Living with human immunodeficiency virus (HIV) sometimes means working hard to differentiate symptoms linked to HIV from those connected to other causes. One such symptom is a cough, which may be infrequent or persistent.

“Painful cough — hope it’s nothing serious,” one myHIVteam member wrote. Another said, “I feel like I have been run over by a semi (cough, cough, cough).”

This article will review how to interpret a cough when you’re living with HIV or at risk of developing the condition.

Cough and Early HIV

Early or acute HIV infection is the first stage of HIV. Recognizing early symptoms of HIV is important because it increases the likelihood of early detection and treatment. Research shows that people have better long-term health when they start antiretroviral therapy (ART) early in the course of HIV.

Studies have found that anywhere from 10 percent to 60 percent of people with early HIV might be asymptomatic, meaning they don’t show symptoms. Pinpointing the exact percentage is difficult because people with symptoms usually get noticed, leaving asymptomatic cases undetected. Symptoms caused by the immune system’s reaction to the virus typically develop within two to four weeks of infection — though in some cases, incubation periods of up to nine months have been reported,

Early-stage HIV may be asymptomatic, but when it’s not, the condition usually causes flu-like symptoms. The exact frequency of specific symptoms at this stage isn’t known. That said, health experts have compiled available research and identified the following signs as the most common during acute HIV infection:

• Fever
• Fatigue (low energy)
• Muscle aches and joint pain
• Swollen lymph nodes
• Headache
• Pharyngitis (sore throat)
• Rash

Cough also occurs in some people with early HIV symptoms, but it’s less common than those listed above. For instance, people with HIV who develop Pneumocystis pneumonia tend to experience a gradual onset of breathing difficulties and coughing, while individuals with bacterial pneumonia often abruptly have fever and cough symptoms.

Late-Stage HIV

After acute HIV infection, chronic (ongoing) HIV infection develops. During this stage, the virus continues multiplying in the body — though at lower levels than during the acute stage. Although some people are asymptomatic during this stage, some develop symptoms, including cough.

A persistent, dry cough in someone with HIV can signal worse disease or AIDS. In addition to cough, people in chronic-stage HIV may have a fever, diarrhea, rapid weight loss, or swollen lymph nodes, among other potential symptoms.

Without detection and HIV treatment, chronic HIV infection will progress to AIDS, also known as late-stage HIV. How quickly this transition happens varies by individual, but it usually takes at least 8 to 10 years.

Once a person develops AIDS, HIV has severely damaged their immune system. HIV also directly damages the lungs, increasing the risk of both infectious and noninfectious lung diseases. With a weakened immune system, people with late-stage HIV and AIDS have an increased risk of life-threatening opportunistic infections — infections or infection-related cancers that are more likely in people with low immune system function.

Many opportunistic infections affect the lungs and can cause cough and breathing difficulties. These include:

• Fungal infections including coccidioidomycosis, histoplasmosis, and Pneumocystis jirovecii pneumonia (PJP)
• Bacterial infections including recurrent pneumonia and tuberculosis (TB)
• Viral infections including cytomegalovirus

The exact prevalence of cough in late-stage HIV isn’t known. However, based on the high prevalence of opportunistic infections like TB and bacterial pneumonia in people with HIV, cough is common.

Other Causes of Cough

Cough is nonspecific to HIV, meaning that it occurs in many other common conditions. In the U.S., cough is more likely due to causes unrelated to HIV. While HIV affects about 1.2 million people in the United States, chronic pulmonary lung disease (COPD) and asthma affect 25 million and 11 million people, respectively.

Both COPD and asthma are caused by long-standing lung inflammation and airway narrowing, leading to cough and shortness of breath.

Other common causes of cough include:

• Allergies
• Rhinovirus (common cold)
• Influenza
• Pneumonia
• Acute bronchitis (airway inflammation)
• Sinusitis (sinus infection)
• Gastroesophageal reflux disease (GERD)
• Cigarette smoking

Because HIV shares symptoms like cough with many other conditions, it’s important to see a health care provider if you have a cough and aren’t sure about the cause.

Get Tested

Although causes other than HIV more commonly lead to coughing, you should get tested if you develop a cough and are at risk of HIV or are concerned you may have been infected. Getting tested can help you get diagnosed and treated early and can empower you to make safer choices to prevent transmitting the virus to others.

Early and chronic HIV are frequently asymptomatic, so the Centers for Disease Control and Prevention (CDC) recommends that all people between ages 13 and 64 get tested at least once in their lifetime for HIV. The agency also recommends people with the following risk factors get tested at least once a year:

• Being diagnosed with or treated for another sexually transmitted infection (STI)
• Having anal or vaginal sex without a condom or medicines to prevent or treat HIV with someone whose status is unknown or who has HIV
• Having multiple sexual partners since your most recent HIV test
• Sharing needles, syringes, or other drug-injection devices
• Having a history of sex work
• Being diagnosed with or treated for hepatitis or TB

If you’re looking to get tested for HIV, talk with your doctor about which test is best for you and how regularly you should be tested.

People with newly diagnosed HIV should also be screened for infections that commonly occur with HIV, including TB and coccidioidomycosis.

For people living with HIV, it’s important to seek medical advice from a health care professional for any new cough, especially if you aren’t taking ART. The best way to prevent cough due to life-threatening infectious diseases and other lung diseases is to take ART as recommended by a doctor who treats HIV.

People living with AIDS should also take antimicrobial prophylaxis — medications that help prevent specific infections. Related to cough prevention, health experts recommend coccidiomycosis prophylaxis for people with a CD4-positive T-cell (CD4) count of less than 250 cells per microliter and PJP prophylaxis for people with a CD4 count of less than 200 cells per microliter.

Talk to your doctor about whether one of these medications might be right for you and about solutions that could help you reduce your coughing episodes.

Find Your Team

On myHIVteam, the social network for people with HIV and their loved ones, more than 37,000 members come together to ask questions, give advice, and share their stories with others who understand life with HIV.

Are you living with HIV and a cough? Have you discussed your symptoms with a doctor? Share your experience in the comments below, or start a conversation by posting on your Activities page.