HIV

What is HIV?

HIV (human immunodeficiency virus) is a virus that attacks the immune system, and over time can lead to a weakened immune system.

HIV infections are spread through contact with certain body fluids and can eventually lead to AIDS (acquired immunodeficiency syndrome).

What is AIDS?

AIDS (acquired immunodeficiency syndrome) is a chronic disease of the immune system that can be caused by an HIV infection.

What’s the difference between HIV and AIDS?

HIV is a virus that spreads through certain bodily fluids. AIDS is a chronic disease that develops from an HIV infection.

The time between getting HIV and developing AIDS is usually around 10-15 years, according to the World Health Organization.

How common is HIV?

According to HIV.gov, approximately 1.2 million people in the United States have HIV, and 13% of them do not know they have it.

In 2020, the CDC reports that 30,635 people received an HIV diagnosis—a 17% decrease from the year before.

Causes of HIV

HIV is a virus that spreads through certain bodily fluids. The most common ways that HIV spreads is through unprotected sex and sharing drug-injection tools, according to the CDC.

How HIV does and does not spread

HIV spreads when certain bodily fluids come in contact with the mucous membranes of the genitals or mouth. Or when certain bodily fluids come in contact with broken skin. According to the CDC, the bodily fluids that spread HIV are

• Blood
• Semen
• Pre-seminal fluid
• Rectal fluids
• Vaginal fluids
• Breast milk

How does HIV become AIDS?

An HIV infection actively destroys parts of your immune system. Over time (10-15 years on average, according to CDC data), the immune system becomes so damaged that HIV can become AIDS.

According to HIV.gov, a person with HIV is considered to have AIDS when the number of their CD4 cells falls below 200 cells per cubic millimeter of blood. For reference, a healthy CD4 count is between 500 and 16000 cells per cubic millimeter.

Who is at risk for HIV infection?

In the United States, men who have sex with other men are the demographic most affected by HIV. In 2020, gay and bisexual men made up 68% of new HIV diagnoses, according to the CDC.

Other less common risk factors include:

• Using drug-injection tools
• Having unprotected oral, anal, or vaginal sex with multiple partners
• Being born to a mother who is HIV positive

HIV Symptoms

The symptoms of HIV can range from bothersome to mild. Many people with HIV do not experience symptoms.

The symptoms of HIV can also change, depending on which stage of the infection you are in. According to the Mayo Clinic, the most common signs and symptoms of HIV are flu-like symptoms that start 2-4 weeks after exposure. These symptoms include:

• Fever
• Headache
• Body aches
• Join paint
• Unexplained rash
• Sore throat
• Swollen lymph nodes
• Diarrhea
• Unexplained weight loss
• Coughing

What are the stages of HIV?

HIV has three stages:

• The primary (or “acute”) stage can last for a few weeks.
• The clinical latent stage (or “chronic stage”), can last for years.
• Late-stage HIV, occurs when the immune system is damaged enough to cause AIDS.

Stage 1: Primary infection (Acute HIV)

The first stage of an HIV infection is the primary (or “acute”) stage. This stage starts at the time of exposure and can continue for several weeks. During this stage, a person with HIV may or may not experience flu-like symptoms.

According to the Mayo Clinic, the viral load during this stage is its highest, therefore the infection is the most contagious to others during this stage.

Stage 2: Clinical latent infection (Chronic HIV)

During the second stage, called the clinical latent stage, HIV becomes a chronic infection that continues to damage the immune system. The Mayo Clinic reports that antiretroviral medications can be used to slow the progression of immune system damage.

Stage 3: AIDS

The development of AIDS is the final stage of an HIV infection. This occurs when the immune system reaches a certain level of damage. Antiretroviral medications can continue to be useful during this stage, to manage symptoms and slow further disease progression.

Symptomatic HIV infection

At any stage, someone with an HIV infection can experience symptoms. According to the Mayo Clinic, these symptoms usually include:

• Fever
• Nausea
• Vomiting
• Loss of appetite / weight loss
• Sores in the mouth or skin
• Thrush (a yeast infection of the mouth, commonly caused by antibiotics)
• Other flu-like symptoms

People with HIV also can develop recurrent infections (such as pneumonia), because of the damaged immune system.

How Do I Know If I Have HIV?

HIV testing is the only way to know for sure your HIV status. Currently, there are several testing options, including home tests that are available.

Complications from HIV

Because HIV damages the immune system, complications include secondary infections that can be worse than in people without HIV.

HIV can also leave you more susceptible to opportunistic infections and certain cancers that can be caused by viruses. These infections and cancers are sometimes referred to as “AIDS-defining illnesses”. According to the Mayo Clinic, some of these AIDS-defining illnesses include:

• Lymphatic cancers
• Fungal infections of the lungs and brain
• Herpes simplex ulcers that could spread to the respiratory tract
• Chronic diarrhea
• Parasitic infections
• Invasive cervical cancer
• Multiple and recurrent bacterial infections
• Tuberculosis
• Recurrent pneumonia
• Recurrent salmonella

Infections common to HIV/AIDS

HIV and AIDS damage the immune system, leaving a person at high risk of developing bacterial, fungal, and viral infections, notes the Mayo Clinic. Some of these infections may be severe.

Cancers common to HIV/AIDS

HIV/AIDS raises the risk of developing certain kinds of cancer, according to John Hopkins, these cancers include:

• Kaposi sarcoma
• Non-Hodgkin lymphoma
• Cervical cancer
• Hodgkin lymphoma
• Cancers of the skin, anus, lungs, and liver

Other complications related to HIV

HIV can also cause neurological complications. According to the NIH, many severe neurological conditions can be prevented with antiretroviral medications. However, symptoms of neurological complications from an HIV infection include:

• Confusion and forgetfulness
• Inability to concentrate
• Behavioral changes
• Headaches
• Mood disorders
• Anxiety
• Depression
• Lack of coordination
• Difficulty walking
• Loss of sensation in the arms and legs
• Generalized pain
• Seizures
• Strokes
• Shingles infection
• Difficulty swallowing
• Vision impairment or loss
• Impaired bladder control
• Impaired sexual function
• Coma

Diagnosing and Testing for HIV

Getting diagnosed with HIV involves getting tested, usually by a healthcare provider. The CDC recommends adults get tested for HIV at least once during their lifetime.

People with risk factors for HIV exposure get tested once per year or anytime they have had a potential exposure.

There is a window period in which each test usually yields an accurate result, however, if you receive negative results during the window period, the CDC recommends being tested again after the window period to confirm.

How is HIV diagnosed?

HIV is diagnosed through antibody or antigen testing. This testing is done with either a blood sample (most common and most reliable) or a saliva sample.

What tests diagnose HIV?

Antigen/antibody testing is the most recommended method of testing, from the CDC. However, there are also home tests available.

Antigen/antibody tests

Antigen/antibody tests screen for both antigens (the HIV virus itself) and antibodies (the cells your body makes in response to a foreign toxin) at the same time. This test can accurately detect HIV 18 to 45 days after exposure, according to the CDC.

This test usually requires a blood sample, from a venipuncture procedure. However, there are rapid antigen/antibody tests available that require a blood sample via fingerstick.

Antibody tests

Antibody tests look for the antibodies produced in response to HIV exposure. This test can be done between 23 and 90 days after exposure and can be done with either a fingerstick blood sample or a saliva sample, according to the CDC.

Nucleic acid tests (NATs)

NAT tests require a blood sample, drawn by a venipuncture procedure. These tests look for how much HIV is present in the bloodstream. These tests can be done between 10 and 33 days after exposure, according to the CDC.

Are there at-home tests for HIV?

There are at-home tests available for HIV. The CDC also notes that the only FDA-approved home test for HIV uses a saliva sample and yields results in about 20 minutes.

HIV Treatments & management

Thanks to advancements in medicine, many antiretroviral medications are effective for the management of HIV and AIDS. The use of these medications varies, depending on medication availability, insurance coverage, and patient response characteristics.

How is HIV treated?

HIV is treated with antiretroviral medications, which help slow the virus from replicating in the body. Treatment can slow the progression of HIV but cannot cure it. HIV can also become resistant to the medication, so often a combination of medication is used, according to The Cleveland Clinic.

Medications used to treat HIV

The antiretroviral medications used to treat HIV are called Nucleoside Reverse Transcriptase Inhibitors (NRTI). According to UCSF Health, the following are FDA-approved NRTIs that are currently used to treat HIV:

• Abacavir (Ziagen, ABC)
• Didanosine (Videx, dideoxyinosine, ddI)
• Emtricitabine (Emtriva, FTC)
• Lamivudine (Epivir, 3TC)
• Stavudine (Zerit, d4T)
• Tenofovir (Viread, TDF)
• Zalcitabine (Hivid, ddC)
• Zidovudine (Retrovir, ZDV or AZT)

Combinations of these medications are also available and are commonly used to keep dosing low but effective, according to UCSF Health.

Is there a cure for HIV?

At this time there is no cure for HIV. However, science and research are diligently working toward this goal.

HIV Prevention

Can medications prevent HIV?

There are FDA-approved medications called pre-exposure prophylaxis medication (abbreviated PrEP). According to the CDC, PrEP is 99% effective in preventing HIV infections caused by sex, and 74% effective in preventing drug use-related HIV infections.

How can I reduce my risk of getting HIV?

You can reduce your risk of getting HIV by reducing your risk factors, and by taking PrEP if your lifestyle makes you vulnerable to HIV Exposure. You can reduce your risks by:

• Use condoms properly and consistently
• Avoid sex with people who are HIV positive
• Have open and honest communication with sexual partners about their HIV status
• Avoid sharing drug-injection tools such as needles and syringes
• Using PrEP as prescribed if you are an injection drug user or a man who has sex with other men

Living With HIV

Thanks to medical advancements HIV positive people are living healthy and active lives now more than ever.

What can I expect if I have HIV?

After an HIV diagnosis, your doctor will discuss a treatment plan that includes one or more antiretroviral medications. You will also need to let your current and future sexual partners know about your HIV status so that they can take the proper steps to protect themselves.

Thanks to antiretroviral medications, many people with HIV live normal lives according to HIV.gov.

Does HIV go away?

No, HIV is a life-long infection. However, medications can keep symptoms managed and slow disease progression.

How do I take care of myself with HIV?

People who are HIV positive, are considered immunocompromised (having a weakened immune system). Because of this, extra precautions should be taken to avoid other illnesses like influenza and covid-19. Here are more things to can do to take care of yourself when you’re living with HIV, as reported by HIV.gov:

• Take any antiretroviral medications as prescribed
• Keep up-to-date with vaccinations, including annual influenza and covid-19 vaccines
• Have regular health check-ups with a primary care physician to monitor your HIV symptoms and general health

If I have HIV, how can I keep from spreading it to others?

Although abstinence is the only sure way to prevent spreading the infection, antiretroviral medications can lower your risk of spreading HIV to your sexual partners. However, these medications cannot prevent other sexually transmitted infections (or STIs), so condoms should still be used properly and consistently.

Can I get pregnant if I have HIV?

An HIV-positive mother does have a risk of transmitting HIV to the baby during pregnancy (through the placenta), during vaginal childbirth, or while breastfeeding. However, antiretroviral medications significantly reduce the risk of transmission when taken during pregnancy and delivery. The American College of Gynecology recommends the following to reduce the risk of passing HIV from other to baby:

• Take a combination of antiretroviral medication during pregnancy, as prescribed
• Deliver the baby by c-section
• Give the baby antiretroviral medication after birth
• Don’t breastfeed

Tests that measure the CD4 (a type of white blood cell) in the blood are used to determine how severe an HIV infection is and monitor its progression.

What happens to your body when you get HIV?

HIV damages the immune system by destroying CD4 cells (a type of white blood cell). This damage makes it difficult for someone to fight off other infections, and can eventually lead to AIDS.