HIV Infection and AIDS Clinical Presentation

Updated: Jan 13, 2023
  • Author: Shelley A Gilroy, MD, FACP, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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The history should be carefully taken to elicit possible exposures to human immunodeficiency virus (HIV). Risk factors include the following:

  • Unprotected sexual intercourse, especially receptive anal intercourse (8-fold higher risk for transmission)

  • A large number of sexual partners

  • Prior or current sexually transmitted diseases (STDs): Gonorrhea and chlamydia infections increase the HIV transmission risk 3-fold, syphilis raises the transmission risk 7-fold, and herpes genitalis raises the transmission risk up to 25-fold during an outbreak

  • Sharing of intravenous drug paraphernalia

  • Receipt of blood products (before 1985 in the United States)

  • Mucosal contact with infected blood or needle-stick injuries

  • Maternal HIV infection (for newborns, infants, and children): Steps taken to reduce the risk of transmission at birth include cesarean delivery and prenatal antiretroviral therapy in the mother and antiretroviral therapy in the newborn immediately after birth.

The patient may present with signs and symptoms of any of the stages of HIV infection. Acute seroconversion manifests as a flulike illness, consisting of fever, malaise, and a generalized rash. The asymptomatic phase generally is benign. Generalized lymphadenopathy is common and may be a presenting symptom.

AIDS manifests as recurrent, severe, and occasionally life-threatening infections and/or opportunistic malignancies. The signs and symptoms are those of the presenting illness, meaning that HIV infection should be suspected as an underlying illness when unusual infections present in apparently healthy individuals.

HIV infection itself does cause some sequelae, including AIDS-associated dementia/encephalopathy and HIV wasting syndrome (chronic diarrhea and weight loss with no identifiable cause).


Physical Examination

No physical findings are specific to HIV infection. The physical findings are those of the presenting infection or illness. Generalized lymphadenopathy is common. Weight loss may be apparent.

Evidence for risk factors or minor concurrent opportunistic infections (eg, herpetic lesions on the groin, widespread oral candidiasis) may be clues to HIV infection.