HIV complications: Types, symptoms, and staying healthy

Today, HIV is no longer the automatic disaster it once was. With modern antiretroviral therapy (ART), many people with HIV live long, full lives, work, raise families, travel, and argue about what to watch on Netflix just like everyone else. Still, HIV is a serious infection. When it’s not treated, or when treatment isn’t working well, it can lead to a range of complications that affect nearly every system in the body.

Understanding HIV complicationswhat they are, how they show up, and how to prevent themis one of the most powerful ways to take control of your health. Think of this as a practical guide: what can happen, what to watch for, and what you can do every day to stay as healthy as possible with HIV.

What happens in the body when HIV goes untreated?

HIV targets the immune system, especially CD4 T cellsthe “coaches” that help other immune cells communicate and organize a defense. Over time, if HIV isn’t treated, the virus makes more and more copies of itself. CD4 cells drop, the immune system gets weaker, and infections or cancers that a healthy body would usually control become more likely.

When CD4 counts fall below a certain level (usually under 200 cells/mm³) or when certain serious infections or cancers appear, a person is considered to have AIDS, the most advanced stage of HIV. This is when many of the classic HIV-related complications tend to show up.

The good news? Starting ART early and taking it consistently can prevent many of these problems and, in many people, keep HIV from ever progressing to AIDS.

Types of HIV complications

HIV complications fall into a few main categories: opportunistic infections, HIV-related cancers, organ and metabolic problems, neurologic issues, and mental health and social complications. Let’s break them down in plain language.

Opportunistic infections (OIs)

Opportunistic infections are illnesses that take advantage of a weakened immune system. They are much more likely when CD4 counts are low and HIV is not controlled. Common OIs include:

• Pneumocystis pneumonia (PCP): A type of pneumonia that can cause fever, dry cough, and shortness of breath that slowly gets worse.
• Tuberculosis (TB): Can affect the lungs or other organs, causing cough, weight loss, fever, and night sweats.
• Cryptococcal meningitis: A fungal infection of the brain and spinal cord, often presenting with headaches, fever, confusion, or vision changes.
• Toxoplasmosis: A parasitic infection that can cause brain lesions, seizures, and neurologic symptoms.
• Candidiasis (thrush): A fungal infection in the mouth, throat, or esophagus that can cause white patches, soreness, and difficulty swallowing.
• CMV (cytomegalovirus): Can cause eye disease leading to vision problems or blindness, as well as gastrointestinal or neurologic issues.

These infections can be severe, but many are preventable with ART, prophylactic (preventive) medications, and vaccines when appropriate.

HIV-related cancers

A weakened immune system also increases the risk of certain cancers. Some are considered “AIDS-defining” illnesses, including:

• Kaposi sarcoma: A cancer of blood vessels that can show up as purple or dark skin lesions or affect internal organs.
• Non-Hodgkin lymphoma: A blood cancer that can cause swollen lymph nodes, fever, weight loss, and fatigue.
• Invasive cervical cancer: Linked to HPV, this can progress more quickly in people with HIV.

With effective HIV treatment and regular cancer screenings (like Pap tests and HPV screening), the risk and impact of these cancers can be greatly reduced.

Neurologic complications

HIV does not just hang out in the blood. It can enter the brain and nervous system as well, sometimes leading to:

• HIV-associated neurocognitive disorder (HAND): Problems with memory, concentration, and thinking speed. It can range from subtle changes to more severe dementia in advanced disease.
• Peripheral neuropathy: Nerve damage causing burning, tingling, or numbness in the hands and feet. This can result from HIV itself or certain medications.
• Opportunistic infections of the brain: Such as toxoplasmosis or cryptococcal meningitis, which can cause headaches, seizures, or weakness.

Early treatment of HIV and careful selection of medications can lower the risk of serious neurologic complications.

Heart and blood vessel (cardiovascular) problems

People with HIV have a higher risk of cardiovascular disease, including heart attacks and strokes. This is due to several factors:

• Chronic inflammation from untreated or poorly controlled HIV.
• Traditional risk factors like smoking, high blood pressure, and high cholesterol.
• Possible side effects of some antiretroviral medicines that affect cholesterol or blood sugar.

The upside is that heart risk can be managed with lifestyle changes, control of blood pressure and cholesterol, and appropriate medication when needed.

Kidney and liver disease

HIV can impact the kidneys directly (for example, HIV-associated nephropathy) and indirectly through medications or co-infections. Some antiretroviral drugs can affect kidney function over time, especially if there are other risk factors like diabetes or high blood pressure.

The liver has a hard jobfiltering medications, toxins, and infections. People with HIV may have:

• Hepatitis B or C coinfection, which greatly increases the risk of liver damage, cirrhosis, and liver cancer.
• Liver inflammation from medications, alcohol, or fatty liver disease.

Regular blood tests, vaccines for hepatitis A and B when appropriate, and careful choice of medications help protect both kidneys and liver.

Bone, metabolic, and endocrine complications

Long-term HIV infection and some antiretroviral drugs are linked with:

• Low bone density (osteopenia, osteoporosis), increasing fracture risk.
• Metabolic syndrome: A cluster of high blood sugar, abnormal cholesterol, increased waist size, and high blood pressure.
• Increased risk of type 2 diabetes and fatty liver disease.
• Hormonal issues such as low testosterone in some people.

These complications are often manageable with lifestyle changes, medication adjustments, and screening tests like bone density scans.

Mental health and social complications

Not all HIV complications show up in blood tests or scans. Living with HIV can mean dealing with:

• Depression and anxiety related to chronic illness, stigma, or fear of the future.
• Stress and burnout from managing appointments, medications, and disclosure to partners or family.
• Substance use as a coping strategy, which can, in turn, worsen health and adherence.

Getting mental health support is just as important as managing viral load and CD4 counts. Therapy, support groups, peer counselors, and trusted friends can make a huge difference.

Symptoms of HIV complications to watch for

Symptoms will vary depending on the complication, but some red flags deserve prompt medical attention:

• Unexplained weight loss, fever, or night sweats.
• Persistent cough, shortness of breath, or chest pain.
• Severe headaches, neck stiffness, vision changes, confusion, or seizures.
• Pain, tingling, or numbness in the hands or feet that keeps getting worse.
• Persistent diarrhea, abdominal pain, or vomiting.
• New skin lesions, unusual bruising, or lumps and swollen lymph nodes that don’t go away.
• Low mood, hopelessness, or thoughts of self-harm.

Any new or rapidly changing symptoms should be discussed with your healthcare provider. You don’t get extra points for “toughing it out.”

How modern HIV treatment changes the picture

Before combination ART became widely available, HIV complications were tragically common. Now, with modern treatment, many people never experience severe opportunistic infections or AIDS-related cancers. When ART is started early and taken consistently, viral load can become undetectable, which:

• Protects the immune system from further damage.
• Greatly lowers the risk of opportunistic infections and many other complications.
• Prevents sexual transmission of HIV (often summarized as “U = U,” undetectable equals untransmittable).

Antiretroviral medications can have side effects, both short- and long-term. Some people experience nausea, headaches, sleep problems, or mood changes when starting a new regimen. Long-term issues like kidney, liver, or bone problems are less common with newer drugs but still monitored closely.

If a certain combination isn’t working well for youbecause of side effects, drug interactions, or resistanceyour provider can often switch to a different regimen. You are not stuck with a treatment that makes you miserable.

Staying healthy with HIV: practical strategies

Managing HIV is a team effort between you, your healthcare providers, and your support system. Here’s how to stack the odds in your favor and reduce the risk of complications.

1. Stick with HIV treatment

Taking your ART exactly as prescribed is the single most important step for preventing HIV complications. That means:

• Starting HIV treatment as soon as recommended (usually right after diagnosis).
• Taking pills or injections on scheduleset reminders, use pill boxes, or link doses with daily routines like brushing your teeth.
• Going to regular medical appointments and blood tests to monitor viral load, CD4 count, kidney and liver function, and other labs.
• Speaking up about side effects instead of silently skipping doses.

If adherence is tough because of work, housing, mental health, or substance use, ask about extra support. Many clinics have social workers, peer navigators, or case managers whose entire job is to help you succeed with treatment.

2. Protect your immune system

Protecting your immune system isn’t only about HIV treatment. It also involves:

• Vaccines: Staying up to date on vaccines like flu, COVID-19, hepatitis A and B, pneumococcal, HPV, and others recommended by your provider.
• Preventive medications: In some cases, if your CD4 count is low, your provider may prescribe antibiotics or other medicines to prevent specific opportunistic infections.
• Screening tests: Regular Pap tests, STD screens, cancer screenings, and lab work catch problems early, when they’re easier to manage.

3. Everyday lifestyle choices that matter

You don’t need a “perfect” lifestyle; you just need one that supports your immune system more than it strains it. Helpful habits include:

• Balanced nutrition: Aim for plenty of vegetables, fruits, whole grains, lean protein, and healthy fats. If you’re underweight or losing weight unintentionally, ask about seeing a dietitian who understands HIV.
• Regular physical activity: Even brisk walking most days can help support heart health, bone strength, mood, and blood sugar.
• Sleep: Prioritize 7–9 hours of quality sleep; your immune system does a lot of its repair work while you’re horizontal.
• Avoiding tobacco and limiting alcohol: Smoking significantly worsens cardiovascular and cancer risk; cutting back is one of the best gifts you can give your future self.

4. Sexual health, substance use, and other infections

Staying healthy with HIV also means reducing the risk of other infections that can complicate things:

• Use condoms or other barrier methods to prevent STIs like syphilis, gonorrhea, chlamydia, and HPV.
• Avoid sharing needles or injection equipment; if you inject drugs, look for syringe services programs or harm reduction resources in your area.
• Get tested and treated for STIs promptlyuntreated infections can increase inflammation and complicate HIV care.

5. Take your mental health seriously

Depression, anxiety, and trauma can make it harder to stick with treatment and self-care. They’re also common, and they are treatable. Helpful options include:

• Talking with a therapist or counselor who has experience working with people living with HIV.
• Joining a support group (in person or online) to connect with others who “get it.”
• Practicing stress management techniques like mindfulness, breathing exercises, or light movement.
• Talking honestly with close friends or family about the kind of support you need.

Asking for help is not a sign of weakness. It is an essential part of protecting your health.

Real-world experiences: living well while managing HIV complications

It’s one thing to read about HIV complications in a list. It’s another to live with the day-to-day decisions that help prevent them. While everyone’s story is different, many people with HIV describe similar turning points when it comes to staying healthy.

One common moment is the first time a routine lab result comes back “undetectable.” For some, it feels like a giant exhale after months of fear and uncertainty. They may still be processing the diagnosis, but seeing that the virus is controlled often restores a sense of hope and momentum. Instead of picturing worst-case scenarios, people start asking questions like, “Okay, what’s my long-term plan?” and “How can I keep this going?”

Another shared experience is learning to navigate side effects. Perhaps someone starts a new medication and suddenly their sleep is off or their dreams are intensely vivid. At first, they might wonder if this is their “new normal.” Over time, they realize they can go back to their provider and say, “This part isn’t working for me.” A regimen change, adjusting the dose time, or adding a short-term sleep strategy can transform their daily life. That shiftfrom silently enduring to actively partnering with the care teamis a big step in preventing complications.

Social support also plays a major role. A person who has just been diagnosed might feel isolated at first, worried about telling anyone. Later, after joining a support group, they may find themselves laughing at in-jokes about pill boxes or pharmacy apps with people who genuinely understand. They realize that staying healthy isn’t just about lab numbers; it’s also about feeling seen and understood. That sense of connection helps people keep showing up for appointments, keep refilling prescriptions, and keep asking questions about symptoms before they snowball into major issues.

Some people describe their relationship with HIV as a “new job” they had to learn. At the beginning, the schedule of pills, labs, and check-ins can feel overwhelming. Over time, it becomes routinetake medication with breakfast, set an alarm on the phone, blood tests every few months. When that routine settles in, it frees up mental space, and HIV becomes one piece of life rather than the center of the universe. The complication risk is lower because the basicslike viral suppression and regular monitoringare on autopilot.

There are also stories about what happens when complications do arise. For example, someone might ignore gradually increasing fatigue and leg swelling, assuming it’s just stress or aging. When they finally mention it, testing reveals heart problems or kidney issues. It can be frightening, but catching it in that moment rather than years later gives them options: medication changes, lifestyle improvements, referrals to specialists. Many people say that after a scare like this, they become more tuned in to their bodies and more willing to bring up “small” symptoms early.

Mental health turning points are equally important. Someone struggling with stigma or shame may avoid appointments or skip doses, feeling like they “don’t deserve” care. A single nonjudgmental conversationwith a counselor, a peer, or a compassionate providercan flip that script. When they start to see themselves as worthy of health and support, adherence improves, complications become less likely, and life feels bigger than the diagnosis again.

If you live with HIV, your journey will have its own twists. Some seasons may feel easy, with stable labs and no symptoms. Others might be bumpier, with side effects, new diagnoses, or life stress. What matters most is that you stay in the game: stay connected to care, stay curious about your options, keep asking questions, and keep reaching out for help. HIV complications are real, but so is your abilitytogether with modern treatment and a good care teamto prevent many of them and manage the rest.

The bottom line

HIV can affect nearly every system in the body, especially when it’s not treated. Complications can include opportunistic infections, cancers, heart and kidney disease, neurologic issues, and mental health challenges. The flip side is that effective, consistent HIV treatment dramatically lowers the risk of many of these problems and allows most people to live long, active lives.

Staying healthy with HIV is not about being perfect. It’s about showing up: taking medications regularly, attending appointments, paying attention to new symptoms, and honoring both your physical and emotional well-being. With the right care and support, HIV becomes something you managenot something that controls your future.