The human immunodeficiency virus (HIV) attacks the body's immune system. A healthy immune system is what keeps you from getting sick.
Because HIV damages your immune system, you are more likely to get sick from bacteria and viruses. It is also harder for your body to fight off these infections when you do get them, so you may have trouble getting better. HIV is the condition that leads to acquired immunodeficiency syndrome (AIDS).
AIDS is a progression of HIV. When HIV moves into its final stages, it is considered to be AIDS. People who have AIDS are at an even higher risk of getting sick, and their bodies are even less able to fight off infections than people who have HIV. They usually die of an infection or cancer.
HIV syndrome is a name for the early stage of HIV infection, when a person is first infected with HIV.
After being infected with HIV, your body works hard to attack the virus. With your body fighting, the virus can't make as many copies of itself. Even though you still have HIV, you'll begin to look well and feel well again. The usual blood tests will be normal.
However, during this time, the virus is still attacking your lymph nodes. Lymph nodes are the centers of your body's immune system. The virus may also attack your brain tissue and slowly cause damage there.
Over 10 to 15 years, HIV kills so many CD4 cells that your body can no longer fight off infections. When your CD4 cell count is 200 or less per mL, you have AIDS (a normal count is 600 to 1000). Once you have AIDS, you can easily catch many serious infections.
When first infected with HIV, a person may not experience any symptoms. However, often a person will develop flu-like symptoms that last several weeks. These include:
If you have recently been infected with HIV, you might not realize it. The person you caught HIV from may not look or feel sick. And the signs and symptoms of HIV infection are similar to other illnesses, such as mononucleosis (mono), tonsillitis or the flu.
As the disease progresses, symptoms may appear and/or get worse. This may take time. Some people who have HIV do not begin experiencing symptoms for up to 10 years. When symptoms do appear, they can include:
HIV infection is mostly the same for men and women. For a long time after becoming infected, the person seems healthy. Over many years, the person's immune system gradually becomes weaker until it is unable to fight off other infections.
The difference between men and women is that HIV-infected women often have additional problems such as repeated vaginal yeast infections, especially as the immune system becomes weaker. More serious infections, such as pelvic inflammatory disease (an infection of a woman's internal reproductive organs), can be harder to treat. Diseases of the cervix, such as precancer (dysplasia) and cancer, progress faster. They can be harder to treat if a woman has HIV.
HIV can only be passed from person to person through body fluids, such as blood, semen and vaginal fluid. Children born to infected mothers can also become infected during pregnancy. The most common ways HIV is passed are:
More than half of women who have HIV got the infection from sexual partners. A woman can be infected by contact with a man or contact with another woman. When a woman has sex with an infected man, she has a high risk of getting HIV if a condom is not used properly.
In the early days of the AIDS epidemic, HIV infection appeared to be confined to certain groups, including intravenous drug users, men who have sex with other men and persons who have hemophilia (a blood-clotting disease that requires treatment with frequent blood transfusions). People who have hemophilia got HIV from receiving blood transfusions with donated blood that contained HIV. Blood donations are now tested for HIV, and HIV-infected blood donations are destroyed.
These days, HIV infection is much more widespread. Here is a list of people who are at high risk of HIV infection:
Babies can get HIV infection from their mothers during pregnancy, during the birth process and during breastfeeding.
It is now possible to prevent many cases of HIV in children by giving medicines to the pregnant mother and to her newborn baby. This protection cannot be offered if a pregnant woman does not know she is infected. Many people who have HIV infection feel perfectly healthy at first. The only way to know if you are infected is to have an HIV test. If you are pregnant, ask your doctor for an HIV test as part of your prenatal care. Better yet, if you are thinking about getting pregnant, talk to your doctor about HIV tests for you and your partner.
HIV can't live very long outside the body, so you can't get it through casual contact. You can't get the virus by touching, shaking hands, hugging, swimming in a public pool, giving blood, or using hot tubs, public toilets, telephones, doorknobs or water fountains. You also can't get it from food, mosquitoes or other insects.
If you think you may be infected with HIV, contact your doctor immediately. Even though there is no cure for the disease, early diagnosis and treatment with medicines can be started to slow the progression of the disease. Your doctor will be able to give you more advice about how to take care of yourself if tests show that you have HIV.
Since most people who are infected with HIV appear healthy, a blood test for the virus is necessary to see who has the infection. People who have a positive blood test for HIV are called HIV-positive. Ask your doctor how to obtain confidential testing for HIV. Your doctor can help you understand what the test results mean.
The Centers for Disease Control (CDC) encourages all sexually active people between 13 years and 64 years of age to get tested. The CDC also recommends that pregnant women be tested for HIV. Most HIV antibody tests done by your doctor are accurate if they are done 2 to 3 months or longer after you think you may have been infected. It takes this long for the antibodies to show up in the blood.
When HIV enters your body, it moves inside white blood cells called "CD4 lymphocytes." HIV takes over the CD4 cells and makes billions of copies of itself each day. The new cells spread through your body.
Your body tries to defend itself against HIV by making the following:
So at the time you are infected with HIV, you won't have enough HIV antibodies in your blood to measure, so this test can't give you a diagnosis.
However, when you are experiencing symptoms of HIV, you do have a high level of HIV RNA in your blood (RNA is the short name for "ribonucleic acid." RNA is made when the virus is active). A test of your "viral load" can measure this. This test tells your doctor the reason that you're feeling sick is because you have HIV.
First your doctor tests to see if you have HIV infection. Your blood is tested with an ELISA (enzyme-linked immunosorbent assay) test. If this test is positive for HIV, your blood is tested again with the Western blot test. If both tests are positive, you are diagnosed with HIV infection.
Three things show that a person who has HIV infection has developed AIDS. If any one or more of the following are present, the person has AIDS:
An AIDS-indicator illness is a physician-diagnosed medical problem that occurs in people who have advanced HIV infection. About 25 medical problems are considered AIDS-indicator illnesses. They include conditions like Pneumocystis pneumonia, Kaposi's sarcoma and wasting syndrome. If a person who is infected with HIV gets an AIDS-indicator illness, that person has AIDS.
Yes. Right now, there is no cure for HIV. Your body can make antibodies and CD4 cells to slow down the progress of HIV, but they can't totally get rid of the virus. In fact, the very act of attacking the HIV infection may wear out your immune system in a short time.
However, treatment with HIV medicines (usually a combination of medicines called anti-retroviral drugs) can hold down the virus and keep your body's immune system strong for a longer time. That's why the U.S. Centers for Disease Control and Prevention (CDC) recommends early treatment of people who have HIV.
There is only one HIV home kit that is approved by the Food and Drug Administration (FDA). The Home Access HIV-1 Test System is a collection kit that is used to collect a blood sample that is then mailed to a laboratory for testing. This test offers the advantage of privacy and anonymity.
Your doctor is concerned about you, your health and your privacy. If you want to be tested for HIV, you should see your doctor. He or she will help you decide whether you should be tested and will give you the support you need before and after the test. You don't get this type of support with home tests.
However, if you are afraid to talk with your doctor about HIV or to be tested, then the home collection test may be a good idea. If the test result is positive, you should see your doctor right away.
Remember, one negative test is not a guarantee that you don't have HIV or won't get it in the future. You should talk with your doctor and learn about ways to protect yourself from getting infected.
There are several kinds of medicines are used to fight HIV infection. The first kind is called nucleoside analog reverse transcriptase (say trans-krip-tase) inhibitors, or "nukes." When HIV infects a healthy cell, it needs the cell's DNA, or genetic instructions, to build copies of itself. These drugs act by blocking the HIV's ability to copy a cell's DNA. Without complete DNA, HIV can't make new virus copies. These medicines include the following:
The second kind of medicine is called a non-nucleoside reverse transcriptase inhibitor. These drugs also prevent HIV from using a healthy cell's DNA to make copies of itself, but in a slightly different way. This group includes the following medicines:
The third kind of medicine is called protease (say pro-tee-ase) inhibitors. These medicines work by preventing infected cells from releasing HIV into the body. This group includes the following medicines:
The fourth kind of medicine is called a fusion inhibitor. This medicine works by preventing the entry of the HIV virus into your body's healthy cells. This medicine is injected by a doctor. This group includes the following medicines:
The last type of medicine is called an integrase inhibitor. This medicine works by disabling integrase. Integrase is a protein that HIV uses to insert its genetic material into the genetic material of CD4 cells. This group includes the following medicine:
The different kinds of medicines are often used together (in combination) to reduce the amount of HIV in the body.
When different drugs are combined with the purpose of reducing the amount of HIV in your blood to very low levels, the resulting treatment regimen is called highly active antiretroviral therapy (HAART). Your doctor must watch you closely when you are being treated with these drugs to see how well they lower the amount of virus in your body. Your doctor also wants to make sure you aren't having side effects like nausea, vomiting, fatigue, anemia or peripheral neuropathy (a numb feeling in your hands or feet).
Three tests can measure the amount of the virus in your blood. Your doctor can use this information to find out how your body is responding to the medicine.
Your doctor will check several things to find out how strong your HIV infection has become. Your doctor will ask you about your symptoms. He or she will look for any signs that the HIV infection is getting worse. Your doctor will also do a blood test to check your CD4 cell count and your viral load. Some of the things that might tell your doctor that your HIV infection has gotten worse since your last visit are the following:
Your doctor will probably want to see you every 6 months as long as your CD4 cell count is higher than 500. Your doctor will probably want to see you every 3 months if your CD4 cell counts are below 500. However, if you take a new medicine, your doctor will want to see you more often, to check your response to the medicine or to see if your HIV infection is getting worse.
Some medicines can help prevent the other infections and complications that come when HIV lowers your body's resistance (makes your immune system weak). Here are some things that can help people with HIV:
Almost all experts agree that medicines for HIV should be started before the person's CD4 cells fall under 200. Most doctors want their patients to start taking medicines earlier, when the CD4 cell count is between 200 and 500. You and your doctor should talk about which medicines to take and when to start taking them.
Each person should talk to his or her doctor about the medicines for HIV. Most doctors treat their patients with more than one medicine.
Your doctor will test your blood to see when you should start taking medicine. The blood tests can also show how well your medicine is working. The tests will help your doctor decide if your treatment should change.
Many cities have telephone hotlines for both patients and the general public. Look for the number in your telephone yellow pages, under AIDS information.
Combination drug therapy has changed HIV disease from the leading killer of young adults to a chronic disease that can be controlled for decades. However, even though you can take HIV medicines and feel okay, you could still give the virus to others through unsafe sex or blood exchanges. The medicines don't kill the virus -- they just keep your immune system strong enough to prevent AIDS or slow it down.
New medicines are being developed and tested that can be taken less often and that are more powerful in holding back the virus. However, it may be a few years before these new drugs become available.
If you are HIV positive, you need to take very good care of yourself. Be sure to eat a balanced diet, exercise regularly and get plenty of rest. Make sure you follow your doctor's instructions and take all of your medicines exactly as directed. You can also take steps to keep yourself from getting infections or diseases that are more common in people who have HIV.
Use a condom every time you have sex. A latex condom will help reduce the risk of you and your partner getting a sexually transmitted infection (STI), such as herpes, human papillomavirus (HPV) or a new strain of HIV that might be resistant to antiretroviral drugs. To reduce your risk of getting intestinal infections, avoid sex that results in oral exposure to feces (oral-anal contact).
Certain activities or jobs (such as working in homeless shelters, hospitals, clinics, nursing homes or prisons) can increase your risk of exposure to tuberculosis (TB) and other infectious diseases. Talk with your doctor about where you work. Your doctor can decide if you should be tested for TB and how often.
Parents of children in day care and people who provide child care are at increased risk of catching cytomegalovirus (CMV) infection, cryptosporidiosis, hepatitis A and giardiasis from the children. The risk can be reduced through good hygiene practices, such as always washing your hands after changing diapers, after touching urine or saliva, after going to the bathroom and before a meal. If your child has HIV, inform the people who help care for your child.
If you work with animals (for example, veterinary work or at a pet store, farm or slaughterhouse), you may be at higher risk for infections such as cryptosporidiosis, toxoplasmosis, salmonellosis, campylobacteriosis or Bartonella infection. The risk of catching these infections probably is not high enough for you to give up your job, but you should take the following special precautions:
Although owning a pet may have risks for people who have HIV, many of the risks can be avoided. Pets provide emotional benefits, so don't be hasty about deciding to give up your pet. The following are some steps to keep you and your pet healthy:
The following are some things that you can do to avoid getting sick from food or drinking water:
Travel may be riskier for HIV-infected people, especially if their immunosuppression is severe. Travel to developing countries may put you at higher risk of food-borne and water-borne illnesses than traveling in the United States. Talk with your doctor before you travel.
Although some studies have shown that medicine to prevent traveler's diarrhea may reduce the risk, none of the studies have specifically included HIV-positive patients.
It isn't generally recommended that you take medicine to prevent an upset stomach or diarrhea before traveling, but you may want to talk with your doctor about this. You should bring an antibiotic with you in case you do get diarrhea. See a doctor right away if your diarrhea is severe and doesn't get better with medicine, if you have blood in your stool, if you get dehydrated or if you have a fever (with or without chills).
Avoid direct skin contact with soil or sand, especially if it's likely the soil may be contaminated with animal feces. Wear shoes and protective clothing. Sit on a towel if you go to a beach.
Talk with your doctor about the vaccinations you need before your trip. Many vaccinations are okay for people who have HIV, but some common vaccinations shouldn't be given to people who have HIV. If you can't have certain vaccinations, your doctor may need to give you special instructions. Your doctor will also want to talk with you about avoiding exposure to fungal infections and protozoal infections, depending on where you will be traveling.
The best ways to protect yourself from getting infected with HIV are to:
You can’t tell who’s infected with HIV by how they look. It takes an average of 8 years for symptoms of AIDS to develop after a person is infected with HIV. So even people who don’t look or feel sick can give you AIDS.
The only 100% sure way to keep from getting the AIDS virus is to not have sex at all or to have sex only with a partner who does not have HIV infection. It is also important to avoid contact with human blood and other body.
The “safest” sex is no sex. If you are having sex, “safer” sex is sex between 2 people who don’t have HIV infection, only have sex with each other and don’t abuse injectable drugs.
Safer sex also means using condoms if you have any doubts about whether your partner is infected or whether he or she is having sex with someone else. Use male latex condoms every time you have sex.
If a man doesn’t want to use a male condom, use a female condom. Female condoms may not be as effective as male condoms, but they offer some protection.
Never let someone else’s blood, semen, urine, vaginal fluid or feces get into your anus, vagina or mouth.
Using condoms the right way is important to make sure you are protected. Latex condoms should be used during all sex acts, including anal, vaginal and oral sex. If you are allergic to latex, use a polyurethane condom. For oral sex on a woman, she can use a condom split lengthwise to place between her body and her partner’s mouth.
If you are thinking about using a spermicide, be aware that research has shown that spermicides containing nonoxynol-9 can cause genital irritation and increase your risk of catching an STI. However, using a condom with nonoxynol-9 is better than not using a condom at all.
Use only water-based lubricants (such as K-Y jelly) with condoms. Oil-based lubricants, such as petroleum jelly (such as Vaseline), baby oil or lotions, cause the rubber in condoms to break.
Use a latex or polyurethane condom. Condoms made from natural membranes, such as sheep gut, aren’t as good because the virus that causes AIDS is small enough to get through the tiny pores in these condoms.
The best decision for your health is to get help for your drug abuse. If you do share needles and syringes, clean them twice with bleach and water to help kill HIV. Draw bleach into the syringe and needle then squirt it out. Do the same with water. Do both steps again.
Written by familydoctor.org editorial staff