• Fever and night sweats
• Aching muscles and tiredness
• Sore throat
• Swollen glands
• Diarrhoea
• Skin rash and ulceration of the inside surface of the mouth and genitals
• Headache, sore eyes and sensitivity to light

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These early symptoms are called the HIV seroconversion illness. This is because the illness coincides with the start of the production of antibodies to the virus. (Antibodies are blood proteins made by the immune system that recognise and attach to organisms invading the body.) Consequently, seroconversion from HIV antibody negative to HIV antibody positive follows; these are the antibodies detected with HIV tests. The seroconversion illness is brief, lasting a week or two.

Thereafter most people remain symptom-free for a long time, on average ten years. Then symptoms associated with the advance of HIV disease, roughly in order of appearance, may include:

• Unexplained weight loss (more than 10% of body weight)
• Swelling of glands in the neck, armpit or groin
• Easy bruising
• Recurring and unusual skin rashes, often itchy
• A thick, white coating of the tongue or mouth (oral thrush) or vagina (vaginal thrush) which is severe and recurs
• Ongoing vaginal discharge and pain in the lower abdomen
• Recurrent genital herpes
• Shingles
• Persistent sore throat
• Recurring fevers lasting more than 10 days without an obvious cause
• Night sweats or chills
• Persistent cough and/or shortness of breath
• Persistent severe diarrhoea (longer than a month)
• Changes in vision
• Pain, loss of control and strength of muscles, paralysis
• Discoloured or purplish growths on the skin or inside the mouth or nose
• Difficulty with concentration, inability to perform mental tasks that have been done in the past, confusion, personality change

Symptoms are slightly different in children. Common symptoms include:

• Persistent oral thrush
• Recurrent bacterial infections, such as ear infections
• Recurrent gastro-enteritis
• Swollen salivary glands (parotitis)
• Swollen lymph nodes in the neck, armpits or groin
• Enlargement of the liver and spleen
• Failure to grow or reach normal points in development at the right time (such as talking, walking)

Reviewed by Dr Craig Corcoran, Clinical Virologist, National Health Laboratory Service and University of Cape Town, October 2006.

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