Signs and Symptoms of HIV in Women

Early on, human immunodeficiency virus (HIV) causes flu-like symptoms, which are similar across all genders. HIV symptoms in women may differ after the initial infection.

HIV is an infection that attacks cells in your immune system, known as CD4 cells. If untreated, HIV may progress to acquired immunodeficiency syndrome (AIDS), which increases the risk of severe infections.

From changes in menstrual cycles to an increase in vaginal infections, HIV can affect the body in ways that lead to symptoms unique to women. Read on to learn about how HIV affects women, special considerations for women with HIV, and when to consult a healthcare provider.

Common HIV Symptoms

Generally, people with HIV do not have symptoms right away. It may take 10 years or longer for people with HIV to notice symptoms or complications.

HIV symptoms progress in stages: acute and chronic HIV. Chronic HIV may progress into AIDS if untreated.

Acute HIV Symptoms

Acute HIV symptoms develop within two to four weeks after HIV exposure. During this stage, HIV quickly multiplies and spreads throughout the body.

Within two to four weeks after exposure, about two-thirds of people with HIV have flu-like symptoms such as fever, chills, and fatigue. Those symptoms are your body's natural response to infection.

Other acute HIV symptoms include:

• Mouth ulcers
• Muscle aches
• Night sweats
• Rash
• Sore throat
• Swollen lymph nodes

Chronic HIV Symptoms

Chronic HIV is also known as asymptomatic HIV infection. It's possible for people not to have any symptoms or feel sick. Severe HIV complications, such as a weak immune system, take years to develop.

With chronic HIV, HIV continues to multiply but at lower levels. Chronic HIV can last about 10 years before progressing to AIDS if untreated.

AIDS Symptoms 

People with HIV develop AIDS if their CD4 counts fall below a certain level. AIDS increases the risk of opportunistic infections, those that happen more often or severely in people with weak immune systems than others.

In addition to opportunistic infections, AIDS symptoms include:

• Anal, genital, or mouth sores
• Blotches on the skin
• Depression
• Diarrhea
• Memory loss or other neurological problems
• Pneumonia
• Rapid unintentional weight loss
• Reoccuring fevers
• Swollen lymph nodes

On average, people with AIDS survive for three years without treatment.

HIV Symptoms in Women

Several HIV-related health changes during chronic HIV infection are specific to women. It's possible not to experience any complications for quite some time. Still, they can eventually develop.

Bone Loss

People with HIV experience faster bone loss than others without HIV, especially women with HIV. Generally, women tend to lose bone faster than men because of the hormonal changes after menopause. Having HIV can affect women's bone loss more so than usual.

Early Menopause

Menopause happens when you do not have a menstrual period for at least 12 months. In the United States, the average age for menopause is 52. People with HIV tend to enter menopause earlier than that.

You may notice various changes, including the onset of hot flashes, during the time leading up to menopause. A hot flash causes sudden heat in the upper part or all of your body. The sensation can last anywhere from 30 seconds to 10 minutes and can happen at varying frequencies.

Typically, people with HIV have more severe hot flashes than those without the virus.

Menstrual Cycle Changes

You may notice changes to your menstrual cycle if you have HIV. For example, people with HIV might miss their periods. They might also have lighter or heavier bleeding than before having HIV.

People with HIV are more likely to have severe premenstrual syndrome (PMS) symptoms than others, such as:

• Backache
• Bloating or a gassy feeling
• Changes in appetite
• Constipation
• Cramps
• Diarrhea
• Headache
• Irritability
• Sleeping too little or too much
• Swollen or tender breasts

HIV Symptoms in Transgender Women

In the United States, about 2% of transgender people make up new HIV diagnoses. Social and medical factors may impact symptoms in transgender women with HIV.

Transgender women may face several obstacles in receiving proper healthcare compared to other women. For example, transgender women may experience discrimination in healthcare settings, such as being called the incorrect name or pronouns.

Some evidence suggests that transgender women with HIV may have concerns over interactions between HIV medicines and gender-affirming treatments. Research has found that transgender women may develop more severe bone loss and have a higher risk of heart disease than others with HIV.

As a result, transgender women with HIV are less likely to take HIV medicine than others. Recognizing those obstacles and taking steps to reduce them may help improve outcomes among transgender women with HIV.

For example, experts advise healthcare providers to consider gender-affirming healthcare history (e.g., past hormone use or surgery) and adjust HIV medicines accordingly.

Related Conditions

HIV attacks and weakens the immune system. As a result, women with HIV have a higher risk than others of developing health conditions, such as:

• Cervical cancer: This cancer begins in the cervix, or the lowermost part of the uterus. Certain strains of human papillomavirus (HPV) are among the most common causes of cervical cancer. Women with HIV are more likely to have HPV than others. Pepople with low CD4 counts are more likely to have abnormal cells in their cervix that may develop into cancer.
• Flu: People with low CD4 counts or those not taking HIV medicine are more likely to have complications from the flu than others. One of the most common flu complications is pneumonia.
• Heart disease: This is a group of conditions that affect your heart. Heart disease occurs when fatty substances build up in your arteries that carry blood to your heart. Certain HIV medicines may increase heart disease risk. Eating a healthy diet, regularly exercising, and not smoking help prevent heart disease.
• Hepatitis: This is an infection of the liver. Experts advise people with HIV to receive vaccines that prevent hepatitis A and B and regular tests for hepatitis B and C.
• Kidney disease: HIV may infect your kidney cells. As a result, HIV—as well as some HIV medicines—may damage the filters, or nephrons, in your kidneys that produce urine and remove waste.
• Pneumocystis pneumonia (PCP): Normally, your body keeps a balance of "bad" and "good" germs in your body. One of those "bad" germs is Pneumocystis jirovecii, a fungus. That fungus may grow out of control in people with weak immune systems, like those with HIV.
• Sexually transmitted infections (STIs): These infections spread through sexual contact. Some people with HIV are at risk for certain STIs, like herpes and pelvic inflammatory disease (PID). STIs may cause more severe symptoms and be harder to treat in people with HIV than others.
• Vaginal yeast infections: These infections happen when a fungus, Candida albicans, overgrows in the vagina. Candida overgrowth may occur if you have an illness that weakens your immune system, such as HIV. Vaginal yeast infections that happen at least four times a year are most common among people with chronic HIV.

Special Considerations for Women With HIV

Pregnant or breastfeeding people and those taking HIV medication may be at risk for potential complications. 

Transmission to Children

HIV can pass from mother to child during pregnancy, birth, and breastfeeding. Still, people with HIV can have healthy pregnancies. The risk of passing HIV to an infant is less than 1% if you take precautions.

A healthcare provider will likely advise the following precautions:

• Getting tested for HIV if you are pregnant or trying to become pregnant: A healthcare provider may advise testing again during your third trimester if you are HIV-negative but at risk of contracting the virus.
• Taking pre-exposure prophylaxis (PrEP): This medicine can help prevent HIV if you test negative for the virus but are at risk of contracting it.
• Using HIV medicine: This helps keep HIV at undetectable levels in your body. You may be able to deliver vaginally if your HIV levels are low. HIV medicine also prevents the virus from spreading through breast milk. 

Pregnant people with HIV—and their children once they are born—need to take HIV medicine to reduce the risk of transmission.

HIV Medicine Complications

People with HIV can take antiretroviral therapy (ART) to bring and keep HIV at undetectable levels. ART allows people to live with few complications and minimal risk of passing HIV to others.

Generally, women taking ART may have different—sometimes more severe— side effects from HIV medicines. Certain HIV medicines may cause nausea, rashes, and vomiting at higher rates in women than others.

Some HIV medicines can interact with hormonal birth control and increase the risk of unintended pregnancy. You can use any form of birth control if you have HIV. Still, you might need a secondary form of protection if you typically use hormonal methods like implants, pills, or shots. 

Talk with a healthcare provider about the best birth control option if you take ART.

When To See a Healthcare Provider

Consult a healthcare provider or go to a clinic to receive a blood test if you suspect that you have had exposure to HIV and have flu-like symptoms. Any number of illnesses may cause those early symptoms and do not necessarily mean you have HIV. Still, the only way to know for sure is a blood test.

Some people with HIV never develop early symptoms. A blood test is essential if you think you have had exposure to HIV and do not have flu-like systems.  

Early diagnosis is vital for HIV. The sooner you receive a blood test and diagnosis, the sooner you can start treatment to bring and keep HIV at undetectable levels.

Staying in close contact with healthcare providers is essential. Reach out if you notice any changes to your health, including seemingly unrelated or minor things like an increase in vaginal infections or menstrual cycle changes.

HIV puts you at an increased risk of complications from infections. Talk to a healthcare provider about what to do if there is a change in your health, such as if you get the flu.

A Quick Review

Women with HIV may notice early menopause, menstrual cycle changes, and more frequent vaginal infections than average. HIV may impact bone loss and cervical cancer risk. 

Consult a healthcare provider if you think you have had exposure to HIV. A blood test is the only way to know if you have HIV. The sooner you know you have HIV, the sooner you can begin treatment to bring and keep HIV at undetectable levels.