HIV, or human immunodeficiency virus, is a blood-borne virus that, in its most severe phases, causes acquired immune deficiency syndrome, or AIDS—the clinical name of a syndrome that was first reported in the United States in 1981 and is now recognized as a great pandemic.
HIV/AIDS is one of the most dangerous health problems of modern times. Because of the complexity of this disease and the rapid development of new treatment strategies, treating HIV/AIDS should be carried on with the advice and care of an expert in this area. Preventing the spread of HIV infection, however, is straightforward and a responsibility that each person can and should undertake.
HIV attacks the body’s immune system and can eventually destroy it. A severely impaired immune system leaves the infected person increasingly unable to fight off invading pathogens, including bacteria and viruses, and thus susceptible to a whole host of “opportunistic” infections and diseases that are often debilitating and can eventually cause death. Worldwide, these infections are no longer as common nor as severe as in the early days of HIV/AIDS (though this varies across countries) because of more effective treatments to keep the immune system strong and to reduce HIV in the body. The infections include Kaposi’s sarcoma (a form of skin cancer), tuberculosis, pneumonia, and certain neurological disorders such as encephalitis.
A diagnosis of AIDS is based on whether the person has at least one opportunistic infection in the presence of HIV infection, or a decline in CD4 cells, typically called T-cells—white blood cells that are critical to defense against infection—below a given threshold level. Symptoms of HIV infection in adults may develop as early as 2 to 4 weeks after HIV exposure, or not appear for months or even years after the initial infection. In children, the time between exposure to HIV and the appearance of symptoms is typically measured in months if the infection goes untreated.
So far there is no cure. And there is currently no vaccine to prevent the disease, though there are ongoing clinical trials of vaccines, including one currently being tested by the NIH. Increasing numbers of HIV-infected people have benefitted from the development and availability of new medications that can prevent HIV from multiplying in the body, allowing the immune system to recover and thereby reducing the risk of developing symptoms. These treatments have also slowed the course of the disease for those who have developed AIDS, improving the quality of their lives and enabling them to live longer.
How prevalent is HIV infection?
The number of new HIV cases in the U.S. declined 19 percent from 2005 to 2014. And because of the use of HIV medicines and other strategies, fewer than 100 babies are born with HIV in the U.S. each year. Still, some 1.2 million people in the U.S. are living with HIV infection, of whom one in eight are unaware of being infected.
Nearly 13,000 people with AIDS die every year in the U.S. In recent years the death rate has decreased in the U.S., which is believed to be the result of many factors: success of drug therapies, better access to care, and increased testing efforts and financing for HIV/AIDS treatment. At the same time, certain groups—women, African Americans, and people age 45 and older—have seen their death rate from HIV/AIDS increase over the last three decades, according to the CDC.
Worldwide, almost 37 million people were living with HIV/AIDSat the end of 2015, approximately 2.1 million of whom became newly infected that year. HIV/AIDS is more prevalent in many developing countries, particularly in sub-Saharan Africa, which accounts for 70 percent of all new HIV infections.
Symptoms of HIV infection
- Symptoms vary depending on how HIV affects a person’s immune system. Milder clinical symptoms include the following:
- Persistent fatigue.
- Fever that can last a few days to a month or longer, with no other symptoms present.
- Night sweats.
- Unexplained weight loss.
- Swollen glands.
Once HIV destroys a sufficient amount of the body’s immune system, certain otherwise controllable infections, such as a specific type of pneumonia, or cancer, can then gain a foothold.
What causes HIV infection/AIDS?
The HIV virus is an infectious agent known as a retrovirus, which has the ability to take over certain cells and interrupt their normal genetic functioning. The virus can be cultured in a laboratory, and scientists have reliable tests to detect its presence in blood samples. The virus is hard to transmit. This is because HIV is inactivated very quickly once it is outside the body. Consequently, it is not transmitted through air or water, nor does it travel easily from person to person, as other infections may. It cannot penetrate intact human skin, and it cannot be spread by casual contact such as touching or hugging, sharing food or a drinking glass, using the same towel, or sharing bathrooms or toilets.
Rather, the virus is carried in bodily fluids such as blood, semen, vaginal fluids, and breast milk, and it can only be spread by the bodily exchange of these fluids with an infected person.
The most common path of HIV transmission is during sexual activity, when the virus in semen or cervical secretions enters cuts or small abrasions. The virus passes from one person to another during anal intercourse more efficiently than it can during vaginal intercourse, and it also passes—though rarely—during oral sex. The virus can also be spread via blood-contaminated hypodermic needles and syringes, and—if donated blood is contaminated—blood transfusions. In addition, an infected mother can pass the virus to her child in utero or during delivery. (Although the virus has been found in saliva and tears, scientists believe that transmission via these fluids is unlikely since the virus is present in very low concentrations.)
Most new HIV cases in the U.S. occur in men who have sex with men (representing 63 percent of all new HIV infections in 2010, according to the CDC). Of people infected with HIV through heterosexual sex, approximately two-thirds are women. For both men and women the risk increases with frequency of intercourse and especially with multiple partners.
What if you do nothing?
If you think you may have been exposed to HIV or you have developed symptoms that might be AIDS-related, one of the quandaries is whether to be tested. But there are clear benefits to diagnosing HIV infection early.
- Numerous drugs can slow the progress of HIV and reduce the likelihood of transmitting HIV to others. And drugs can also prevent, delay, or treat opportunistic diseases that strike people with AIDS. There are also better ways to monitor the progress of the disease.
- Testing is accurate.
- The confidentiality of the test results is easy to ensure. Not only are there clinics that offer anonymous testing, but accurate, anonymous home testing is available. Because of these benefits, anyone who might be at risk should know his or her HIV status. Yet as many as one in eight of all HIV-positive Americans do not know they are infected. At the very least, each of us should be familiar with—and know when to use—safer sex practices and other measures for preventing transmission of HIV.
Are there home remedies for HIV/AIDS?
There are no home remedies for HIV/AIDS. If you think you have HIV infection or AIDS, you should always consult a qualified health care practitioner, who can advise you and help provide medical treatments that may be able to offset or delay symptoms.
How to prevent HIV infection
Until a vaccine can be developed, halting the spread of HIV infection must depend solely on educating those at risk—which includes all sexually active people, particularly those who have not lived in strict, long-term monogamy. Though education may not be the ultimate weapon, it is an effective and powerful means of controlling the spread of the disease.
One common myth about AIDS is that it is solely a disease of male homosexuals and injection drug users; other people have nothing to worry about. It is true that the vast majority of reported AIDS cases in the United States continue to be in homosexual or bisexual men or injection drug users. But while these two main risk groups remain for the moment well defined, anybody who has unprotected sex—including oral sex—can get HIV. When it is transmitted heterosexually, women appear to be at greater risk than men, as noted above: The virus is far less likely to pass from a woman to man during vaginal intercourse than from man to woman.
The frequency of sexual contact appears to be more important than the form. Though a single contact can spread HIV, people who have multiple sexual partners are in much more danger than those with fewer partners. Prostitutes, both male and female, are more likely to be infected by HIV and to transmit it, since in addition to frequent exposure, many use injectable drugs.
Ultimately, it is not who you are, but what you do and with whom you do it, that puts you at risk for contracting HIV. The following are known to be high-risk practices:
- Sharing drug needles or syringes.
- Anal sex with someone who might carry HIV. The virus is passed easily during anal sex.
- Unprotected vaginal or oral sex (without a condom) with someone who might carry HIV. Obviously, the more times you have unprotected sex, the greater your risk. Sex with prostitutes is particularly risky. Many people believe they can’t get HIV from oral sex, but this is incorrect.
With that in mind, here are steps you should take to prevent HIV/AIDS.
- Choose your sexual partners carefully. Ask about the sexual history of a potential partner. Any person who has had multiple partners or has a sexual relationship with someone who has multiple partners may be at risk. Unless you and your sex partner are both sure you are not infected, you need to take precautions: use condoms, and avoid high-risk practices such as anal intercourse. Couples who have not been monogamous may wish to consider testing.
- Always use a latex condom. Used consistently and correctly, latex condoms provide a highly effective HIV preventive: the virus cannot penetrate an intact latex condom. (“Natural membrane,” or skin, condoms are not effective.) Adequate lubrication with a water-based lubricant (such as K-Y jelly) is important to prevent condom breakage. Unless you are certain that you and your sexual partner have not been exposed to HIV, using condoms must be habitual for any and all episodes of sexual intercourse.
- Don’t rely on spermicide. Spermicides alone are not effective for preventing HIV transmission. And, according to the CDC, the popular spermicide nonoxynol-9 can actually increase the risk of HIV transmission and should not be usedat all.
- Don’t inject recreational drugs. If you do, never share needles.
- Know that age isn’t a barrier against infection. In 2013, people at least 55 years old represented 26 percent of Americans with HIV. But though older people have the same HIV risk as younger folks, they may be less aware of the risk factors and more likely to be diagnosed with HIV later in the course of the disease, which means treatment is started later and the immune system may become more damaged.
- Take precautions if you’re a health care worker. Accidental self-puncture with an HIV-infected needle is a possible danger for doctors, nurses, dentists, physician’s assistants, and laboratory workers who give injections or handle blood—although there have been few confirmed cases of HIV infection among health-care workers since the 1990s.
- If you are infected with HIV, follow these same preventive measures. It is incumbent upon anyone who is infected to avoid exposing others to HIV. In addition, anyone who is HIV-positive and contemplating parenthood should be aware that there is a high risk of an infected mother transmitting the virus to a fetus or newborn (though early treatment with medications can help reduce the risk). Mother-to-child transmission is the most common way for a child to become infected with HIV.
When to call your doctor
You should call your doctor if you suspect you have been at risk for exposure to HIV, whether or not you have symptoms.
If you have been diagnosed with HIV/AIDS and are undergoing treatment, discuss with your doctor what criteria to use for monitoring and assessing your condition.
Should You Be Tested for HIV?
Learn who should seek counseling and testing for HIV and where to go to get tested.
What your doctor will do
Your doctor will examine you to determine the extent and possible cause of any symptoms, including taking a history to determine if you should be tested for HIV (or lab tested to confirm the results of a home test). The doctor will want to know when you think you were exposed to the virus, since there is a time lag, or “window,” during which a person can be infected with HIV but will test negative.
Testing is fairly simple. There are three types of tests:
Antibody tests. Most HIV tests require a sample of blood or oral fluid and are designed to detect antibodies that are produced by the immune system when exposed to the HIV virus. Blood tests can detect HIV slightly earlier after infection than those tests using oral fluid. It takes about 3 to 12 weeks after being infected with HIV for the body to make enough antibodies for the test to detect them. (This is referred to as the “window” period.) If your test is negative during that period, it’s recommended you get re-tested three months after you believe you were exposed to HIV. A rapid antibody test can have the results in no more than 30 minutes. If you use any type of antibody test and have a positive result, you will need to take a follow-up test to confirm your results.
Combination tests. Also called fourth-generation tests, these detect both HIV antibodies and antigens, foreign substances that activate the immune system (in this case part of the HIV virus that is present in the blood right after someone is infected but before antibodies have formed). Combination screening tests are quite commonly done now in the U.S., and are the lab tests recommended by the CDC. Because it can take 2 to 6 weeks to make a sufficient combination of antigens and antibodies for the test to detect HIV (the window period), if you get a negative result, you should be retested 3 months after you believe you were exposed to HIV.
Nucleic acid test (NAT). This test detects the genetic material of the HIV virus. This is an expensive blood test that’s not routinely done unless the person just had a high-risk exposure or was possibly exposed and has symptoms. It can take 7 to 28 days for a NAT test to detect HIV. If your result is negative, it’s best to get an antibody or combination test. That’s because in a few people the amount of virus in the blood may decline over time, producing a false negative result.
If testing confirms a diagnosis of HIV, your doctor will talk to you about treatment options, further testing to determine the extent of your infection, and methods to prevent opportunistic infections. If your doctor is not experienced in diagnosing and treating HIV/AIDS, he or she should refer you to an HIV/AIDS specialist. Efforts will also be made to treat existing symptoms, reduce the risk of infections, and maintain proper nutrition. Your doctor can also help you find an HIV/AIDS support network to provide emotional support and information.
For more information on HIV/AIDS, visit TheBody.com, a comprehensive online HIV/AIDS resource published by the same parent company as Berkeley Wellness.
Published March 27, 2017