HIV conversion sickness?

(1) Dear Alice,

Is it true that after contact with the AIDS virus, one develops flu-like symptoms within 6 weeks?

— Symptom monger

(2) Alice,

I've heard about conversion sickness and being HIV positive; could you tell me more about the symptoms and what exactly it is?

— Unenlightened

(3) Dear Alice,

I have had an unsafe sexual encounter, receiving oral sex without wearing a condom. Three days after this, I noticed a slight itching on the tip of my penis, and three weeks later I started to feel a slight aching in my lower joints, in the thigh and leg muscles. This aching varied in location. I took an HIV antibody test, which was negative, nine weeks after having sex. Some weeks later on, I began to feel a little aching in my arms and other joints, as well, and I developed a fever and very swollen lymph glands in the throat. This lasted for about one-and-a-half weeks.

I went to a doctor and they took some blood tests, I don't know what, but the doctor said that it was a bacterial infection and I was given antibiotics. The fever and swollen glands ceased, but I still have aching muscles and joints, which has been going on for seven weeks after the fever. The aching is light, and varies in location from my underarms, overarms, legs, and thighs. Are these signs of HIV conversion sickness and do HIV antibodies only develop after the fever symptoms and not before this?

— Worried

Dear Symptom Monger, Unenlightened, and Worried,

Though HIV/AIDS remains a complex condition, there have been many advances in both diagnosis and treatment in recent years. Conversion sickness — also called the acute retroviral syndrome (ARS) or primary HIV infection (PHI) — is when the immune system begins to produce antibodies to the virus (this usually occurs within two to four weeks of infection). This acute period, which often causes flu-like symptoms, usually lasts anywhere from a few weeks to a couple of months (however, sometimes it takes up to six months for the body to produce enough antibodies to be detected in an HIV antibody test). Some HIV tests identify whether specific antibodies have been created by the immune system, which confirms the existence of HIV in the body. Newer HIV tests are able to determine if the virus is present even before antibodies have been produced, meaning an accurate diagnosis may be possible as early as ten days after infection when using these tests. What’s crucial to remember is that experiencing flu-like symptoms alone is not enough to confirm that HIV has been contracted — having a reliable HIV test is the only way to know for sure.

HIV is transmitted through body fluids including blood, breast milk, semen, and vaginal fluid. It’s possible to contract HIV while receiving oral sex without a condom, but the risk is very low. In fact, there's a higher chance of getting other sexually transmitted infections (STIs), such as chlamydia or gonorrhea, from unprotected oral sex. After possible exposure to HIV, fast treatment can greatly reduce the chance of infection. Dubbed post-exposure prophylaxis or PEP, the treatment consists of a four-week regimen of antiretroviral medication. Even if HIV is contracted, some research has shown that starting antiretroviral treatment during the acute period could prove extremely beneficial for long-term health by decreasing the severity of the illness. Another reason to begin antiretroviral treatment early is that during the acute stage, individuals with HIV are extremely infectious. However, receiving proper treatment makes them less likely to infect others.

During ARS, the immune system is working in overdrive to combat the quickly spreading virus. Individuals vary in what symptoms they experience and how long the symptoms last, but common symptoms of conversion sickness include:

  • Fever
  • Sore throat
  • Swollen lymph glands
  • Headache
  • Rash
  • Pain in muscles or joints

List adapted from Mayo Clinic.

Symptoms tend to occur for about one to seven weeks after first infection, although swelling and aches can last longer. Conversion sickness can be tough to spot since it often resembles many other things including the flu, a common cold, stress, mono, or other STIs. Like the flu, not everyone has the same symptoms and not everyone who contracts HIV will experience conversion sickness. Worried, that means it's tough to say if your achiness and swollen glands are HIV-related.

The surest way to confirm or rule out HIV infection is to get tested. There are several different tests available, each with different time windows. Some tests search blood or oral fluid for the presence of HIV antigens or antibodies produced by the immune system in response to the virus; these tests have a window of about two to three weeks after exposure to produce reliable results. HIV RNA tests are more expensive and complex, but they can produce accurate results as soon as ten days after contracting HIV. They’re able to work so quickly because they detect the virus directly, so there is no need to wait until the immune system produces antibodies. A re-test at a later date is often recommended after an initial test. In the interim, practicing safer sex will reduce further chances of HIV exposure.

Worried, it sounds like you are unsure about the diagnosis from your health care provider. If so, you may want to go back them and ask what type of bacterial infection you had. A return visit will also give you the opportunity to discuss your lingering aches and pains. If you have any other questions or concerns about HIV or AIDS, you may consider talking directly with a health care provider. For more general information about HIV, including transmission risk and prevention strategies, visit AIDS.gov, the Centers for Disease Control and Prevention (CDC) HIV/AIDS website, and the HIV/AIDS category in the Go Ask Alice! Sexual and Reproductive Health archives.

From day one, an HIV infection looks different from person to person, so it's not advised to self-diagnose an HIV infection based solely on symptoms. For the most accurate results and peace of mind, an HIV test during the appropriate window after exposure (helping to determine which type of test would be most appropriate) is still the best way to be sure about your status.

Last updated Feb 03, 2017
Originally published Feb 15, 1996

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