HIV/AIDS

What Complications Can Occur With HIV?

Joseph Bennington-Castro
By Medically Reviewed by 
Reviewed:
Medically Reviewed
Pneumonia caused by the bacteria Streptococcus pneumoniae HIV complication
Pneumonia caused by the bacteria Streptococcus pneumoniae is a common opportunistic infection affecting people with HIV or AIDS.Adobe Stock
Advances in HIV treatment and antiretroviral medicines now make it possible for people with HIV to live long, healthy lives. Still, complications from HIV can arise, particularly in those patients who aren’t adhering to treatment, or those who don’t even know they have the virus. The latter group accounts for about 13 percent of people with HIV, according to HIV.gov.

How HIV Raises the Risk of Complications

On its own, HIV, which infects a vital immune system cell called the CD4 cell, doesn’t produce many life-threatening symptoms. What makes it so dangerous is that the virus ultimately destroys CD4 cells — also known as T-cells, white blood cells that are critical to a healthy immune system.

A weakened immune system makes the body vulnerable to deadly opportunistic infections and diseases — a sign that AIDS, the final stage of the HIV virus, has taken hold.

HIV-Related Opportunistic Infections

People living with poorly treated HIV or AIDS are at a high risk of becoming infected with a wide range of different viruses and microbes, including bacteria, fungi, and parasites. These opportunistic infections (OIs) are forms of diseases that don’t usually affect people with healthy immune systems that are able to fight them off.

These days, OIs are less common in this population than they once were, because of effective antiretroviral treatment (ART), which helps maintain the immune system by reducing the amount of HIV in the body.

When your CD4 count falls below 200 cells per cubic millimeter of blood, you are at the greatest risk of developing an OI. Some OIs can take hold when the CD4 count is below 500.

A normal CD4 count ranges between 500 and 1,200.

Despite the decrease in OIs among people living with HIV, these infections still occur. A number of people living with HIV either don’t know they have the virus, may not be treating it properly, or, despite treatment, their viral load (the amount of HIV in the body) isn’t low enough to keep their immune system functioning normally.

The most common opportunistic infections for people with HIV or AIDS include:

  • Candidiasis, an infection by yeast in the genus Candida, which in serious cases can affect the esophagus, trachea, bronchi, and deeper lung tissues
  • Coccidioidomycosis, an infection caused by the fungus Coccidioides, which can lead to a form of pneumonia called desert fever, San Joaquin Valley fever, or Valley fever
  • Cryptococcosis, an infection caused by several species of the fungus Cryptococcus, the most common being Cryptococcus neoformans, which first affects the lungs (leading to pneumonia) and brain (causing swelling) before potentially spreading to the skin, bones, and urinary tract
  • Cryptosporidiosis, an infection and diarrheal disease caused by the protozoan parasite Cryptosporidium
  • Cystoisosporiasis, formerly known as isosporiasis, is an infection caused by the parasite Cystoisospora belli (formerly known as Isospora belli). It can cause diarrhea, fever, headache, abdominal pain, vomiting, and weight loss
  • Cytomegalovirus infections, which can cause pneumonia, gastroenteritis (stomach and intestine inflammation), encephalitis (brain inflammation), and retinitis (an infection of the retina that can cause blindness)
  • Herpes simplex virus infections, which can cause painful blistering, bronchitis, pneumonia, and esophagitis
  • Histoplasmosis, a lung infection caused by the fungus Histoplasma capsulatum, which leads to flu- and pneumonia-like symptoms, as well as progressive disseminated histoplasmosis, a disease that can affect other organs
  • Tuberculosis, which is caused by the bacteria Mycobacterium tuberculosis
  • Systemic diseases (affecting the whole body) caused by the bacteria Mycobacterium avium, M. intracellulare, and M. kansasii
  • Pneumocystis pneumonia, caused by the fungus Pneumocystis jirovecii
  • Pneumonia, caused by the bacteria Streptococcus pneumoniae
  • Progressive multifocal leukoencephalopathy, a brain and spinal cord (central nervous system, or CNS) disease caused by the JC (John Cunningham) virus
  • Salmonella septicemia, a blood infection caused by the bacteria salmonella
  • Toxoplasmosis, an infection caused by a parasite that can affect the brain, lungs, eyes, heart, and certain other organs
In addition to ART, your healthcare provider will likely recommend some ways you can help prevent certain OIs. These include taking certain medications and getting certain vaccinations, avoiding undercooked or unpasteurized foods, being aware of what germs you may be exposing yourself to, and preventing exposure to other sexually transmitted infections.

Neurological Complications Associated With HIV and AIDS

HIV doesn’t appear to invade nerve cells, but it does infect cells called glia that protect and support nerves.

As virus-related inflammation damages the CNS, people with advanced HIV or AIDS may experience various symptoms, such as confusion, forgetfulness, behavioral issues, headaches, weakness, and numbness in the extremities.

CNS complications from the virus, or from drugs used to treat it, may include the following:


Opportunistic infections that affect the central nervous system (CNS) include

cryptococcus, progressive multifocal leukoencephalopathy, the cytomegalovirus that can cause encephalitis (brain inflammation), and Treponema pallidum, which causes neurosyphilis.

Other neurological complications unrelated to infections are also possible, such as AIDS dementia complex or HIV-associated dementia, CNS lymphomas, neuropathies (nerve disorders), vacuolar myelopathy (a spinal cord condition), and various psychological and neuropsychiatric disorders.

Other Complications Associated With HIV or AIDS

People with HIV or AIDS may also experience:

  • Lymphomas, or cancers of the lymph nodes

  • Kaposi’s sarcoma, a kind of blood vessel cancer caused by Kaposi’s sarcoma–associated herpesvirus (KSHV), also called human herpesvirus 8 (HHV-8)

  • Invasive cervical cancer, which the CDC notes can be prevented by having your doctor perform regular cervical examinations

  • Kidney disease, or HIV-associated nephropathy

  • Wasting syndrome due to HIV, defined as involuntary loss of more than 10 percent of body weight while having experienced diarrhea, weakness, and fever for more than 30 days.

COVID-19 and HIV

Almost half of people diagnosed with HIV in the United States are older than 50, and people with HIV also have higher rates of certain underlying health conditions — both of which can make them more susceptible to serious illness if they get COVID-19.

While people with HIV should get vaccinated against COVID-19), even when fully vaccinated, immunocompromised people should take precautions recommended for unvaccinated people, such as wearing masks.

The CDC recommends that everyone with HIV get two primary doses of the Pfizer-BioNtech or Moderna vaccine for COVID-19. If you have advanced or untreated HIV, the CDC recommends three primary doses. In addition, everyone with HIV should receive the updated bivalent booster.

Side Effects of HIV Medication

Although ART has reduced opportunistic infections and the conditions mentioned above, HIV medicines can themselves cause complications or side effects. These vary from person to person and depend on the treatment regimen, but most side effects are manageable.

Over time, diabetes, high cholesterol, problems with kidney and liver function, and osteoporosis can in some cases occur with use of HIV medicines.

In general, the side effects from current ART are much less severe than they were in the past. There are many more options now when it comes to HIV medicines, and the benefits of treatment far outweigh the risk of side effects.

If you’re experiencing side effects, it’s important to discuss treatment alternatives with your doctor.

Additional reporting by Deborah Shapiro.

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