Many of the symptoms of influenza (flu), cold, and COVID-19 are similar. This can make it hard to figure out what you might be dealing with. On top of that, the early symptoms of HIV can be similar to a cold, flu, or COVID-19. It’s estimated that in the United States, about 13% of people living with HIV don’t know that they have it.

The COVID-19 pandemic has created so many challenges throughout the health system. One of the trends seen in the United States and throughout the world is that rates of HIV testing were much lower than before the pandemic.

Early diagnosis and treatment of HIV are important. With the right treatment, people with HIV can live long and healthy lives. HIV is now considered a chronic condition. Treatment with antiretroviral therapies (ART) can lower the amount of HIV in the body to an undetectable range. At this level, HIV can’t be spread to another person.

People with untreated HIV or people living with AIDS are at a higher risk of complications from COVID-19, the flu, or a cold. HIV kills a type of immune cell called CD4 cells. These are also known as helper cells or T-cells. Part of managing HIV involves regular blood work to monitor CD4 cell levels.

A typical CD4 count is above 500 cells per cubic millimeter of blood. The lower the CD4 count, the more likely a person with HIV is to get sick, especially with a CD4 count below 200. Without enough CD4 cells, it’s very difficult for the immune system to fight off infection.

With advances in HIV care and treatment, many people do not progress to developing AIDS. With the right treatment to manage HIV, a person is not at a greater risk of complications from a cold or flu.

Recent studies suggest that adherence to HIV treatment may also reduce the risk of complications, including mortality, from COVID-19. But it’s important to note that other research has found conflicting evidence.

If someone is living with HIV but doesn’t know it or if their HIV is not well managed, there’s a greater risk of illness. Over time, if a person living with HIV is left untreated HIV, their CD4 count can decline. This makes it harder for the body to fight off infection. A person with a low CD4 count is more likely to develop complications from a cold, flu, or COVID-19.

Complications from the flu or COVID-19 may include:

  • sinus infection
  • ear infection
  • worsening of existing chronic conditions
  • pneumonia
  • inflammation in the heart (myocarditis)
  • inflammation in the brain (encephalitis)
  • inflammation in the muscle tissues (myositis, rhabdomyolysis)
  • sepsis

With many of the symptoms overlapping, it can be tricky to know what you might be dealing with. Testing is available for COVID-19, the flu, and acute HIV infection. Acute HIV infection is the earliest stage of infection when a person may present with symptoms that are similar to the flu or COVID-19.

Here are some signs that can help you determine what’s causing your symptoms.


The SARS-CoV-2 virus, which causes COVID-19, can cause a variety of symptoms. Symptoms can be mild, moderate, or severe.

Some of the most common symptoms include:

  • sore throat
  • cough
  • fever
  • feeling generally unwell
  • headache
  • body aches
  • shortness of breath
  • nausea, vomiting
  • reduced senses of taste and smell

Symptoms often improve within 1 to 2 weeks. Some people have symptoms that last much longer.

If you suspect you may have COVID-19, consider getting tested. If you live in the United States, you can look up your options for getting tested here.

You can help protect yourself by getting a COVID-19 vaccine and staying up to date with any recommended boosters.

Influenza (flu)

Symptoms of the flu can be very similar to symptoms of COVID-19. Testing is the best way to find out which virus has caused your symptoms.

Symptoms of the flu include:

  • cough
  • fever
  • runny nose
  • fatigue
  • headache
  • body aches
  • nausea, vomiting (more common in children)
  • diarrhea (more common in children)

Most people feel back to their usual selves within 2 weeks of getting the flu.

You can help protect yourself by getting your annual flu shot. The flu strains change every year, which is why you need to get a new flu vaccine annually to stay protected.


What we know as the “common cold” can actually be caused by many different viruses.

Some symptoms of a cold are the same as the flu or COVID-19. The primary symptoms of a cold are:

  • sore throat
  • cough
  • sneezing
  • runny nose

In adults, a cold doesn’t typically cause a fever. If you have a fever, it’s more likely to be something else. Children are more likely to get a fever when they have a cold.

Colds may cause a general feeling of being unwell but are less likely to cause the body aches that the flu or COVID-19 can cause.

In adults, cold symptoms usually last 5 to 7 days.


HIV is a chronic condition. Without treatment, it can progress to AIDS, which is considered stage 3 HIV. With the right treatment using ART, people with HIV can live long and full lives.

There are symptoms of early HIV that may occur within a few weeks of contracting HIV. About two-thirds of people who contract HIV will have symptoms.

Symptoms can include:

  • sore throat
  • fatigue
  • night sweats
  • fever
  • chills
  • swollen lymph nodes
  • mouth ulcers

These symptoms can last a few days or up to a few weeks.

People with HIV do best when they start ART early. ART lowers the amount of HIV in the body and keeps the CD4 cell count in a more typical range.

Without treatment, HIV may progress to AIDS. AIDS has different symptoms than HIV. These symptoms happen when the immune system gets weaker and is not working properly. The body is no longer able to fight off infections without CD4 cells.

Symptoms of AIDS include:

  • ongoing swelling in the lymph glands
  • extreme fatigue
  • quick unexplained weight loss
  • red or purple patches on or under the skin
  • sores in the mouth or around the genitals
  • fevers that keep coming back

In the early stage of HIV, it’s possible to have symptoms that are similar to a cold, flu, or COVID-19. They show up within the first 2 to 4 weeks after contracting HIV. Not everyone will have symptoms.

Testing for HIV is the only way to know for sure. HIV is a treatable condition now. Taking ART is effective in keeping the level of HIV in the body at an undetectable level. When HIV is undetectable, it can’t be passed to anyone else.

A person can live a long and full life with HIV. ART may also be used to help prevent someone from contracting HIV if they are considered at risk.

Preventive treatments include:

  • Preexposure prophylaxis (PrEP): This is an effective way for people to prevent getting HIV if they are at a higher risk. ART medications are taken on an ongoing basis along with medical monitoring.
  • Postexposure prophylaxis (PEP): This can prevent contracting HIV if started within 72 hours of possible exposure to HIV. It’s a combination of three ART medications taken for 28 days.

For someone living with HIV who has an undetectable viral load and a normal CD4 count, it’s possible to live a long and full life, and there aren’t necessarily higher risks of complications from the flu or a cold. Some research even suggests the risk of complications from COVID-19 isn’t necessarily higher with HIV.

If you have a cold, flu, or COVID-19 symptoms, you may be able to manage at home with:

  • rest
  • staying hydrated
  • taking any HIV medications or ART as needed for symptom management

Do your best to continue to take your HIV medication as directed even while you are sick.

If someone isn’t taking ART or knows their CD4 count is low, they’re more likely to need medical attention. There are antiviral medications for the flu and COVID-19 that may be an option. They work best when they are used within 48 hours of symptom onset.

It’s important to be aware of signs that a person may require medical attention.

They include:

  • difficulty breathing
  • continuous pain or pressure in your chest
  • feeling unsteady
  • new onset of confusion
  • being unable to stay awake

5 fast facts on HIV and infections

  • In the United States, about 1.2 million people are living with HIV, with 13% undiagnosed.
  • A lower CD4 count is linked with a higher risk of getting COVID-19.
  • People with HIV who take ART are not necessarily at a higher risk of getting COVID-19, the flu, or a cold.
  • People with HIV on ART are 40% less likely to be admitted to the hospital with severe COVID-19 compared to those who are not on ART. People on ART are also 17% less likely to die from COVID-19 than those not on ART.
  • Thanks to advances in ART, hospitalization rates from all causes have decreased among people with HIV.
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In the United States, it’s estimated that 1.2 million people are living with HIV. Of that estimate, about 13% are undiagnosed. HIV testing is the only way to confirm that someone has HIV.

People who are not aware they have HIV or who are not taking ART are at a higher risk if they become sick with COVID-19, the flu, or a cold.

For people who take ART, the risk of getting COVID-19, flu, or cold is not necessarily higher. If treatment keeps CD4 counts in a normal range, the immune system should be able to fight off infections. A lower CD4 count is associated with a higher risk of getting COVID-19.

Some studies have suggested that people with HIV have a higher risk of death from COVID-19. But the studies have been inconsistent in terms of what populations they are studying. Some only looked at people who were already in the hospital.

A 2022 systematic review and meta-analysis showed that overall, there was not an increased risk of death from COVID-19 for those with HIV. But other studies, including this analysis, have found conflicting evidence.

Other research looked at the risk of severe COVID-19 and death in people who did or did not take ART. Early findings showed that people living with HIV who are on ART are 40% less likely to be admitted to the hospital with severe COVID-19 compared to those not on ART. The same research showed that people on ART were 17% less likely to die from COVID-19 compared to HIV-positive people not on ART.

With advances in ART, the rates of hospitalization from all causes have decreased among people with HIV.

Many symptoms of COVID-19, flu, and cold are similar. Early HIV symptoms can also be similar. Testing for COVID-19, flu, or HIV is recommended to know for sure.

HIV has effective treatments, allowing people with HIV to live full lives. People with an undetectable HIV viral load are not necessarily at a higher risk of complications from the flu, cold, or COVID-19.