HIV

Last Updated March 2021 | This article was created by familydoctor.org editorial staff and reviewed by Deepak S. Patel, MD, FAAFP, FACSM

What is HIV?

The human immunodeficiency virus (HIV) attacks the body’s immune system. A healthy immune system is what keeps you from getting sick.

When HIV damages your immune system, you are more likely to get sick from bacteria, fungi, 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.

AIDS (acquired immunodeficiency syndrome) is the term used when persons have advanced HIV disease. This increases your risk for infections and other serious HIV-associated conditions. With treatment, most Americans who have HIV are unlikely to develop AIDS.

Symptoms of HIV

When first infected with HIV, you may not experience any symptoms. More often, though, you’ll have flu-like symptoms, including:

  • Fever
  • Headache
  • Fatigue
  • Swollen lymph nodes (lymph glands)
  • Sore throat
  • Rash

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:

  • Swollen lymph nodes (lymph glands)
  • Diarrhea
  • Fever
  • Cough
  • Shortness of breath
  • Unintended weight loss

What causes HIV?

HIV can only be passed from person to person through infectious body fluids, such as blood, semen, and vaginal fluid.

Children born to mothers with HIV can also acquire HIV during pregnancy, delivery, and breastfeeding. However, this happens less often now. It can be prevented by giving medicines to the pregnant mother and to her newborn baby.

The most common ways HIV is passed are:

  • By having unprotected (without using a condom) anal, vaginal, or oral sex with a person who has HIV
  • By sharing drug-use equipment (needles or syringes) for injecting drugs with a person who has HIV

You are more at risk for HIV if you:

  • Have multiple sex partners
  • Have sex with a person who trades sex for money or other items
  • Share needles using illegal injected drugs
  • Exchange sex for drugs or money
  • Have a sexually transmitted infection
  • Currently have or did have a sexual partner with any of the above risk factors
  • Are a man who has sex with other men

How is HIV diagnosed?

If you think you may have 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 have 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 American Academy of Family Physicians (AAFP) encourages all sexually active people between 15 years and 65 years of age to get tested. Younger adolescents and older adults who are at increased risk should also be tested. The AAFP 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 acquired HIV. It takes this long for the antibodies to show up in the blood. Newer tests are available that may be able to detect HIV sooner (after 1-2 months), so check with your doctor.

Does it help me to find out I have HIV at an early stage?

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 antiretroviral 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.

Are there HIV tests I can do at home?

Yes. Home-based HIV testing kits are available. These are used to collect a blood sample that is then mailed overnight to a laboratory for testing. You get results the next day. These tests offer the advantage of privacy and anonymity. There are also at-home tests that involve swabbing the inside of your mouth. You do not have to collect your blood. Your results are ready within 20 minutes.

Should I use the home test or see my doctor?

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.  Your doctor can also determine if you should be tested for other infections.

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 prevent infection.

Can HIV be prevented or avoided?

The best way to prevent HIV is to not have sex (vaginal, anal, or oral) with a person who has HIV, or share a needle with a person who has HIV.

Other ways to prevent HIV include:

  • When you have sex, practice “safer” sex by using a condom. The best condom is a male latex condom. A female condom is not as effective but does offer some protection.
  • Do not share needles and syringes.
  • Never let someone else’s blood, semen, urine, vaginal fluid, or feces get into your anus, vagina, or mouth.

HIV treatment

Even though there is no cure for HIV, there are many medicines available to help combat it. These medicines (called antiretroviral therapy or ART) will often prevent HIV from progressing to AIDS. Even when HIV does progress to AIDS, antiretroviral therapy is often still effective. However, it is most effective the earlier you begin treatment.

Better ART 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 (without using a condom) 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.

With treatment, the survival rate for HIV is very good. In the United States, people with HIV who are diagnosed early can have a life span that is about the same as someone like them who does not HIV, according to HIV.gov.

Living with HIV

If you are living with HIV, 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 other infections or diseases that are more common in people who have HIV.

It is also important to see your doctor regularly so that he or she can monitor your treatment. Your doctor will probably want to see you every 6 months as long as your CD4 cell count is good. If it drops below 500, your doctor may want to see you every 3 months. Your doctor also may want to see you more often if you are trying a new medicine to see how you’re responding to it. It is important to make sure your HIV infection is not getting worse.

Some of the things that might tell your doctor that your HIV infection has gotten worse since your last visit are:

  • New symptoms of nausea, vomiting, fatigue, fever, headache, chills, night sweats, cough, shortness of breath or diarrhea
  • Signs of weight loss, mouth sores (ulcers), thrush (a yeast infection of the mouth and tongue), or bigger lymph nodes (glands located in your neck, armpits and hip area)
  • A drop in the CD4 cell count in your blood
  • A rise in the viral load in your blood

You should also proactively try to prevent other infections and complications. HIV can increase your risk for other diseases and conditions because it weakens your immune system. Here are some things you can do to help protect yourself.

  • A flu shot every fall helps prevent the flu.
  • A periodic pneumonia shot can prevent pneumonia caused by the bacteria called Streptococcus pneumoniae. It’s easier for people who have HIV to get this kind of pneumonia. Your doctor will review your immunization history to determine when you need to get these shots.
  • A tuberculosis (TB) skin test every year can tell if you have TB. TB is a very serious illness, especially in people who have HIV.
  • A Pap test for women checks for dysplasia (a pre-cancer condition) and for cancer of the cervix. Both of these conditions occur more often in women who have HIV infection. At first, Pap tests are done every 6 months. After 2 Pap tests in a row are normal, you might only have to get them once a year.

All persons with HIV should also be tested for, and immunized against, hepatitis B.

Questions to ask your doctor

  • Is there any sure way to avoid acquiring HIV?
  • What is the best treatment for me?
  • How can I avoid getting any infections that will make me very sick?
  • How can I find support groups in my community?
  • What diagnostic tests will you run?
  • How often will I need to see my doctor?
  • Will there be any side effects to my treatment?
  • How does this affect my plans for having a family?
  • Is it safe for me to breastfeed my baby?
  • Will using a condom keep my sex partners from acquiring HIV?
  • Should I follow a special diet?