Stages of HIV infection - assuming no treatment

Some people have a short illness soon after infection, called a ‘seroconversion illness’ because it coincides with the period during which the body first produces antibodies to HIV. Common symptoms include a fever lasting more than a few days, aching limbs, a blotchy red rash, headache, diarrhoea and mouth ulcers. This stage of HIV infection is also sometimes called primary HIV infection or acute HIV infection.

The severity of symptoms at this stage can vary considerably between people – they can be so mild as to go unnoticed or so severe that admission to hospital is required. It's now thought that the longer and more severe the symptoms, the greater your chance of becoming ill because of HIV in the medium term, presuming that you do not take anti-HIV drugs.

Doctors are currently trying to see if taking HIV treatment soon after you are infected with HIV is of any long-term benefit. You can find out more and about HIV treatment in the section HIV treatment.

Initially, any effects which HIV is having on the immune system don’t cause outward signs or symptoms. For this reason, this period is called ‘asymptomatic HIV infection’ and it can last for several years.

But even if you are feeling 100% well, HIV is damaging your immune system. Doctors use two key laboratory tests to see how active HIV is and what impact it is having on your immune system. These tests are a CD4 cell count, which gives a rough indication of the strength of the immune system, and an HIV viral load test, which shows how active HIV is in the body. Both these tests are discussed in a lot more detail in the section Key tests to monitor HIV - CD4 and viral load .

Sometimes you may notice that the glands, or lymph nodes, in various parts of your body become and stay swollen. This is called PGL, or Persistent Generalised Lymphadenopathy. This can happen when you’ve no other symptoms, and isn’t a sign that you are becoming unwell or are at increased risk of doing so in the near future.

The longer you live with HIV without treatment, the greater your risk of developing symptoms. These can be caused by infections that take advantage of your weakened immune system, certain cancers and/or the direct effects that HIV can have on the body.

If you have certain serious infections or cancers which have been confirmed by tests, then you will be diagnosed as having AIDS. In the US, if your CD4 cell count falls to below 200, the level at which you become vulnerable to serious infections, you are also diagnosed as having AIDS.

The way HIV disease progression is often described suggests that there is an inevitable, one-way course in HIV infection. It implies that everybody with HIV will be initially well, then get abnormal CD4 and viral load tests before becoming ill with minor illnesses, and finally go on to develop severe and fatal illness.

This has been the pattern for many people, but even before effective HIV treatment became available, others have had very different experiences. For example, some people have had an illness which has led to them being diagnosed with AIDS, and then completely recovered and lived for many years, even decades, in very good health. What’s more, many people who have had HIV for many years have never experienced any illness or disease because of HIV.