EDGE Philadelphia

Question:
Dear Dr. Jason,

I’ve read a lot about the initial symptoms of HIV infection, but everyone seems to have a different list. Can you clear up this confusion?

Unaware

Doctor Jason’s Response:

If the initial symptoms of HIV infection were uniform and specific, then we would always be able to determine acute infection; however, the initial symptoms are myriad and quite non-specific.

HIV is a virus and causes symptoms similar to other viral infections: fever, chills, rash, fatigue, joint pains, and swollen lymph nodes. The "classic" presentation of acute HIV is a flu-like illness that can last anywhere from 3-14 days. Other possible symptoms can include meningitis, nausea, vomiting, diarrhea, headache (not actual meningitis), lethargy, night sweats, oral ulcers, and thrush (a fungal infection of the mouth).

The symptoms tend to appear around 2-4 weeks after infection with HIV. As a result, common antibody testing--whether it is the rapid test or serum-based test--would be negative at this time. The diagnosis has to be made from specifically finding the virus, either by performing a "viral load" or a test called the p24 antigen assay. These are blood tests specific for HIV, and they should be positive in the setting of symptomatic acute infection.

Since the symptoms are quite non-specific and commonplace for several different other viruses, including Influenza and Epstein-Barr (common cause of Mono), some people may not seek medical attention during this time. As a result, the diagnosis may not occur until later, during routine screening. If you do develop flu-like symptoms, even during flu season, and you have engaged in behavior that could put you at risk for HIV infection, then you should seek medical attention and be forthright with your health care provider about the possibility of acute HIV infection.

Stay healthy,
Doctor Jason