS will develop a generalized rash of pink to red bumps, usually on the upper half of the body. The rash will sometimes gradually converge into larger, raised hives.

Per HIV.gov, other common ARS symptoms include:

• Fever
• Fatigue
• Headache
• Sore throat
• Muscle aches
• Joint pain
• Swollen lymph nodes
• Night sweats
• Nausea
• Diarrhea

The average duration of ARS symptoms is 14 days.

3 to 4 Weeks After Exposure

By around the third or fourth week, the virus will begin to stop multiplying rapidly, according to the University of Washington–led National HIV Curriculum. Although some people can experience ARS symptoms for up to three months, most people will start feeling better within two weeks, as the immune system gradually brings the infection under control.

The exception: a symptom called lymphadenopathy, the sometimes painful swelling of lymph nodes in areas of the body, such as the neck, armpits, or groin region. Even when the other symptoms have disappeared, lymphadenopathy may continue for months or even longer.

And in general, the lack of symptoms in some people or the seeming resolution of early-stage symptoms does not mean that the HIV infection is gone, as the Centers for Disease Control and Prevention notes: HIV is an ongoing condition that requires consistent, regular treatment.

4 Weeks After Exposure

The chronic stage of infection occurs once the immune system brings the virus under control. During this phase, HIV will go into hiding, where it resides in various cells and tissues throughout the body in a dormant state known as latency, according to HIV.gov. HIV latency can persist without symptoms for 10 years or more, although some people may experience signs within a year or two.

During the early chronic phase, lymphadenopathy may be the only notable sign of an HIV infection. In some cases, the glands may be visibly enlarged and reach up to an inch or more in size. If the condition persists for more than three months, it’s referred to as persistent generalized lymphadenopathy (PGL), notes HIV.gov.

Even during latency, the virus will multiple imperceptibly and gradually deplete immune cells known as CD4 T-cells. As immune deficiency develops, a number of nonspecific symptoms are likely to appear, including:

• Oral candidiasis (thrush), a fungal infection that causes the formation of creamy, white patches on the sides of the tongue and lining of the mouth
• Unexplained fevers or weight loss
• Severe, uncontrolled diarrhea that lasts for more than three days

These symptoms are commonly seen in people with immune deficiency. With the exception of thrush, they may, in some cases, be caused by HIV itself or by an infection that has yet to be diagnosed.

Later-Stage HIV and AIDS

If left untreated, HIV will almost invariably lead to symptomatic disease. There is no timeline or pattern as to when this might occur. Generally speaking, the lower a person’s immune health (as measured by the CD4 count), the greater the risk of certain illnesses, according to MedlinePlus. Medical experts refer to these illnesses as “opportunistic” because they occur only when a person’s immune defenses are down.

At a certain point, if still untreated, the depletion of CD4 T-cells can lead to a stage of disease called AIDS, or acquired immunodeficiency syndrome. This is when the most serious opportunistic infections tend to occur. AIDS is officially defined as either having a CD4 count under 200 or the presence of at least one of over 25 different AIDS-defining conditions, notes StatPearls.

Symptoms in later-stage HIV and AIDS include viral, bacterial, fungal, and parasitic infections as well as cancers like invasive cervical cancer and non-Hodgkin lymphoma. These infections affect the organs and other areas of the body, per HIV.gov, including:

• Lungs (bacterial pneumonia, tuberculosis, pneumocystis pneumonia)
• Skin (shingles, Kaposi sarcoma)
• Gastrointestinal system (mycobacterium avium complex, cryptosporidiosis)
• Brain (toxoplasmosis, cryptococcal meningitis)
• Eyes (cytomegalovirus retinitis, herpes zoster ophthalmicus)
• Blood (salmonella septicemia)