More on HIV symptoms
I previously wrote an article on early HIV symptoms.
I am still receiving a lot of questions with regards to HIV symptoms so I am writing another article to provide more details.
What is HIV ARS?
When people talk about ‘HIV symptoms’ they are generally referring to the symptoms that appear soon (2 to 6 weeks) after a person is infected with HIV (as opposed to late AIDS symptoms which take years to develop).
These symptoms are a result of the body mounting an immune response to the HIV infection, NOT due to the infection itself. That is why you find similar or identical symptoms with other infections.
It is also commonly known as Acute-Retroviral Syndrome (ARS, ARVS), acute primary HIV illness, acute HIV syndrome and Acute Sero-Conversion Syndrome.
What are the early symptoms of HIV infection?
Because the whole body is reacting to fight off the virus, it is not surprising to find a variety symptoms affecting all bodily systems.
General – Fever, Sweats, Lethargy, Malaise, swollen lymph nodes, weight loss
Skin – Rash, ulcers , Sore throat
Digestive – Nausea, Diarrhea, Loss of Appetite
Neurological – Headache
Musculo-Skeletal – Muscle aches, Joint aches
Not everyone will develop all these symptoms. These symptoms can develop in varying combinations. The most common symptoms are fever, sore throat, rash and swollen lymph nodes.
Who gets HIV ARS symptoms?
It is estimated that between 50% to 90% (some say 40% to 70%) of people who have been infected with HIV will develop HIV ARS. There is no way to predict who will develop ARS and who will not.
When do HIV symptoms appear and how long do they last?
HIV symptoms can appear anytime between 2 weeks and 6 weeks after infection. Most people who do develop the symptoms do so at 3 weeks.
Symptoms generally last for at least 2 weeks but have been known to last up to 10 weeks.
‘Flu-like’ is not ‘Cold-like’
HIV ARS symptoms are often described as ‘Flu-Like’. Many people think having a Flu is similar to having a Cold and this has led to a lot of confusion.
Many patients see me for minor cold symptoms such as running nose, sore throat or a mild cough and are worried to death about HIV. These are Cold symptoms, they are not Flu symptoms.
For those of you who have had the Flu before, you will know what I am talking about. With a Flu, you will be very sick. The fever is high and persistent, the bodyache is very bad and you literally cannot get out of bed.
To be more precise, ARS is also described as mononucleosis-like symptoms.
The HIV ARS Rash
This is a great source of worry for many people I see. I have seen people coming in with literally one tiny red dot on their forearm convinced that it was a HIV rash. It is not.
The HIV rash usually comes on 2 to 3 days after the onset of the fever and lasts for at least 2 weeks. It is a Morbiliform (looks like measles) Exanthem rash consisting of macules and papules up to 1cm in diameter which are pink to red in colour. Each lesion remains discrete and do not become confluent. It is widespread and always (100%) involves the upper thorax and collar region also commonly (60% to 40%) affects the face, arms, scalp, thighs and palms in descending order of frequency.
Basically, the rash is BAD. Your friends and colleagues are going to take one look at you and ask ‘Hey why do you have a rash? Go see a doctor’. If you have to hunt for individual spots or patches randomly on your skin, it is not a HIV rash.
The HIV ARS Fever
Where do I start? I have patients measuring their temperatures hourly and freaking out when it hits 37.1⁰C because they read somewhere that ‘normal body temperature’ is 36.9⁰C and therefore they have a fever and therefore they have HIV. That is paranoia.
The HIV ARS Fever is high, usually above 38.5⁰C when taken from the ear. The HIV ARS Fever is long, usually lasting for at least 2 weeks most of the time longer. It is usually associated with other symptoms such as lethargy, malaise, muscle aches and joint aches.
The HIV ARS Lymph Nodes
This is another great source of worry. I have seen patients who cannot stop rubbing their necks feeling for lymph nodes and melting into a panic state whenever they feel a lump that they have not felt before.
First of all, you can feel normal non-enlarged lymph nodes especially in thin people. So being able to palpate a lymph node does NOT mean it is enlarged.
Enlarged lymph nodes are about 1cm in diameter. In HIV ARS, there are usually many of such lymph nodes in the neck, groin and underarms. They are usually tender (i.e. painful to touch).
The HIV ARS Sore Throat and Mouth Ulcers
The sore throat associated with HIV ARS is bad. It is not a little discomfort in the throat or the sensation of having to clear your throat. It is painful. If you ever had Strep Throat before, it feels like that.
It is commonly described as an exudative tonsillitis. In other words, you will be able to see white or yellow pus-like substance on the tonsils. The tonsils themselves will be red and swollen. About 20% of the time, there are also ulcers round to oval in shape, 5mm to 10mm in diameter with a white base and red halo on the inside gums, tonsils or roof of the mouth.
Anxiety can frequently cause the muscles around the throat to tighten leading to some throat discomfort. This is NOT HIV.
What other diseases have the same symptoms as HIV ARS?
First of all, the Flu. And by that I mean an Influenza infection, not a cold. See above for details.
HIV ARS symptoms also mimic the symptoms of infectious mononucleosis very closely (also known as Mono or Glandular Fever). HIV ARS symptoms can also be mistaken for an acute Hepatitis A or B infection, Parvovirus infection, Cytomegalovirus infection and Toxoplasmosis. It can even be mistaken for Rubella (German Measles).
Take home message: Do not assume and do not self-diagnose based on symptoms. Go get tested.Click here for HIV Testing FAQ
The only way to know for sure if you are infected with HIV or not is to get tested. Until that is done, try not to worry about your symptoms.
If you have to worry, then worry if you fulfil the following criteria:
- You have had a high risk exposure 2 to 6 weeks ago
- You have a fever above 38.5⁰C that just does not go away
- You have multiple small red spots covering your face, neck and upper chest
- You have a really bad sore throat with ulcers in your mouth
- You have been diagnosed with another STD like Gonorrhea or Chlamydia
If you had a high risk exposure to HIV within the past 72 hours, you can take medicines to reduce your risk of actually contracting HIV. Find out more on HIV PEP Treatment.Click here for info on PEP Treatment at Our Clinic
Remember, you are not doing yourself any good by hunting for symptoms. Take a deep breath, calm down and focus on getting the HIV tests done.Click here to see the full range of our HIV/STD Services
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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.