The 3 stages of HIV and how it can develop into AIDS - and what to know about testing and treatment

• The first stage of HIV is called acute HIV and causes flu-like symptoms like fever, chills, and fatigue.
• During stage two of HIV, symptoms subside and you may even start to feel better.
• In the last stage of HIV, called AIDS, the immune system becomes severely damaged and the body has trouble defending itself against infections.

HIV (human immunodeficiency virus) presents in three stages. It starts with flu-like symptoms and can progress to severely damage your immune system if left untreated.

Here's what you should know about the stages and symptoms of HIV and how to navigate testing and treatment.

Important: HIV is a rare yet serious infection. You may be at an increased risk if you frequently have unprotected sex with multiple partners or share needles.

Stage 1: Acute HIV

The first stage of HIV is the acute infection stage. It is mostly characterized by flu-like symptoms. However, not everyone will experience these symptoms and some HIV tests may even come up negative.

Most people experience these flu-like symptoms about two to six weeks after they have been infected. These symptoms are a sign that your immune system is fighting the virus and usually last about one to two weeks.

Some of the symptoms you may experience are:

• Mouth sores
• Chills
• Fever
• Rash
• Sore throat
• Fatigue
• Inflamed lymph nodes
• Muscle aches
• Joint pain
• Nausea
• Vomiting
• Diarrhea
• Night sweats
• Dry cough

"Some of the most common early signs of HIV are a high fever, a rash on your upper body, fatigue, sore throat, severe headache, and muscle weakness," says Peter Gulick, MD, a professor of medicine at Michigan State University (MSU), College of Osteopathic Medicine, and Director of the MSU HIV and Hepatitis Clinic.

Important: Many people in this stage of HIV won't have any symptoms at all. That's why if you suspect you've been exposed to the virus, it's advisable to get tested whether or not you are presenting symptoms.

It's especially important to get tested at this stage of HIV because your viral load is very high, meaning that you are highly infectious and could easily infect someone else with the disease unknowingly.

Stage 2: Asymptomatic infection

This stage comes after the acute infection stage and is commonly called the clinical latency, chronic, or asymptomatic infection stage. At this stage of HIV, most of the earlier symptoms of the condition fade, and a person might start to feel better.

This stage can last for up to 10 years or even longer. But even though a person might not be showing symptoms at this stage, the virus is still active and spreading.

At this stage of the virus, a blood test will be able to indicate how active the virus is and how much of an effect it's having on your immune system. A person at this stage is also infectious. If the condition goes untreated, it will continue to progress, damaging the immune system.

Stage 3: AIDS

At this stage, the virus develops into Acquired Immunodeficiency Syndrome (AIDS). When a person has AIDS, their immune system is critically damaged. This is the most severe stage of HIV.

A person with HIV at this stage is also very susceptible to infections and diseases. The body will be unable to defend itself against opportunistic infections, including viral infections like shingles and bacterial infections like tuberculosis and pneumonia.

Medical term: Opportunistic infections are more likely to happen to people who are immunocompromised than people who have healthy immune systems.

People who have AIDS have a very high viral load of the virus and are very infectious. At this stage without treatment, the condition can be fatal and could cause death. Most people with AIDS are likely to only survive for 1 to 3 years if they have no access to proper treatment.

Some common symptoms of AIDS include:

• Fever
• Recurring cough
• Weight loss
• Mouth sores
• Chronic diarrhea
• Extreme fatigue
• Swollen lymph nodes
• Pneumonia

Testing and next steps

If you are experiencing early signs of HIV or suspect you've been exposed to someone with the condition, getting tested is the next step.

"If you notice any early signs of HIV or have been exposed to a person who has it, get tested immediately. If you test negative but continue to engage in high-risk activities like unprotected sex, then you should get tested every three to six months," says Gulick.

General advice: According to the Centers for Disease Control and Prevention (CDC), it's advisable for everyone between the ages of 13 and 64 to get tested for HIV at least once. If you are sexually active, they advise that you test at least once a year.

You can get an HIV test at any of the following places:

• Private clinics
• Sexual health clinics
• Charity clinics
• Family planning clinics
• Community health centers

If you test positive for HIV, you should know that with proper management and treatment, the virus can be kept well under control and you can live a long and healthy life. If you are unsure of what test you should be taking, speak to your doctor first for a recommendation.

3 types of HIV tests

• A nucleic acid test (NAT): Here, your blood is drawn and tested for the actual virus. This test will detect whether there's HIV in the blood and what the viral load count is. This test is able to detect if you have the virus as early as 10 to 33 days after you might have been exposed. However, it may take several days for you to get your results.
• An antibody test: This is used to test your blood or saliva for HIV antibodies. These tests can detect the virus between 23 to 90 days after you might have been exposed.
• An antibody and antigen test: This tests your blood for both HIV antibodies and antigens. It can detect if you have the virus between 18 to 45 days after you might have been exposed. This is the most common type of HIV test.

Treatment

HIV medication helps to reduce the viral load in your body, or the amount of HIV in your blood. HIV medicines work by blocking or changing the enzymes the virus uses to replicate itself.

Some of the treatment options approved by the FDA for HIV include:

• Protease inhibitors: These block the protease enzyme, which the virus can use to copy itself. Some examples include Lexiva, Norvir, and Reyataz.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): These alter the reverse transcriptase enzyme, which HIV needs to replicate itself. Some examples include Edurant, Sustiva, and Viramune.
• Nucleoside reverse transcriptase inhibitors (NRTIs): These block - instead of alter - the reverse transcriptase enzyme. Some examples include Epivir, Retrovir, and Ziagen.
• Fusion inhibitors: Fusion inhibitors work by blocking the virus from entering your cells. The most commonly available type is Fuzeon.
• Integrase inhibitors: These block the integrase enzyme, which stops the virus from replicating itself.
• Attachment inhibitors: Attachment inhibitors work by binding to the protein on the surface of the HIV. This prevents HIV from entering the cells.

Insider's takeaway

There's currently no cure for HIV, but with the proper treatment and medication, the condition can be well-managed. People who have HIV and get adequate treatment and medication are capable of living long and healthy lives.

Keeping an eye out for the first signs of HIV if you suspect you've been infected, and testing as early as possible, will help you to manage the condition better. It's also important to take your HIV medication regularly to prevent the condition from progressing.

"Taking medication for HIV is a lifelong therapy. Stopping your HIV medication will cause the disease to start to progress again," Gulick says.

Related articles from Health Reference:

• Herpes isn't curable, but you can manage it with medication
• How to tell if you have genital warts or herpes
• Understanding the first signs of HIV and why getting tested regularly is important
• How do you get HPV? The major symptoms, risk factors, and how to prevent it
• How to last longer during sex