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More on HIV symptoms

stop aids signI 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.

HIV Symptoms are due to the immune system responding to the virus that is why many other infections can cause the same symptoms.

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.

Only 40% to 70% of people infected with HIV will develop ARS symptoms

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 Rash looks like Measles

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

Conclusion

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:

  1. You have had a high risk exposure 2 to 6 weeks ago
  2. You have a fever above 38.5⁰C that just does not go away
  3. You have multiple small red spots covering your face, neck and upper chest
  4. You have a really bad sore throat with ulcers in your mouth
  5. You have been diagnosed with another STD like Gonorrhea or Chlamydia
Click here to learn about other factors that increase HIV risk

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 for Info on STD Symptoms in Men
Click here for Info on STD Symptoms in Women
Click here to see the full range of our HIV/STD Services

 

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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.

HIV Prevention within 72 hours of exposure (PEP) – Click Here
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If you have any questions, visit our free online forum on sexual health, HIV and STDs.

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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.

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1,935 Comments

  1. Hi Doctor,
    How are u? I hope you are well. I have started my PEP on the date of 23.8.2016 exactly at 6pm for first time. then next day i started at 10 am in the morning and till now i am talking this way and never missed. My pills are Lopinavir 200mg+Ritonavir 50mg(keletra), Lamivudine 15omg+Zidovudine 300mg. 1. Should i be taking every 8 hours or every 12 hours?
    2.Can i still be start from tomorrow onwards to 12hrs-12hrs? I know i have to be taken the pills everyday at the same time. I am so sorry for this questions. Would you please let me know? Will there be any less pill’s effectiveness of this Pep treatment if i just switch from 8-8hrs to 12-12hrs now? I m on Pep for 5 days now. Pls help me answer this doctor. I have slight rashes and they were gone for now. My body feels really hot and i am in such worries right now? My doctor will only be available on monday and hence i am looking some answers from you and i hope you would answer me.
    Thanks doctor and i will be waiting to hear from u.

  2. Vincent

    I am worried about drinking drinks with contaminated blood in it. What are the chances of transmission?

    • What? It sounds to me like you need to see a psychiatrist. As a direct answer to your question: there is no risk of getting HIV this way.

  3. Is Sore thoart with shortness of breath and a mild cough signs of HIV or any other STD, I don’t have swollen glands or rash or even being fatigue

    • That is an impossible question to answer. What I can say it that they do not sound like the typical symptoms of HIV or STDs. However, that is not to say you are not infected with HIV or STDs. The only sure way to know if you are infected or not is to get tested.

  4. Worried soldier

    Hi Doctor,

    I have unprotected oral sex (giving and receiving) with a woman later found to be transgender male in Pattaya, Thailand. But I had protected intercourse with her. After having sex when I went to toilet, I spit in the sink and found blood like fluid and when I ask her, she said it was lipstick not her blood. Since then I have been in a really scared state and worried about contracting HIV. It’s been now 2 weeks of my contact. I am having mild fever and chills now and then. I have lost my apetite and my knees started to have mild pain. I do go for run and the knee doesn’t hurt during that period. I have mild itchiness on my neck as well.

    Am I going to have HIV? I have not tested yet as I am really worried. Could you please give me advice on this matter. Thank you.

    • I think what you are looking for is reassurance rather than advice. The advice is simple: go get tested. You had sex with a transgender sex worker in Thailand. I think nobody is going to argue the fact that you are at risk of HIV. You have a multitude of symptoms. Whether or not those are due to HIV nobody knows and no doctor can tell you either. You just need to get tested plain and simple. No amount of worrying will change that fact.

      • Worried soldier

        Hi Doc,

        I have been to the doctor for my HIV test. When I described about my situation and symptoms he just laughed. He said I don’t have any symptoms of HIV. It’s just that I am worrying too much. But I don’t think I got symptoms of HIV due to worry. He even advice no point of taking blood test as I don’t have HIV. But I requested him to take blood test for me.

        I am going to get my results this week. I am really worried about my early symptoms and what my doctor told me. Could you please help on what really going on me?

        Thank you

  5. I had unprotected sex and oral on a female almost 4 weeks ago, and after that started feeling funny, I would get a sore throat only at night it feel like and go aways and also I had trouble breathing at One point but I think it was due to me panicking about getting hiv or an std. Now it’s like I’m ok I have a mild cough but I don’t cough that much. I just got test and waiting on the the result

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