Symptoms of the acute phase of HIV infection
The acute phase of HIV infection is the first defensive reaction of the body to the intruder. It manifests itself through a variety of symptoms and in principle serves to fight the virus – in the case of the HI virus, however, this does not succeed completely. The acute phase begins about 1-6 weeks after the virus has entered the body.
Only every second to third person affected passes through it. This means that the majority of HIV-infected persons do not show any acute symptoms that would draw attention to the disease at an early stage. For this reason, infection with the HI virus is often detected late.
If symptoms occur, they are often similar to those of “whistling glandular fever” or flu: patients often complain of fever and sore throat, swollen tonsils and aching limbs. Lymph nodes in several parts of the body can be swollen. Less frequently, lymph nodes also show other signs of inflammation such as pain, redness and overheating.
Occasionally a skin rash occurs. The symptoms may also resemble a gastrointestinal infection: diarrhea lasting several days with thin to watery stools may occur. In addition, nausea may develop, sometimes even vomiting.
Some of those affected already lose more than 2.5 kg of weight in this phase of the disease.As with whistling glandular fever, infection with the HI virus can also cause swelling of the spleen. This may occasionally be noticed by left-sided abdominal pain or during a physical examination by a doctor, but is usually only seen in an abdominal ultrasound. Some patients describe a muscle pain.
This can affect many muscles at the same time and often begins in the arms or legs. Joint pain, for example in the knee, hip or elbow, also occurs occasionally. Less frequent, but also possible, are headaches and other signs of meningitis such as tiredness, loss of consciousness, paralysis of the face or neck stiffness.
Usually the symptoms subside after a few weeks at the latest, when the body has found the virus strong enough to fight it off. The lymph node swellings are an exception. They can persist for months after the other symptoms have subsided – then, if the disease has not yet been diagnosed by then, they are an important indication of HIV infection.
The unspecific symptoms of the acute phase are described in more detail below. Abdominal pain is a very unspecific symptom that can occur in all stages of the HIV disease and has many different causes. In the acute phase, symptoms of a gastrointestinal infection can cause the pain.
Spleen swelling due to the infection can also be responsible for left lower abdominal pain. During the course of the disease, abdominal pain may occur repeatedly, which cannot necessarily be attributed to a cause or require treatment. Often, temporary opportunistic gastrointestinal infections with diarrhea are behind the pain.
Since the cause of the abdominal pain is in most cases not HIV, we recommend our page on: Abdominal pain – what’s behind itCoughing can be a typical early symptom of an HIV infection, but can also occur as an accompanying symptom in later stages of the disease. The acute symptoms of HIV infection itself usually appear within a few weeks, when the virus has multiplied in the body. These symptoms are similar to those of a common viral infection and can be accompanied by cough, fever and diarrhea.
Long-term HIV disease can lead to so-called “opportunistic infections” due to the resulting immune deficiency. Coughing can also be a symptom of HIV disease. If an existing HIV disease leads to spontaneous coughing and other signs of infection, a physician should be consulted as soon as possible, since infectious diseases can sometimes take a severe course and pneumonia is more likely to occur.
Fever is a very unspecific symptom and can indicate many diseases. High fever occurs within the first two months after infection with HIV, the early stage of the disease – often together with other general symptoms. But also later in the course, when the disease has reached an advanced stage, recurrent subfebrile temperatures (between 37.
5 and 37. 9 °C) are common. A few days to weeks after the HI virus has entered the body, a skin rash may appear in the acute phase following primary infection.
About 30-50% of patients are affected by skin changes shortly after infection. Rashes are therefore, along with fever and swelling of the lymph nodes, among the most common symptoms after primary infection and usually begin 2-3 days after the onset of fever. They can be very versatile and vary from patient to patient.
The most common rash is a rash known in technical terms as “maculopapular”. It is characterized by mostly red spots that appear slightly raised or knotted when touched with the hand. The rash is often similar to the skin changes caused by rubella or measles infection.
The spots may feel smooth, rough or scaly. In people with dark skin color, the spots are black or dark brown. Itching or a burning pain is very rare.
The spots can appear simultaneously on the whole skin or only affect certain areas such as the face, chest, neck, back or limbs. The rash is usually limited to the face, neck and trunk – only rarely does it appear on the arms and legs. In most patients it disappears about 24-48 hours after the first appearance.
However, it can also persist for 2 weeks. As a rule, it heals without consequences and does not leave scars on the skin.If a skin rash together with fever occurs a few weeks after sexual intercourse with a potentially HIV-infected person or after intravenous drug abuse with “needle-sharing”, the alarm bells should ring – these could be the first signs of HIV. In stage B, there may be the appearance of molluscum contagiosum (molluscum contagiosum), approximately 2 mm large, whitish-shiny pustules with a small dent in the middle, caused by a virus.
They often appear on the face, trunk and genital area. Herpes Zoster, a reactivation of the chickenpox virus, is somewhat more unpleasant and more common in HIV-infected patients than in healthy patients. It manifests itself with reddened, fluid-filled and later encrusted blisters about 5 mm in size on the face or trunk and is accompanied by severe pain.
In addition to the rash on the skin, mucous membranes can also show signs of HIV infection. In the mouth and genitals, small, sore spots, also known as “ulcers”, occasionally appear. They usually heal quickly and leave no traces.
In addition, genital warts often develop on the anus and vagina of HIV-infected persons. Itching, like numerous other unspecific symptoms, can be an indication of an acute HIV infection, but can also be caused by accompanying diseases in later stages. A few weeks after the primary infection, unspecific symptoms of infection such as coughing, rhinitis and fever can occur.
Sometimes a skin rash also occurs, which manifests itself in itching, redness and small lumps. These symptoms subside within a few weeks at the latest. In the course of time, however, opportunistic infections can attack the skin again and cause skin infections with rashes and itching.
Typically, fungal infections, herpes viruses, various bacteria and malignant tumors as a result of HIV disease can cause itching of the skin. Diarrhea is a very common and annoying symptom of HIV disease. Chronic diarrhea is an unspecific symptom that can be caused primarily and secondarily by the virus.
The virus itself can lead to long-lasting diarrhea when first infected by intestinal mucosa inflammation, which usually subsides after some time. However, in the long term, so-called “opportunistic” intestinal infections are not uncommon. They can use the body’s immune deficiency to trigger chronic and persistent inflammation of the entire gastrointestinal tract.
The frequently accompanying liver diseases can also lead to diarrhea due to their involvement in digestion. Night sweat is defined as such heavy night sweating that pyjamas or even bed linen must be changed at least once a night. An increased tendency to sweat with fever is initially assumed to be a viral or bacterial infection.
Behind this, in addition to the acute HIV infection, there are possibly flu-like infections, respiratory or urinary tract infections and the Pfeiffer’s glandular fever. More serious infections are also possible in advanced HIV disease, such as tuberculosis, meningitis or endocarditis. Night sweats can also occur in the context of so-called “B-symptoms”.
In addition to night sweat, these include weight loss, fever and other unspecific symptoms that may indicate a malignant tumor disease. Possibly the cause can be a blood or lymph cancer, but also a tumor disease, which can be favored by the HI virus. In rare cases, night sweats can also be attributed to certain medications.
This may be due to hormone-altering agents such as thyroid medication. Antidepressants can also be responsible in this context. Cachexia” is a form of enormous weight loss in connection with the infectious disease AIDS.
Cachexia” is a form of enormous weight loss in connection with the infectious disease AIDS. The lymph nodes play a special role in HIV infection and its detection – because symptoms such as swelling, pain or overheating in the lymph nodes are often the first sign of HIV infection. Affected persons usually notice small nodes either on the neck, jaw, groin or armpits.
These nodes grow to a diameter of up to about 3 cm. In contrast to most other infectious diseases, the lymph nodes often remain swollen for a very long time when infected by the HIV virus. In addition, not only one lymph node station is affected, as is the case with many other pathogens, but several regions of the body show symptoms in the lymph nodes at the same time at a very early stage.However, generalized lymph node swelling is not only typical for HIV.
It can also occur in other viral diseases, e.g. Pfeiffer’s glandular fever, or lymphoma, i.e. cancer of the lymph nodes. Headache and aching limbs, fever and fatigue together form the symptom complex of the so-called flu-like symptoms.
They are typical above all for infections with the flu virus, hence the name. However, they also occur within the first two months after an HIV infection, when the immune system is still trying to defend itself vigorously against the infection, and are part of the early stages of the infection. In HIV, however, these symptoms usually last somewhat longer than in influenza.
HIV infection can manifest itself in any phase of the disease with symptoms on and in the mouth. Since oral symptoms often interfere with eating and drinking, they play a special role in the lives of those affected. During the acute HIV disease shortly after infection, small wounds, also called “ulcers”, appear on the oral mucosa in some patients.
They often resemble the widely known aphthae. In addition, a reddish, sometimes nodular rash can become visible in the mouth during this phase. Whether symptoms appear in the mouth in later phases usually depends on how severely the immune system is affected by the virus.
If the number of defence cells is low, bacterial infections of the oral mucosa and gums are more frequent. Herpes in the mouth and on the lips is then one of the most common diseases. Some bacterial infections can lead to the destruction and blackening of the gums without treatment.
Furthermore, fungal infection in the mouth (stage B) with the pathogen “Candida albicans” is very typical of HIV. It develops a white seam of fungal pathogens on the tongue, mouth mucus and palate. The fungus should not be confused with another frequently occurring whitish discoloration in the mouth – the so-called “oral hairy leukoplakia“.
Behind the complicated name is a whitish change in mucosal cells at the edges of the tongue, which is caused by an infection with the Epstein-Barr virus. After a longer period of illness, various tumor diseases such as “Kaposi’s sarcoma” or lymphomas can appear in the mouth and cause severe symptoms. Yellow tongue A yellow tongue can have many causes and is by no means typical of HIV disease.
The causes can range from poor oral hygiene, living and eating habits, to pathogen-related infections. Some causes can be directly or indirectly favored by the HIV infection. Fungal or bacterial infections can cause the plaque to form and also cause pain and other signs of infection.
Due to a reduced immune defence, they can be indirectly caused by HIV. Antibiotic treatment can also cause yellowish coatings on the tongue as a side effect. Antibiotic treatments are becoming more frequent due to the increased susceptibility of HIV infected persons to infection, which can also cause a yellow tongue.
More rarely, changes in the liver are behind the tongue color. In the case of liver damage, the eyes, nails, mucous membranes and tongue may also turn yellow in addition to a yellowish skin color. More rarely, however, a lack of trace elements is behind the symptom.
Iron or vitamin deficiencies can also cause a yellow tongue and thus indirectly cause HIV. In stage C, the so-called Kaposi sarcomas can also appear in the mouth, an AIDS-defining disease. It manifests itself through bluish nodules in the skin and mucous membranes, which can also be painful.
Gum bleeding is an unpleasant symptom that can be indirectly related to HIV disease. In many cases the cause is an inflammation of the gums or the oral cavity, a so-called “gingivitis“. It can be caused by pathogens but also by food residues and lack of oral hygiene.
Before an infection is assumed, adequate oral hygiene should be the first priority. In the course of an advanced HIV disease, however, the weakness of the immune system can also lead to bacterial or viral inflammation of the gums. Frequently, fungal infections of the oral cavity can also be associated with HIV disease and cause bleeding.
