Introduction

The human immunodeficiency virus (HIV) infection is a viral infection that gradually destroys the immune system and progresses to acquired immune deficiency syndrome (AIDS).  HIV is primarily spread from an infected person to another during sexual activity, needle sharing, or transmission between a mother and baby during or after pregnancy.
For the vast majority of people, HIV results in AIDS if left untreated.  AIDS is the final stage of HIV and results in death.  There is no cure for HIV or AIDS.  There are medications that can help people live longer and with a better quality of life than ever before.  You can help stop the spread of HIV by abstaining from sex. If you are sexually active, getting tested regularly and taking precautions to prevent getting infected with HIV can help prevent the spread of HIV to others.

Anatomy

The white blood cells and antibodies in your body fight and destroy infections.  CD4 lymphocytes are the cell’s responsible for your body’s immune response.  CD4 cells are also called T-cells or helper cells.  HIV targets the CD4 lymphocytes.  HIV enters the CD4 cells, inserts its own genetic material, and replicates itself.  The new HIV cells enter the blood stream, target more CD4 cells, and the replication process repeats itself, while at the same time lowering the number of CD4 cells.  As the number of CD4 cells decrease, the body becomes more vulnerable to and less capable of fighting infections.  An HIV infection advances to the definition of AIDS when the CD4 blood count drops to 200 or less or certain infections develop because the immune system is not functioning properly.

Causes

HIV is a viral infection that is transmitted from an infected person to another person.  HIV is transmitted in several ways, including transmission by sexual activity, needle sharing, accidental needle sticks by healthcare workers, and transmission between a mother and baby during or after pregnancy.  In rare cases, HIV may be transmitted by infected blood products, organ or tissue transplant, or unsterilized dental or surgical equipment.

HIV can be contracted during vaginal, anal, or oral sex or from the shared use of sexual devices, “sex toys”.  HIV infection can spread during male and female, male and male, or female and female sexual activity.  HIV can be transmitted by contact with semen, pre-seminal fluid, vaginal secretions, or the blood of an infected person.  HIV may enter the body in small tears in the vagina or rectum during sexual activity or through sores in the mouth.  People with STDs that cause sores have a higher risk of getting HIV.  The spermicide nonoxynol-9 that is used in gels or on some types of condoms can actually irritate the vagina and cause tears that allow HIV to enter the body.

Shared needles during intravenous (IV) drug use can transmit HIV.  Using the same needle that a person with HIV used substantially increases your risk of contracting HIV.  Although healthcare workers use precautions when handling needles, they may be exposed to HIV from accidental needle sticks on the job.

Blood donations before 1985 were not screened for HIV and some people contracted HIV from receiving donated blood.  After 1985, all blood donations in the United States are tested for HIV to ensure that HIV infected donations are not received by anyone.

A mother with HIV may pass the infection to her developing baby during pregnancy because of the shared blood supply.  HIV may be passed in breast milk from a HIV infected mother to a breast-feeding baby.

Initially, most people with HIV experience flu-like symptoms, although some people do not.  People with HIV may not have symptoms for many years, but may transmit HIV to others during their symptom-free period.  As HIV suppresses the immune system, life-threatening infections, such as pneumonia or cancers, develop.  For the vast majority of people who are not treated with medications, HIV results in AIDS.  AIDS is the final stage of HIV and usually results in death if not treated.

There is no cure for HIV or AIDS.  AIDS is still a leading cause of death for people between ages 25 and 44 in the United States.  AIDS is a worldwide problem, and over 25 million people have died of AIDS since the epidemic began over 25 years ago.  You can help stop the spread of HIV by getting tested and preventing the spread of HIV to others or taking precautions to prevent getting infected with HIV.

Symptoms

It is common to experience brief flu-like symptoms two to six weeks after becoming infected with HIV.  The initial flu-like symptoms may include fever, headache, rash, sore throat, and swollen lymph nodes.  Some people do not experience initial symptoms.  Whether you experience symptoms or not, you can spread HIV to others.  Additionally, it may take three to six months after exposure to HIV for a person to test HIV positive.

HIV may not cause symptoms for many years—for eight to ten years or more for some people.  During this symptom-free time, you can spread HIV to others.  The virus multiplies within your body and destroys your immune cells.  You may develop mild infections or lingering symptoms.  You may experience swollen lymph nodes, fever, diarrhea, and weight loss.  You may have a chronic cough or shortness of breath.

After about 10 years or more of having HIV, you may develop more serious symptoms.  During the last phase of HIV, the condition is called AIDS.  The Centers for Disease Control defines AIDS as the presence of HIV with a CD4 count of 200 or less or the development of an infection as the result of a compromised immune system.  Infections during late stage HIV or AIDS can cause a variety of symptoms including night sweats that leave you soaking wet, chills or a fever that lasts several weeks, and chronic diarrhea.  You may develop a dry cough and shortness of breath.  You may have sores or white spots in your mouth or on your tongue.  You may have headaches, vision changes, or weight loss.  You may feel very tired or weak most of the time.

You may develop pneumonia or cancers.  You may develop cervical, skin, lung, or bowel cancer.  People with HIV and AIDS commonly experience cervical cancer, tuberculosis, oral or vaginal yeast infections, Non-Hodgkin’s lymphoma, herpes simplex virus, and Kaposi’s sarcoma, a type of skin cancer.

Increasingly life-threatening infections occur as AIDS progresses and CD4 counts drop lower.  Infections may spread to the brain and cause dementia and loss of movement.  Wasting syndrome may occur because of loss of appetite, weight loss, and extreme diarrhea.  Infections may occur in any organ.  Medical complications from AIDS lead to death.

Diagnosis

You can be tested for HIV with a simple blood or oral mucus test.  You should be tested if you suspect that you may have been exposed to HIV or if you are at risk for contracting HIV.  It is important to know your HIV status for your own health but also to prevent the spread to other people.  Your may be advised to be tested for HIV again because it can take the infection three to six months after initial infection to produce positive test results.

The Centers for Disease Control encourages routine testing for people between the ages of 13 to 64.  They advise that everyone should be tested at least once, and that people in high-risk groups should be tested each year.  You should be tested for HIV and STDs if you have been raped.  Women that are thinking about becoming pregnant or who are pregnant should be tested as well.

You may be tested for HIV at your doctor’s office, hospital, public health clinics, Planned Parenthood and some homeless shelters or AIDS organizations.  You may also find testing locations by contacting your state health department.  Testing is confidential, and many clinics offer free testing.  The FDA has approved only one home test, the Home Access HIV Test, which involves mailing a sample of your blood to be tested and using a telephone code to obtain your results.

Newer in-office testing methods produce results in just 20 minutes.  Results from other testing methods may take a few days.  Positive tests are repeated to rule out false-positive results.

You should seek immediate medical treatment if you are a healthcare worker and sustain an accidental needle stick.  It appears that an immediate course of anti-viral drugs, termed post-exposure prophylaxis (PEP), may reduce the chance of infection.

If you test positive for HIV, you will receive testing to measure the exact amount of virus in your blood.  This is helpful for treatment planning and for predicting the probable progression of your disease.  It is helpful to meet with counselors that can offer emotional support, education, and helpful resources.  It is very important to tell your partner or partners if you test positive for HIV so that they may receive testing and treatment as well.

Treatment

There is no cure for HIV or AIDS.  The focus of treatment is to suppress the HIV infection for as long as possible.  Highly active antiretroviral therapy (HAART) uses several drugs to keep the amount of virus in the blood very low.  HAART therapy has helped people live longer and with a better quality of life than ever before.

Over time, HIV may become less responsive to HAART.  Salvage therapy, the combination of different medications, is used to treat drug-resistant HIV.  It is very important to take your medication exactly as prescribed, and do not miss any doses.  Talk to your doctor about the side effects you experience, as your doctor may have helpful suggestions, and new medications may be prescribed to avoid these effects.

It can be helpful to participate in counseling with professionals that are familiar with HIV and AIDS.  They can provide you with support and education.  It is important that you learn how to prevent spreading the disease to others.  It is also important to learn how to access the services and possible funding assistance that may help you.

As your condition progresses, infections and cancers will be treated as they occur.  Rehabilitation therapies may help you improve or learn to compensate for physical or cognitive impairments that may result.  You may need help from other people at times.  There are many programs that offer relief and support for individuals and their loved ones.

The experience of being diagnosed with HIV or AIDS, illness, and treatments can be an emotional experience for both the infected person and their loved ones.  It is important to receive support from positive sources that you trust and are comfortable with.  Some people find support in their partners, family, friends, co-workers, and faith.  HIV/AIDS support groups and organizations are a good source for information, education, and possible funding assistance.  Support groups are a good place to meet other people in similar situations and receive support from people that understand what you are experiencing.

Am I at Risk

HIV is a problem in the United States and worldwide.  It may occur in men, women, and children regardless of their socioeconomic status, age, sexual orientation, religion, or race.  HIV infections occur if HIV infected blood, semen, or vaginal secretions enter your body.  There is a greater risk of this occurring during specific situations including:

  • You have an increased risk of contracting HIV if you have unprotected sex with multiple partners.  Unprotected sex means that you did not use a condom correctly and consistently.
  • Your risk is increased if you had unprotected sex with a person that has HIV.  Some people may not know that they have HIV because they may not have symptoms and may not have been tested, but they may spread the virus to others.
  • Your risk is increased if you do not know the HIV status of your partner.  Couples considering sexual relations should be tested for HIV and sexually transmitted diseases before beginning sexual activity.
  • If you have a sexually transmitted disease, such as syphilis, herpes, Chlamydia, genital warts, or gonorrhea, you have an increased risk of contracting HIV.
  • Participating in high-risk sexual activity, such as anal sex, increases the risk for HIV.
  • If you share needles with other people during IV drug use, you have an increased risk for HIV
  • People that received blood products before 1985 have a risk of HIV.  After 1985, donated blood products in the United States are screened for HIV.
  • Healthcare workers that routinely handle used needles have a risk of contaminating themselves during an accidental needle stick on the job, but this is a rare occurrence.
  • Newborns of mothers with HIV are at high risk.  A pregnant mother with HIV may transmit the virus to her developing baby during pregnancy.  A mother with HIV may transmit HIV to her baby through breast milk during breastfeeding.  Mothers with HIV may receive treatment during pregnancy to reduce the risk of spreading HIV to their developing babies.
  • You are at risk for HIV if you have been raped.  People that have been raped should be offered a course of anti-viral drugs and receive testing for HIV.

Complications

As HIV progresses it weakens the immune system and becomes less effective at fighting infections and disease.  With advanced HIV and AIDS, a multitude of life-threatening infections and cancers develop which eventually cause death.