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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
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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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882 Comments

  1. Dear Dr. Tan,

    I’m the living example that a garden variety virus or bacteria, coupled with intense anxiety can produce symptoms that really look like ARS. Generalized (or perceived) swollen lymph nodes, temperature, fatigue and weakness for almost two weeks and went away on their own. Shortly after a risk exposure.

    Thank you for dealing with my anxiety a few weeks ago.

    Elisa way after the window period came back unreactive. And one thing that Elisa doesn’t do is produce false negatives.

    Just wanted to pass this on to all the worried wells. I was one of you, I was sure my life was over. I never get sick, and then was feeling crap for two weeks out of nowhere. I can guarantee, it doesn’t have to be the worst possible situation. Find out for certain or you will live an HIV hell that’s worse than the real one.

    Thank you for taking the time.

  2. Dr. Tan thanks for the good job that your here this is my second post . I was expose to HIV after 6wks i went for test which is negative and went back at 4mouths which is negative but aM still having this symptom that boarded me like recurring throat pain and white patches in tonsill with headache and fever and general body pain am confuse what will i do pls is the test not conclusive anti body test at 4mths

    • As far as I am concerned, your test is conclusive. So logically there must be some other explanation for your symptoms.

  3. Confused

    I read that during acute HIV infection someone may have thrombocytopenia. I read also that someone may develop Reactive Arthritis during acute HIV infection, and one of the markers of reactive arthritis is thrombocytosis. I’m cofused now. Which condition do exist during acute HIV infection? THROMBOCYTOSIS OR THROMBOCYTOPENIA?

    • Either or. It depends on which bodily reaction dominates. However, in the vast majority of cases, HIV infected people get NEITHER. Anyway, thrombocytosis and thrombocytopenia are so non-specific (can be caused by lots of things) that they really are not useful in the diagnosis of HIV. For example in Singapore, if a patient see s Doctor with fever, rash and thrombocytopenia, 99.9% of Doctors will test for Dengue and not HIV.

  4. Hi Dr.Tan

    I am seeing some white cheese like substance from my mouth when I wake up in the morning and its smelly. This is seen for past 35 days. Please can you confirm if this is yeast infection or ARS symptom?

  5. Thanks again Dr. And sorry for the many questions as I am really very very worried about this incident

    A couple of questions relating to your last response:

    1- how often do you see exudative tonsils as part of ARS infection?

    2- if it is present, is it usually related more to oral sex compared to vaginal sex?

    3- would the excudative tonsils be a result of the virus infiltrating the body thru the tonsils?

    4- I read that drinking beer before oral sex ( in my case deep kissing and that night I drank lots of beer) would affect the mucos of the mouth and tonsil and make it easier for the hiv to infiltrate them into the body. Is this true?

    • Can you please stop asking me question on tonsillitis and ARS. I have answered you twice already.

      • Dr Tan
        I am sorry for the many questions and I really appreciate you patience. If I was in Singapore, I would probably be at your clinic first thing in the morning to get tested and get this over with . But I iam not in Singapore,

        I hope you will be able to find the time to answer my latest questions which are different from questions I raised earlier and believe me , I really appreciate your patience and support

    • 1. Very rarely. Less than 10% of patients. 2. I have never seen HIV infection from oral sex. 3. No. It is a reaction by the body’s immune system to fight the virus. The tonsils are basically lymph nodes. 4. I have never heard of this and there is certainly no scientific proof.

  6. Hi doc,

    I had unprotected sex on 5th oct 2014. Going by the list of ARS symptoms you have posted, I have had a slight sore throat, a tiny ulcer (less than 5mm in diameter), blocked nose and some rash. I am thinking of going for a combo test at4 weeks post exposure

    Question:
    1) judging from my symptoms, do you think that I am at high risk of contracting hiv?
    2) what exactly does hiv rash look like?

    Thanks

    • 1. No. The symptoms of ARS are usually much more severe. 2. Like measles.

      • Hi Dr tan,

        thanks for getting back to me.

        As i was worried, i went for a rapid test at 3 weeks and it came out negative. Going for another test at 4-5 weeks.

        Since my last post, i have had body aches, ulcer still not gone after 3-4 days and a dry throat. In addition, i do feel that my body temperature fluctuates, although it doesnt go as high at 38 degrees.

        Question:
        Is HIV ARS symptoms always as you described in the post above? that it is usually a very bad flu, strep throat like, and with a 38.5 degrees fever?

        Thanks

        • also, do you think that after my test at 3 weeks (i understand it is unconclusive), i am at risk of HIV considering the development of the above mentioned symptoms?

  7. A Letter of Thanks to Dr. Tan
    I’d like to thank you, doctor, so much for the help and support you have been providing to so many people who are worried about a possible exposure to HIV. Actually, I was one of them. I lived in real hell for three months getting more worried every day, searching my body and the Google for HIV signs, getting even more and more worried when reading about other people’s experience with HIV. I had so many sleepless nights and unhappy days. To relieve myself, I kept remembering your words” Your symptoms do not sound like HIV ARS. Go get tested”. In fact, these words helped me get a sleep.
    After three months of my possible exposure, I got tested for both HIV and Syphilis. Both are negative. Thank you doctor. A final word to the people who keep worrying about their symptoms: Worry does not do you any good. The best thing to do, as Dr. Tan keeps saying, is to get tested. Put an end to your worries and stress by getting a test. The test will not change the reality. If you have the disease, may God forbid, you can start your treatment early, and if you do not have it, you will end your worries. HIV is an incurable disease. It has changed from fatal to chronic through medication. Therefore, the best thing to do is to avoid risky sexual exposures. Thanks a lot doctor.

    • Thank you for sharing. I am gland you found our site useful. I am sure many people appreciate your story and will learn valuable lessons from it.

  8. Ahugemistake

    Doctor, help me please!!!I’m going crazy…just tell me what you think about all of these symptoms at this stage!!!Please

  9. Ahugemistake

    Hello Dr.

    I know that it’s so tiring to answer at the same questions again and again but please Doctor, HELP ME. Please

    JUST WANT TO UPDATE MY STATUS.

    25 Days after exposure and 21days after I started the late PEP I have a fever (37.1 maximum) since 5days wich is on and off(is it really a hiv ars fever?), I have a wound just around my anus which is bleeding when I clean myself with the toilet paper and it’s painful when I touch it(it started 6days post exposure) and before there was like water which was coming out of this wound, I still don’t have any rash on my skin but I think it’s coming because I could see some small pimples(like an allergy) on my arms, I had a sore throat which lasted a week but my doctor gave me some antibiotics and it was fine in 3days but I won’t lie to you, I can feel like it’s coming back now my antibiotics are done(5days under antibiotics), I have a running nose sometime in a day and I have a joint ache on my right knee and on the right shoulder sometime since 6days post exposure. I have a muscle pain oin the back of my tighs and on the neck(felling like it’s stiffy) since 3days. And I had a diarhhea 3weeks post exposure which lasted 5days). I’m still drink the PEP medication so 1)As a Doctor, what do you think about all of this after 25days? 2)And the wound around my anus, is it also a HIV ARS? 3)Can the PEP slow the rash on my chest and face? 4)What about the muscle pain, is it a proof that I do have HIV? 5)I’ve lost 8kg in 4weeks, does it means that I’m fighting something which is already in my body? 6)I have dry eyes and I know it’s one of the hiv ars symptoms, what do u think?

    • So why don’t you go for a HIV test?

      • Ahugemistake

        Good morning Dr.

        Why don’t you want to help me Dr Tan, I promise these was my last questions but please…tell me honestly what you think about all of what I did write.

        I can’t get tested now because I’m still drinking the medicines. I’ll finish them this saturday and I’ll try to get tested 4weeks past PEP.

        • First of all I really do not appreciate the accusation that I don’t want to help you. This is a blog we run for free at great sacrifices to ourselves. We don’t even ask for any thanks but it would be nice if you do not make accusations. Secondly, my reply was practical and to the point. Get tested for HIV. All this worrying and analyzing and pondering over symptoms is useless and will only cause you more anxiety. That is the point of my reply.

  10. Is Hives (Urticaria) a symptom of HIV? I am suffering from Hives for past 3 weeks now. It comes as red itchy rashes which looks like mosquito bites and disappears after 1 or 2 days and comes again. Have you seen this in any of your patients? I am in my 34th days post exposure now. I got scared after reading this link, where they say Hives is HIV. Please advise me. http://www.ehealthme.com/cs/hiv+infection/urticaria

    • Yes it can be. But then there are also at least a hundred other things that can cause hives. Some of which like vasculitis arguably can be even more serious than HIV. So my suggestion to you is to see your doctor and find out what is causing your hives. At 34 days post exposure you should also get a HIV combo test.

      • Thank You Dr.Tan. I have done HIV rapid test on 28 days and HIV combo test on 30 days post exposure. Both my results are Negative/Non Reactive. I will redo the HIV combo test at end of 90 days to be conclusive? I spoke with my doctor and he told me that it’s due to some allergy. But those red rashes like mosquito bites are itchy and painful? Is it an HIV rash? Does it itch and pain?

        • I think your combo test at 30 days is already conclusive.

          • Thank You Dr.Tan. I am seeing some cracks at my finger tips and also needle like pain on my big toes for past few days. Is it due to fungal infection or HIV symptom? Do I need to go for any blood tests?Please advise me.

          • I am sorry. This platform is not for dispensing medical advice. Please see your doctor.

  11. Dear Doctor,
    Is a ERS (cardmethod tridot) showing non-reactive for both HIV1 and HIV2 along with an ELISA 4th gen test result of 0.34 conclusive after 16-17 weeks??
    Will be of very helpful in making me relieved of my stress, Thanks.

  12. Dr, Tan
    1- many medical journals and web site described the sore throat with ars as “non-exudative ” and considered it as a sign to distinguish between ars and other possibilities like mono or strep throat, while you have the exudative tonsils as a major sign of ars. Is this note coming from your personal experience ? And how often do you see exudative vs non excudative tonsils in new hiv infections?
    2- is a rash always part of ars.? And does not having a rash reduce greatly reduce the possibilty of ars?
    3- if the CSW had a high viral load, would that have an effect on the onset of ARS ie start in 5 – 5.5 days?

    Dr. Tan , I am sorry for the many questions and I hope you understand my situation which I do scribed to you in my earlier posts and I really appreciate your patience and your always prompt response.

    • 1. Most of the people I diagnosed with HIV do NOT have sore throats. In fact, most of them do NOT have any symptoms at all. For the people who do have symptoms, I find fever and rash the 2 most common. 2. Not always. But it is one of the 4 commonest symptoms. 3. No it does not. My suggestion to you is to get your mind off symptoms. The simple fact is as low as 40% of people infected with HIV will get ARS. So even if you feel 100% fine, you still could be infected. The converse is also true. The so called “ARS Symptoms” can also be caused be a a variety of other illnesses. So even if you have every ARS symptoms described in the textbook, you may not be infected with HIV. My take on this: ignore symptoms, just test.

      • Thank you Dr Tan

        I wish I can test today but the fact is that I live in a place with limited access to testing stds . I have these two final questions :

        1- in cases where there was a sore throat, how often do you see exudative vs non exudative tonsils (pharagitis ) in new hiv infections?

        2- you mentioned that fever and rash are the 2 most common symptoms out of 4 most common. What are the other two ?

        • 1. I usually see non-exudative. 2. Sore throat and swollen cervical lymph nodes.

  13. Jonathan

    How likely is it that ARS symptoms can come after 2.5 months of an exposure? Would you recommend testing past 12 weeks in such a situation? Have not had PEP or anything and am in otherwise good health with no known immune conditions.

    • ARS does not happen at 2.5 months post exposure. I would recommend testing regardless of the absence or presence of symptoms and regardless of risk. You can get an antibody test at 12 weeks or a combo test at 1 month.

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