What is HIV?
HIV stands for human immunodeficiency virus, a virus that attacks immune cells in your body that normally fight off infection. If you have HIV, your body’s immune system is weakened and you’re more at risk for developing other infections and diseases.
People with HIV are at risk for getting opportunistic infections (which cause more serious disease in people with weakened immune systems), most commonly herpes simplex virus 1, salmonella, candidiasis (thrush), tuberculosis and toxoplasmosis.
It’s important to know that HIV is not the same as AIDS (acquired immunodeficiency syndrome). But if you don’t treat HIV, you may eventually develop AIDS, usually after around 10 years. People with AIDS have severely weakened immune systems and are more susceptible to life-threatening infections. But thanks to better treatments for HIV, AIDS is much less common now.
While in the past people with HIV didn’t have many treatment options, there are now medications available so that you can have a long, healthy life.
HIV has three stages and the symptoms vary depending on the stage. HIV symptoms can also vary from person to person, but these are some of the common ones.
Stage 1: Acute HIV Infection
This is the period of time right after being infected. It is also when the virus is most contagious because the amount of virus is high. Some people have no symptoms during this stage and may pass it to others before they know they have HIV. But around two-thirds of people will come down with what feels like the flu within 2–4 weeks of being infected with HIV. Symptoms can include:
Stage 2: Chronic HIV infection
Chronic HIV infection, also known as clinical latency or asymptomatic HIV infection, is the stage that you may remain at for your lifetime if you are taking the right medications. You may not feel sick or have any symptoms. But without medication, most people with chronic HIV infection will go on to the next phase, which is AIDS, in about 10 or more years.
Stage 3: AIDS
Without treatment, HIV will weaken your immune system to the point where you have AIDS. This is because the virus has destroyed almost all specialized infection-fighting cells called CD4 cells. The symptoms of AIDS include:
- Unintentional weight loss
- Regular fevers and extreme night sweats
- Swollen lymph nodes
- Long-term diarrhea
- Sores in the mouth and/or genital area
- Cough, often due to pneumonia
- Blotches on the skin
- Memory loss or depression
I also ask about symptoms of sexually transmitted infections (STIs) like vaginal or penile discharge, itchiness, rash, as well as urinary symptoms like pain, burning, or blood on urination and increased urinary frequency. Often, people who have certain STIs, especially gonorrhea, herpes, and syphilis, also have HIV. —Dr. Elizabeth Grand
What is the main cause of HIV?
The only way to get HIV is from being exposed to certain body fluids from someone who has detectable levels of the virus. Those fluids are blood, semen, rectal fluids, vaginal fluids, and breast milk. If any of these get into your own bloodstream, you can become infected.
You can’t get infected by simply touching someone with HIV, eating foods they cook, or sharing a water fountain. The fluids need to come in direct contact with an open wound or a mucous membrane (these are found in the rectum, vagina, mouth, or penis tip) or be injected into your body with a used needle.
That’s why the majority of HIV transmission happens through unprotected sex (anal or vaginal—there is very little risk with oral sex) or sharing needles with an infected person. A mother could pass HIV on to her child during pregnancy, birth, or breastfeeding, but it’s less likely now that there are medications to treat HIV.
How to get tested for HIV
Because symptoms can vary so much (and sometimes there may not be any), the only way to know for sure if you have HIV is to get tested. If you have shared a needle or had unprotected sex with someone who has HIV (or you have done either of those things with someone and aren’t sure of their status), it’s a good idea to get an HIV test.
There are a few different ways to get tested:
- Antigen/antibody test: These tests involve taking blood from a vein and sending it to a lab for testing. These can detect HIV only 18–45 days after you are exposed. The test is done in a doctor’s office or community health center. It will take a few days to get your results.
- Rapid antibody screening test: This is similar to the antigen/antibody test, but it uses a finger prick and the results are ready in about 30 minutes. They can detect HIV 23–90 days after exposure.
- Rapid self-test: You can find at-home rapid testing kits at drugstores or online. They use your saliva and can give you results within 20 minutes. While convenient to use, it can take longer for HIV to show up in your saliva than it does in your blood—so the test may not catch it if you were just recently exposed. You also need to do the test exactly as instructed or there is a risk of a false negative result (the test says you’re negative when you actually have HIV). The rate of false negative results for saliva tests is 1 in 12.
- Mail-in self-test: Prick your finger and use this kit to collect a small amount of blood, then mail it into a lab. It can be very accurate since medical professionals are doing the actual test. Some people like doing it this way as it can be more private than going to a doctor’s office or clinic.
If you take a test very soon after your exposure, there is a chance that you may get a false negative result. This is known as the “window period,” where the virus is present but has not reached high enough levels in the body to be detected by tests.
Different tests have different window periods, but for antibody tests the window period can last up to 90 days. If you had an HIV exposure within the past 3 months and test negative, the Centers for Disease Control and Prevention (CDC) recommends testing again in 3 months.
If you have a positive result, you should always follow it up with a second test to be certain. If you did a self-test, have your follow-up test done in a health care clinic or doctor’s office.
Don’t let fear of it not being private stop you from getting tested. You can take anonymous tests to be sure nothing connects your test result to you (you get a code to use to see your results). All HIV tests are considered confidential, meaning they are protected by privacy laws and can’t be shared without your permission.
Starting HIV treatment as soon as possible is particularly important for people who are in the acute infection phase of HIV, which is felt to be the most contagious phase, as well as women who are pregnant, to decrease the risk of transmitting HIV to their child. —Dr. Grand
Advancements in HIV treatment mean that the virus can be managed incredibly well with medication. The goal of HIV medicine, which is called antiretroviral therapy (ART), is to lower your viral load (the amount of the virus in your body). The drugs work by stopping HIV from multiplying.
The lower the amount of HIV, the less it harms your immune system cells and the lower your risk for developing AIDS. A low viral load also means that you’re less contagious. ART is so effective that it can lead to something called an undetectable viral load within 3–6 months.
There are a few ways to make sure the treatment works as well as it can:
- Start taking it as soon as possible after a positive test
- Take it as prescribed every day. If you skip a dose, the HIV in your body can quickly multiply. Repeatedly missing doses can also cause the virus to mutate (change) so much that it stops responding to ART.
ART is often a combination of different HIV medications. Some stop the virus from multiplying while others interfere with the virus’s ability to damage the immune system. Your doctor will look at any other drugs you’re taking, your existing health conditions, specific needs (like if you’re pregnant), and other factors to come up with the treatment plan that’s right for you.
While on the medication, you will have your CD4 and viral load checked regularly. CD4 is a type of immune T-cell found in your blood that shows how strong or weak your immune system is. You’ll be monitored every 3 to 4 months at first, then every 6 months if your viral load is undetected (not seen) for an extended period of time.
If your HIV leads to AIDS and you get other infections and medical issues because of your weakened immune system, you will have to take more medications.
The medications that may make up your ART are:
- Fusion inhibitors
- CCR5 antagonists
- Post-attachment inhibitors
You may experience side effects from some of the medications. Make sure to talk to your doctor if you aren’t happy with how you feel on your medication, since there are different kinds of drugs that can be tried instead. You should never stop your medication without first talking to your doctor, since additional tests may be needed to check your risk for certain side effects.
Side effects may include:
- Trouble sleeping
- Dry mouth
There are two drugs that can be taken to help stop you from getting HIV. One is PrEP (pre-exposure prophylaxis). It’s taken preventively to protect people who are at high risk of getting HIV, such as those who routinely have unprotected sex, share needles, or have regular sexual intercourse with a partner who is HIV-positive.
For people who cannot afford their HIV medication, there are programs that will either completely cover the cost or decrease the cost to make it more affordable. These programs are known as Patient Assistance Programs. Most pharmaceutical companies that make HIV medications offer them to low-income individuals or people who do not have health insurance. Talk to your doctor about getting connected to one of these programs. —Dr. Grand
The other is called PEP (post-exposure prophylaxis) and is taken when you believe you’ve been exposed to HIV within the last 3 days. It can prevent the virus from staying in your body.
If you have HIV, one of the key ways to avoid transmitting HIV to anyone else is to take your ART medications exactly as prescribed. Once your viral load is undetectable, it’s impossible to transmit HIV to others—even through unprotected sex or sharing needles, according to the CDC.
If your viral load is still detectable, the only way to keep others safe is to practice safe sex by using condoms and avoid other risky behaviors like sharing needles.
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