HIV Infection

HIV is a virus that attacks the body’s immune system, but with today’s medicines, people with HIV can live long, healthy lives and protect their partners from infection.

Table of contents

• What is HIV?
• What is AIDS?
• Symptoms of HIV infection
• How HIV spreads
• Testing for HIV
• Preventing HIV infection
• Treatment of HIV
• Living with HIV

What is HIV?

HIV stands for human immunodeficiency virus. This is a virus that attacks and damages the body’s immune system, which is the system that normally protects you from infections and diseases^[1][2]. HIV works by infecting and destroying white blood cells called CD4 cells (also known as helper T cells), which are key parts of the immune system^[2][5].

HIV is a special type of virus called a retrovirus. Unlike normal human cells that have their instructions written as DNA, retroviruses have their instructions written on RNA. When HIV invades your cells, it changes its RNA to look like your cells’ DNA instructions and inserts them into your own DNA. Your cell then acts as though the virus’s instructions are its own^[5].

Once people get HIV, they have it for life. There is currently no cure that can completely remove HIV from the body^[1][2]. However, proper medical care can control the virus, and people with HIV who receive treatment can live long, healthy lives^[1].

What is AIDS?

AIDS stands for acquired immunodeficiency syndrome. It is the most advanced and serious stage of HIV infection^[1][3]. AIDS occurs when HIV has severely weakened the immune system, making it very difficult for the body to fight off infections and certain cancers^[2][4].

The difference between HIV and AIDS is that HIV is the virus itself, while AIDS is a condition that can happen as a result of HIV infection when the immune system becomes severely damaged^[5]. You cannot get AIDS if you are not infected with HIV. Not everyone with HIV develops AIDS, especially with proper treatment^[5]. Without treatment, HIV infections typically progress to AIDS in about 10 years^[5].

Thanks to effective treatments available today, most people being treated for HIV in developed countries do not develop AIDS^[8][15].

Symptoms of HIV infection

Most people infected with HIV do not know they have become infected right away because symptoms may not appear immediately^[4]. Within 2 to 4 weeks after infection, some people develop flu-like symptoms. This early stage is called acute HIV infection or primary infection^[1][3].

These early symptoms may include^[1][3]:

• Fever
• Headache
• Muscle aches and joint pain
• Rash
• Sore throat and painful mouth sores
• Swollen lymph glands, mainly on the neck
• Diarrhea
• Weight loss
• Cough
• Night sweats
• Extreme tiredness

These symptoms may last for a few days or several weeks^[1][3]. However, having these symptoms alone does not mean you have HIV, as other common illnesses can cause similar symptoms^[1]. Some people have no symptoms at all during this stage^[1].

After the initial symptoms, you may not have any other symptoms of HIV for years. During this time, the virus continues to slowly destroy the immune system, but many people do not know they have HIV^[8][15]. This is why testing is so important.

If HIV is not treated, it eventually damages the immune system enough to cause more serious illnesses. When HIV progresses to AIDS, symptoms can include rapid weight loss, extreme tiredness, mouth or genital ulcers, fevers, night sweats, and skin discolorations^[5]. People with AIDS are vulnerable to serious infections like tuberculosis, pneumonia, and certain cancers^[8][15].

How HIV spreads

HIV is spread through contact with certain body fluids from a person who has HIV. These fluids include blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk^[1][2]. For transmission to occur, these fluids must come in contact with a mucous membrane, damaged tissue, or be directly injected into the bloodstream^[1].

The most common ways HIV spreads are^[1][8][9]:

• Unprotected sexual intercourse (vaginal or anal) with someone who has HIV
• Sharing needles, syringes, or other drug injection equipment with someone who has HIV
• From mother to child during pregnancy, childbirth, or breastfeeding if the mother has untreated HIV

Oral sex with someone who has HIV poses a lower risk than vaginal or anal intercourse, but there is still some risk of transmission^[9]. HIV can also be transmitted by sharing sex toys with someone who has HIV^[8].

You cannot get HIV from kissing, hugging, shaking hands, or sharing toilet seats, food, drinks, or everyday household items like cups and cutlery^[8][15].

Factors like a person’s viral load (the amount of HIV in the blood), other sexually transmitted infections, and alcohol or drug use can increase the chances of getting or transmitting HIV^[1]. However, if someone with HIV is receiving effective treatment and has an undetectable viral load (an extremely low level of the virus in their blood), they cannot pass HIV to others through sex^[8][15].

Since 1985, donated blood has been tested for HIV in many countries, making the risk of getting HIV from a blood transfusion very low^[8].

Testing for HIV

The only way to know if you have HIV is to get tested^[1]. You cannot tell by looking at someone whether they have HIV or AIDS^[9]. Knowing your HIV status gives you important information to protect your health and the health of your partners^[1].

There are many options for quick, free, and painless HIV testing^[1]. Everyone between the ages of 13 and 64 should get tested for HIV at least once. People with certain risk factors should get tested more often^[1].

HIV tests can be done using blood or saliva samples^[11]. Different types of tests include^[11]:

• Antigen-antibody tests: These look for both parts of the HIV virus (antigens) and antibodies your immune system makes against HIV. They usually use blood from a vein and can detect HIV 2 to 6 weeks after exposure
• Antibody tests: These look for antibodies to HIV in blood or saliva. Most rapid HIV tests, including self-tests done at home, are antibody tests. They can detect HIV 3 to 12 weeks after exposure
• Nucleic acid tests (NATs): These look for the virus itself in the blood. They can detect HIV the earliest, within a few weeks of exposure

If your test result is positive, you can start medicine to treat HIV, which helps you live a long, healthy life and protects others^[1]. If your test result is negative, you can take actions to prevent HIV^[1].

Preventing HIV infection

Today, more tools than ever are available to prevent HIV transmission^[1]. Prevention strategies include^[1][8]:

• Using condoms correctly every time you have sex. Condoms are the most effective protection against HIV and other sexually transmitted infections. Use water-based lubricants instead of oil-based lubricants with condoms, as oil-based lubricants can cause condoms to break^[8]
• Never sharing needles, syringes, or other drug injection equipment. A doctor or drug counselor can advise you about needle exchange programs^[8]
• Taking PrEP (pre-exposure prophylaxis), which is medicine that people at high risk for HIV can take to prevent infection^[1]
• Taking PEP (post-exposure prophylaxis), which is emergency medicine that can prevent HIV if taken within 72 hours after possible exposure to the virus. It is available from sexual health clinics and emergency departments^[1][8]

If you have HIV, there are many ways to prevent transmitting it to others. The most important is taking HIV treatment as prescribed to achieve and maintain an undetectable viral load^[1]. When your viral load is undetectable, you will not transmit HIV to others through sex^[1].

For pregnant women with HIV, taking HIV medicines throughout pregnancy and childbirth greatly reduces the risk of transmission to the baby^[9].

Treatment of HIV

HIV treatment is called antiretroviral therapy or ART^[1][2]. ART involves taking a combination of HIV medicines prescribed by a healthcare provider^[1][10]. You should start HIV treatment as soon as possible after diagnosis^[1][12].

HIV treatment is recommended for everyone who has HIV^[2][10]. While ART cannot cure HIV, these medicines help people with HIV live long, healthy lives and reduce the risk of transmitting HIV to others^[2][10].

ART reduces the amount of HIV in the blood, called the viral load^[1][10]. HIV treatment can make the viral load so low that a test cannot detect it. This is called having an undetectable viral load^[1][10].

Having an undetectable viral load has important benefits^[1][10]:

• You will not transmit HIV to others through sex
• It reduces the risk of HIV transmission through sharing drug injection equipment
• It reduces the risk of HIV transmission during pregnancy, labor, and delivery
• It is the best way to stay healthy with HIV

Most people can get HIV under control within six months of starting treatment^[12]. There are two main types of HIV treatment available today: pills and shots^[12]. Pills are recommended for people just starting HIV treatment, and there are many single pill and combination medicines available^[12]. HIV treatment shots are long-acting injections given once a month or once every other month and may be suitable for some people who have already achieved an undetectable viral load^[12].

It is very important to take your medicines exactly as prescribed by your healthcare provider, at specific times of the day, with or without certain kinds of food^[12]. If you miss doses or do not follow a regular schedule, your treatment may not work, and the HIV virus may become resistant to the medicines^[16].

HIV medicines can sometimes cause side effects. If you experience side effects, talk to your healthcare provider or pharmacist. You may need to change how you take your medicine or switch to a different medicine^[12].

Living with HIV

With proper treatment and care, HIV is now considered a manageable chronic illness, like many other long-term health conditions^[7][18]. People with HIV who receive effective treatment can live long and healthy lives^[1][18].

To stay as healthy as possible with HIV, you should^[17][20][21]:

• Get medical care as soon as you find out you have HIV and find a healthcare provider with experience in treating HIV
• Take your medicines every day as prescribed
• Keep up with regular medical and dental care visits
• Stay up to date with recommended vaccinations and health screenings
• Eat healthy, balanced meals to give your body energy to fight infections and help your medicines work properly
• Get regular physical activity, which can strengthen your body and immune system and may reduce the risk of depression
• Get enough sleep, which is important for your physical strength and mental health
• Not smoke, as smoking increases the risk of certain cancers and infections in people with HIV
• Avoid heavy drinking and illegal drugs, which can damage your liver and make HIV medicines less effective
• Take care of your mental health by managing stress and seeking support from support groups, therapists, or social service organizations

You will need to see your healthcare provider regularly for blood tests to check your viral load, CD4 cell count, and how well your medicines are working^[22]. Other specialists such as nutritionists, case managers, or mental health specialists may also be part of your care team to help ensure you stay healthy and address your needs^[22].

Many people with HIV maintain close relationships with partners who do not have HIV. With modern treatments and preventive measures, couples can enjoy long and fulfilling lives together^[19]. If you have an undetectable viral load through effective treatment, you cannot pass HIV to your partner through sex^[19].

Living with HIV also means protecting yourself from other infections. This includes practicing good hand washing techniques, being careful about food safety, and taking medicines or vaccines to prevent certain infections that can be more serious for people with weakened immune systems^[17][22].

It is important to know that there are laws in some places that require you to share your HIV status with your sexual or drug injection partners, but sharing your status with anyone else is your personal choice^[18]. Your healthcare team and social service providers can help you navigate these conversations and connect you with resources and support^[18].