Everything You Need to Know About HIV/AIDS


What is HIV?

HIV is a virus that enters your body and begins to destroy T cells. You need T cells in order to fight infections. HIV spreads through bodily fluids that include:

  • blood
  • semen
  • vaginal and rectal fluids
  • breast milk

The first few weeks after infection is called the acute infection stage. During this time the virus rapidly reproduces. Your immune system responds by producing HIV antibodies. Many people experience temporary flu-like symptoms during this stage. Even without symptoms, HIV is highly contagious during this time.

After the first month or so, HIV enters the clinical latency stage. This stage can last from a few years to a few decades. Progression can be slowed with antiretroviral therapy. Some people have symptoms. Many people do not, but it’s still contagious. As the virus progresses, you’re left with fewer T cells. This makes you more susceptible to disease, infection, and infection-related cancers. HIV is a lifetime condition with no cure. Medical care, including antiretroviral therapy, can help manage HIV and prevent AIDS.

Without treatment, HIV is likely to advance to AIDS. At that point, the immune system is too weak to fight off life-threatening disease and infection. Untreated, life expectancy with AIDS is about three years.

It is estimated that 1.1 million Americans are currently living with HIV. And one in five don’t know it.

symptoms of HIV?

Some people infected with HIV are asymptomatic at first. Most people experience symptoms in the first month or two after becoming infected. That’s because your immune system is reacting to the virus as it rapidly reproduces.

This early stage is called acute stage. Symptoms are similar to those of the flu and may last anywhere from a few days to several weeks. These include:

  • fever
  • swollen lymph glands
  • general aches and pains

During the first few months of infection, an HIV test may provide a false-negative result. This is because it takes time for the immune system to build up enough antibodies to be detected in a blood test. But the virus is active and highly contagious during this time.

The clinical latent infection, or chronic stage of HIV, can last from a few years to a few decades. During this time the virus is still reproducing, but at lower levels. Some people have few, if any, symptoms. Others may have many symptoms. Without antiretroviral therapy, you’re likely to pass through this phase faster.

As the disease progresses, other symptoms may include:

  • swollen lymph nodes
  • recurrent fevers
  • fatigue
  • aches and pains
  • nausea, vomiting
  • diarrhea
  • weight loss
  • skin rashes
  • oral yeast infections or other infections
  • shingles

Symptoms may come and go or progress rapidly. Even if you have no symptoms, you can still transmit the virus to others.

With the use of antiretroviral therapy, chronic HIV can last several decades. Without treatment, HIV can be expected to progress to AIDS sooner. By that time, the immune system is quite damaged and has a hard time fighting off infection and disease.

Symptoms of AIDS can include:

  • recurrent fever
  • chronic swollen lymph glands, especially of the armpits, neck, and groin
  • chronic fatigue
  • night sweats
  • dark splotches under the skin or inside the mouth, nose, or eyelids
  • sores, spots, or lesions of the mouth and tongue, genitals, or anus
  • bumps, lesions, or rashes of the skin
  • recurrent or chronic diarrhea
  • rapid weight loss
  • neurologic problems such as difficulty concentrating, memory loss, and confusion
  • anxiety and depression

Because you have a weakened immune system, you’re at increased risk of pneumonia and other opportunistic infections. Other potential complications of AIDS include:

  • candidiasis
  • tuberculosis
  • cytomegalovirus (CMV), a type of herpes virus
  • cryptococcal meningitis
  • toxoplasmosis, and infection caused by a parasite
  • cryptosporidiosis, an infection caused by an intestinal parasite
  • cancer, including Kaposi’s sarcoma (KS)and lymphoma
  • kidney disease

Antiviral medications can help control the virus. Treatment for other infections and complications of AIDS must be tailored to your individual needs.

What tests are used to diagnose HIV?

Antibody test

Between 21 and 84 days after infection, about 97 percent of people will develop detectable HIV antibodies, which can be found in the blood or saliva.

There’s no preparation necessary for blood tests or mouth swabs. Some tests provide results in 30 minutes or less and can be performed in a doctor’s office or clinic. There are also home test kits available:

  • OraQuick HIV Test: An oral swab provides results in as little as 20 minutes.
  • Home Access HIV-1 Test System: After pricking your finger, you send a blood sample to a licensed laboratory. You can remain anonymous and call for results the next business day.

If you think you’ve recently been exposed to HIV, but tested negative, repeat the test in three months. If you have a positive result, follow up with your doctor to confirm.

Antibody/antigen test

An antigen is part of the virus that activates your immune system. It takes from 13 to 42 days for antibodies and antigens to be detectable.

Nucleic acid test (NAT)

This expensive test isn’t used for general screening. It’s for people who have early symptoms of HIV or recently had a high-risk exposure. This test doesn’t look for antibodies, but for the virus itself. It takes from seven to 28 days for HIV to be detectable in the blood. This test is usually accompanied by an antibody test.

Is rash a symptom of HIV?

About 90 percent of people with HIV experience changes to the skin. Rash is often one of the first symptoms of HIV infection. Generally, an HIV rash appears as a flat red area with small bumps.

HIV makes you more susceptible to skin problems because the virus destroys immune system cells that fight infection. Co-infections that can cause rash include:

  • molluscum contagiosum
  • herpes simplex
  • shingles

The appearance of the rash, how long it lasts, and how it can be treated depend on the cause.

Some medicines used to treat HIV or other infections can cause a rash. It usually appears within a week or two of starting on a new medication. Sometimes the rash will clear up on its own. If it doesn’t, you may need to switch medicines. Rash due to an allergic reaction to medicine can be serious. Other symptoms of an allergic reaction include trouble breathing or swallowing, dizziness, and fever. Stevens-Johnson syndrome (SJS) is a rare allergic reaction to HIV medication. Symptoms include fever and swelling of the face and tongue. Rash, which can involve the skin and mucous membranes, appears and spreads quickly. When 30 percent of the skin is affected it’s called toxic epidermal necrolysis, which is a life-threatening condition.

HIV symptoms in men: Is there a difference?

Symptoms of HIV vary from person to person, but they’re similar in men and women. During the first two to four weeks, the virus reproduces at a very high rate.

You may experience flu-like symptoms such as:

  • fever
  • chills
  • swollen lymph glands

Symptoms can be mild to severe and usually resolve within a few weeks. Following the acute stage of infection, it’s not uncommon to be symptom-free for a long time.

As the infection progresses, other symptoms may include:

  • headaches and other aches and pains
  • night sweats
  • fatigue
  • skin rashes
  • oral infections
  • pneumonia
  • nausea
  • vomiting
  • persistent diarrhea
  • weight loss

These symptoms can come and go or get progressively worse. If you’ve been exposed to HIV, you may also have been exposed to other sexually transmitted diseases (STDs). Men are more likely than women to notice symptoms like sores on their genitals. But men typically don’t seek medical care as often as women.

Without treatment, HIV can advance to AIDS. At that stage, the immune system is so weakened that it cannot fight off infections and disease.

What is AIDS?

AIDS is a disease caused by HIV. It’s the most advanced stage of HIV. But just because you have HIV doesn’t mean you’ll develop AIDS. HIV destroys T cells called CD4 cells. These cells help your immune system fight infections. Healthy adults generally have a CD4 count of 800 to 1,000 per cubic millimeter. If you have HIV and your CD4 count falls below 200 per cubic millimeter, you will be diagnosed with AIDS. You can also be diagnosed with AIDS if you have HIV and develop an opportunistic infection that is rare in people who don’t have HIV.

AIDS weakens your immune system to the point where it can no longer fight off most diseases and infections. That makes you vulnerable to a wide range of illnesses, including:

  • pneumonia
  • tuberculosis
  • candidiasis
  • cytomegalovirus, a type of herpes virus
  • cryptococcal meningitis
  • toxoplasmosis, an infection causes by a parasite
  • cryptosporidiosis, an infection caused by an intestinal parasite
  • cancer, including Kaposi’s sarcoma (KS)and lymphoma
  • kidney disease

Untreated, HIV can progress to AIDS within a decade. Treatment with antiretroviral drugs can prevent AIDS from developing for far longer. There is no cure for AIDS. Without treatment, life expectancy after an AIDS diagnosis is about three years. This may be reduced if you develop a severe opportunistic illness.

HIV symptoms in women: Is there a difference?

For the most part, symptoms of HIV are about the same in men and women. The virus reproduces rapidly in the first two to four weeks.

Temporary flu-like symptoms in this acute stage may include:

  • fever
  • chills
  • swollen lymph glands
  • As the infection progresses, other symptoms may include:
  • headaches and other aches and pains
  • night sweats
  • fatigue
  • skin rashes
  • oral infections
  • pneumonia
  • nausea, vomiting
  • persistent diarrhea
  • weight loss
  • In addition, women with HIV are at increased risk of:
  • vaginal yeast infections and other vaginal infections, including bacterial vaginosis
  • sexually transmitted diseases (STDs) such as gonorrhea, chlamydia, and trichomoniasis
  • pelvic inflammatory disease (PID)
  • infection of the reproductive organs and menstrual cycle changes
  • human papillomavirus (HPV), which can cause genital warts and lead to cervical cancer

Another gender difference is that women are less likely than men to notice small spots or other changes to their genitals.

HIV can be transmitted to your baby during pregnancy. The virus can also be passed to your baby through breast milk. If your doctor knows you have HIV, treatment can lower the risk of passing the virus on to your child to less than 2 percent.

HIV and AIDS Connection?

To develop AIDS, you have to have been infected with HIV. But having HIV doesn’t necessarily mean you’ll develop AIDS. HIV is passed from person to person through bodily fluids such as blood and semen. Once the virus enters your body, it attacks your immune system by destroying CD4 cells, which help keep you from getting sick.

There are three stages of HIV infection:

  1. acute stage, the first few weeks after infection
  2. clinical latency, or chronic stage
  3. AIDS, the last stage

As HIV lowers your CD4 cell count your immune system weakens. A normal adult CD4 count is 800 to 1,000 per cubic millimeter. A count below 200 is considered AIDS.

How quickly HIV progresses through the chronic stage varies significantly from person to person. Without treatment, it can last up to a decade before advancing to AIDS. With treatment, it can last indefinitely. There is no cure for HIV, but it can be controlled. People with HIV often have a near-normal lifespan with early intervention with antiretroviral therapy. There’s no cure for AIDS, but individual infections and diseases are often treatable.

Treatment options for HIV

Treatment should begin as soon as possible after a diagnosis of HIV.

The main treatment for HIV is antiretroviral therapy (ART), a combination of daily medications that stop the virus from reproducing. This helps protect your CD4 cells, keeping your immune system strong enough to fight off disease.

ART helps keep HIV from progressing to AIDS. It also helps reduce the risk of transmission. There are more than 25 medications in six drug classes approved to treat HIV. The U.S. Department of Health and Human Services (HHS) recommends a starting regimen of three HIV medicines from at least two drug classes.

Your doctor will help you choose a regimen based on your overall health and personal circumstances. These medications must be taken consistently and exactly as prescribed. Failure to adhere to therapy guidelines can jeopardize your health. Side effects vary and may include headache and dizziness. Serious side effects include swelling of the mouth and tongue and liver damage. Some people eventually develop drug-resistant strains of HIV. If you have serious side effects, your medications can be adjusted.

Your doctor may also recommend vaccinations for the following conditions:

  • hepatitis B
  • influenza
  • pneumonia

Treatment for individual symptoms can be addressed as they arise. To strengthen your overall health, maintain a healthy diet, exercise regularly, and get enough sleep.

vaccine for HIV?

Currently, there are no vaccines to prevent or treat HIV. Research and testing on experimental vaccines are ongoing. But none are close to being approved for general use.

HIV is a complicated virus. It mutates rapidly and is adept at evading immune system responses. Only a small number of people infected with HIV develop broadly neutralizing antibodies, the kind of antibodies that can fight a range of strains. The first HIV vaccine efficacy study in seven years is currently underway in South Africa. The experimental vaccine is an updated version of one used in a 2009 trial that took place in Thailand. A 3.5-year follow up after vaccination showed the vaccine was 31.2 percent effective in preventing HIV infection. It’s the most successful HIV vaccine trial to date. The new study involves 5,400 men and women from South Africa. In South Africa more than 1,000 people are infected with HIV every year. The results of the study are expected in 2020.

While there’s still no vaccine to prevent HIV, people with HIV can benefit from other vaccines to prevent HIV-related illnesses that include:

  • pneumonia
  • Influenza
  • hepatitis B

Early symptoms of HIV

As soon as you’re infected with HIV, your immune system starts to react to the rapidly multiplying virus. This is known as the acute stage. Some people have only very mild symptoms or none at all.

Others have symptoms that include:

  • fever
  • sore throat
  • swollen lymph glands
  • headache
  • general aches and pains
  • upset stomach
  • skin rash

Symptoms may come and go or last for weeks. Because these symptoms are similar to common illnesses like the flu, you might not see a doctor. Even if your doctor suspects the flu or mononucleosis, HIV may not be considered.

With or without symptoms, your viral load is likely very high during this period. It can be easily passed to someone else during unprotected sex. Initial symptoms usually resolve within a few months as you enter the chronic, or clinical latent stage of HIV. This stage can last many years or even decades with treatment. Even if caught early, HIV cannot be cured. However, early treatment with antiretroviral medication can keep your immune system healthy longer, prevent AIDS, and make transmission less likely.

HIV transmission

HIV does not play favorites. Anyone can become infected. The virus is transmitted in bodily fluids that include:

  • blood
  • semen
  • vaginal and rectal fluids
  • breast milk
  • Some of the ways HIV is spread from person to person include:
  • having unprotected sex with an infected person. This is the most common route of transmission
  • sharing needles, syringes, and other items for injection drug use with an infected person
  • passing it on to an unborn child if the mother is HIV-positive
  • passing it on to a baby through breast milk if the mother is HIV-positive
  • being exposed to infected fluids, usually through needle sticks.

Having a blood transfusion or organ and tissue transplant can also transmit the virus. But rigorous testing for HIV in blood ensures that this is very rare in the United States.

It’s theoretically possible, but considered extremely rare, for HIV to spread via:

  • oral sex
  • being bitten by an infected person
  • contact between broken skin, wounds, or mucous membranes and HIV-infected blood or fluids
  • HIV does NOT spread through:
  • skin-to-skin contact
  • hugging, shaking hands, or kissing
  • air or water
  • eating or drinking items, including drinking fountains
  • saliva, tears, or sweat (unless mixed with blood from an infected person)
  • sharing a toilet, towels, or bedding
  • mosquitoes or other insects

HIV medications

There are at least 25 medications approved to treat HIV. They work to prevent HIV from reproducing and destroying CD4 cells, which help your immune system fight infection. This also helps reduce the risk of transmitting the virus.

These antiretroviral medications are grouped into six classes:

  • non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • nucleoside reverse transcriptase inhibitors (NRTIs)
  • protease inhibitors
  • fusion inhibitors
  • CCR5 antagonists, also known as entry inhibitors
  • integrase strand transfer inhibitors

Treatment should begin as quickly as possible and usually starts with a regimen of three drugs from at least two classes. Your health will help determine your best options.

Antiretroviral medications must be taken exactly as prescribed to be effective. Some are available in combination pills so they’re easier to take. Side effects differ from person to person. The most common are dizziness and headache. Serious side effects may include swelling of the mouth and tongue and liver damage. Drug interactions and drug resistance are also possible. Blood testing will help determine if the regimen is working to keep your viral count down and your CD4 count up. Costs vary according to where you live and type of insurance coverage. Some pharmaceutical companies have assistance programs to lower the cost. Average wholesale prices of commonly used antiretroviral drugs range from $54 to $4,097 a month.

Living with HIV

More than one million people in the United States are living with HIV. It’s different for everybody, but many enjoy a good quality of life and can expect a longer lifespan than those diagnosed before today’s treatments were available. The most important thing you can do is start antiretroviral treatment as soon as possible. And it’s important to follow up with your doctor regularly. By taking your medications exactly as prescribed, you can keep your viral count low and your immune system strong.

Fuel your body with a well-balanced diet. Get regular exercise and plenty of rest. And report any new symptoms to your doctor right away.

Make your health your top priority — and that includes your emotional health. You could see a licensed therapist who is experienced in treating people with HIV. Your doctor can steer you toward a variety of resources in your area. You can also join an HIV support group so you can meet with others who deal with the same concerns you have.

Talk to your sexual partner(s). Get tested for other sexually transmitted diseases (STDs), and use protection every time you have sex. Talk to your doctor about pre-exposure prophylaxis (PrEP). When used consistently, this daily medication can lower the chances of transmission.

Causes of AIDS

AIDS is caused by HIV. You can’t get AIDS if you haven’t been infected with HIV.

HIV may be the human version of simian immunodeficiency virus (SIV), known to infect African chimpanzees. It may have crossed over and mutated in humans who ate infected chimpanzee meat as long ago as the late 1800s.Slowly, the virus spread across Africa and to other continents. It is thought that HIV has existed in the United States since the 1970s. HIV spreads from person to person through bodily fluids such as blood and semen. It then attacks CD4 cells, which help your immune system fight off disease and infection. Healthy individuals have a CD4 count of 800 to 1,000 per cubic millimeter. Without treatment, the virus continues to multiply and destroy CD4 cells. If your CD4 count falls below 200, you have AIDS.

If you have HIV and have developed an opportunistic infection associated with HIV, you can still be diagnosed with AIDS, even if your CD4 count is above 200. AIDS means your immune system is profoundly compromised, making you vulnerable to life-threatening diseases.

Causes of HIV

HIV is a variation of a virus that infects African chimpanzees.

Scientists suspect the simian immunodeficiency virus (SIV) jumped from chimps to humans when people consumed infected chimpanzee meat. Once inside the human population, the virus mutated into what we now know as HIV. HIV spread from person to person throughout Africa over the course of several decades. Eventually, the virus migrated to other parts of the world. Scientists first discovered HIV in a human blood sample in 1959.

HIV has been in the United States since the 1970s. It didn’t start to hit public consciousness until the 1980s.

HIV spreads from person to person in bodily fluids such as blood, semen, and breast milk when you:

  • have unprotected sex with an infected person
  • share needles and other items for injection drug use with an infected person
  • pass it to your infant during labor or through breastfeeding

Healthcare workers can acquire the virus if exposed to infected fluids, usually in a needle stick. HIV can also be transmitted through blood transfusions or organ and tissue transplants. But this is rare in the United States due to strict testing. The virus doesn’t spread in air, water, or through casual contact.

HIV prevention

There’s no vaccine to prevent HIV infection.

Unprotected sex is the most common way for HIV to spread. You can’t completely eliminate this risk unless you abstain from sex, but you can lower risk considerably by taking a few precautions:

  • Get tested for HIV to learn your status and your partner’s.
  • Get tested for other sexually transmitted diseases (STDs). If you have one, get treated, because having an STD increases the risk of HIV.
  • Learn the correct way to use condoms, and use them every time you have sex, whether it’s vaginal, anal, or oral. Keep in mind that pre-seminal fluids can contain the virus.
  • Limit your sexual partners. Have only one sexual partner who only has sex with you.
  • If you have HIV, lower the risk of transmitting it to your sexual partner by taking your medicines as directed. Although this will lower your viral load, you still need to use condoms.

HIV is also transmitted through blood. Never share needles or other drug paraphernalia.

If you’re at a high risk of HIV, talk to your doctor about pre-exposure prophylaxis (PrEP). PrEP is a combination of two drugs available in pill form. If you take it consistently, you can lower your risk of contracting HIV.

HIV statistics

In 2015, about 36.7 million people worldwide were living with HIV. Only about 46 percent had access to antiretroviral therapy. Of the 2.1 million newly infected people, 150,000 were under age 15.

Since the pandemic began, 78 million people have contracted HIV, and AIDS has claimed 35 million lives. In 2015, 1.1 million people died from AIDS-related diseases. East and southern Africa are hardest hit. In 2015, 19 million people were living with HIV, and 960,000 more became infected. The region has 46 percent of new HIV infections worldwide. Every 9.5 minutes, someone in the United States becomes infected. That’s more than 56,000 new cases a year. It is estimated that 1.1 million Americans are currently living with HIV. And 1 in 5 are unaware they are infected. About 180,000 American women are living with HIV. In the United States, almost half of all new cases occur in African-Americans. About 97 percent of people develop detectable HIV antibodies 21 to 84 days after infection.

Untreated, a woman with HIV has a 25 percent chance of passing HIV to her baby during pregnancy or breastfeeding. With antiretroviral therapy and without breastfeeding, it’s less than 2 percent. In the 1990s, a 20-year-old person infected with HIV had a life expectancy of 19 years. By 2011, it had improved to 53 years.

What’s the HIV window period?

As soon as you’re infected with HIV, it starts to reproduce in your body. Your immune system reacts to the antigens by producing antibodies. The time between exposure to HIV and when it becomes detectable in your blood is called the HIV window period.

If you take an HIV test during the window period, it’s likely you’ll receive a negative result. But you can still transmit the virus to others. If you think you may have been exposed to HIV, but tested negative during this time, you should repeat the test in three months to confirm. About 97 percent of people develop detectable HIV antibodies within 21 to 84 days after infection. Some may take longer. A nucleic acid test can detect the virus in the blood as early as seven to 28 days after infection. This test is expensive and rarely given unless you’re at particularly high risk or already have symptoms of HIV.

If you’ve been exposed to HIV, but test negative during the window, you might benefit from pre-exposure prophylaxis (PrEP). A combination of HIV-approved drugs, PrEP can lower the risk of contracting or spreading HIV when taken consistently.

HIV life expectancy: Know the facts

In the 1990s, a 20-year-old person with HIV had a 19-year life expectancy. By 2011, a 20-year-old person with HIV could expect to live another 53 years. It’s a dramatic improvement, due in large part to antiretroviral therapy. With proper treatment, many people with HIV can expect a normal or near normal lifespan.

Of course, many things affect life expectancy when you have HIV. Among them are:

  • CD4 cell count
  • viral load
  • serious HIV-related illnesses, including hepatitis infection
  • injection drug use
  • smoking
  • access and adherence to treatment
  • other health conditions
  • age

Where you live matters. People in the United States and other developed countries are more likely to have access to antiretroviral therapy. Consistent use of these drugs helps prevent HIV from progressing to AIDS. Worldwide, there are approximately 36.7 million people living with HIV. Only about 46 percent have access to antiretroviral therapy. When HIV advances to AIDS, life expectancy without treatment is about three years.

An individual’s outlook depends on a variety of factors, such as:

  • development of opportunistic disease and infection
  • treatment options
  • response to treatment
  • adherence to therapy

Life expectancy statistics are just general guidelines. Consult your doctor to learn more about what you can expect.

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