HIV is a virus that damages the immune system. The immune system helps the body fight off infections. Untreated HIV infects and kills CD4 cells, which are a type of immune cell called T cells. Over time, as HIV kills more CD4 cells, the body is more likely to get various types of infections and cancers.
HIV is transmitted through bodily fluids that include:
- vaginal and rectal fluids
- breast milk
The virus doesn’t spread in air or water, or through casual contact. HIV is a lifelong condition and currently there is no cure, although many scientists are working to find one. However, with medical care, including treatment called antiretroviral therapy, it’s possible to manage HIV and live with the virus for many years.
Without treatment, a person with HIV is likely to develop a serious condition called AIDS. At that point, the immune system is too weak to fight off other diseases and infections. Untreated, life expectancy with AIDS is about three years. With antiretroviral therapy, HIV can be well-controlled and life expectancy can be nearly the same as someone who has not contracted HIV.
What is AIDS?
AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV. But just because a person has HIV doesn’t mean they’ll develop AIDS. HIV kills CD4 cells. Healthy adults generally have a CD4 count of 500 to 1,500 per cubic millimeter. A person with HIV whose CD4 count falls below 200 per cubic millimeter will be diagnosed with AIDS.
A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer that’s rare in people who don’t have HIV. An opportunistic infection, such as pneumonia, is one that takes advantage of a unique situation, such as HIV.
Untreated HIV can progress to AIDS within a decade. There’s no cure for AIDS, and without treatment, life expectancy after diagnosis is about three years. This may be shorter if the person develops a severe opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing.
If AIDS does develop, it means that the immune system is severely compromised. It’s weakened to the point where it can no longer fight off most diseases and infections. That makes the person vulnerable to a wide range of illnesses, including;
- oral thrush, a fungal infection in the mouth or throat.
- cytomegalovirus (CMV), a type of herpes virus.
- cryptococcal meningitis, a fungal infection in the brain.
- toxoplasmosis, a brain infection caused by a parasite.
- cryptosporidiosis, an infection caused by an intestinal parasite.
- cancer, including Kaposi’s sarcoma (KS) and lymphoma.
HIV and AIDS: What’s the connection?
To develop AIDS, a person has to have contracted HIV. But having HIV doesn’t necessarily mean that someone will develop AIDS. Cases of HIV progress through three stages:
- stage 1: acute stage, the first few weeks after transmission.
- stage 2: clinical latency, or chronic stage.
- stage 3: AIDS
As HIV lowers the CD4 cell count, the immune system weakens. A typical adult’s CD4 count is 500 to 1,500 per cubic millimeter. A person with a count below 200 is considered to have AIDS.
How quickly a case of 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.
HIV Transmission Facts
Anyone can contract HIV. The virus is transmitted in bodily fluids. Some of the ways HIV is spread from person to person include:
- through vaginal or anal sex — the most common route of transmission, especially among men who have sex with men.
- by sharing needles, syringes, and other items for injection drug use.
- by sharing tattoo equipment without sterilizing it between uses.
- during pregnancy, labor, or delivery from a woman to her baby.
- during breastfeeding.
- through “pre-mastication,” or chewing a baby’s food before feeding it to them.
- through exposure to the blood of someone living with HIV, such as through a needle stick.
The virus can also be transmitted through a blood transfusion or organ and tissue transplant.
It’s theoretically possible, but considered extremely rare, for HIV to spread through:
- oral sex (only if there are bleeding gums or open sores in the person’s mouth).
- being bitten by a person with HIV (only if the saliva is bloody or there are open sores in the person’s mouth).
- contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV.
HIV does NOT spread through;
- skin-to-skin contact.
- hugging, shaking hands, or kissing.
- air or water.
- sharing food or drinks, including drinking fountains.
- saliva, tears, or sweat (unless mixed with the blood of a person with HIV).
- sharing a toilet, towels, or bedding.
- mosquitoes or other insects.
It’s important to note that a person with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.
What’s the HIV window period?
As soon as someone contracts HIV, it starts to reproduce in their body. The person’s immune system reacts to the antigens (parts of the virus) by producing antibodies (cells that fight the virus). The time between exposure to HIV and when it becomes detectable in the blood is called the HIV window period.
Most people develop detectable HIV antibodies within 23 to 90 days after infection. If a person takes an HIV test during the window period, it’s likely they’ll receive a negative result. However, they can still transmit the virus to others during this time.
If someone thinks they may have been exposed to HIV but tested negative during this time, they should repeat the test in a few months to confirm (the timing depends on the test used). And during that time, they need to use condoms to prevent possibly spreading HIV.
Someone who tests negative during the window might benefit from post-exposure prophylaxis (PEP). This is medication taken after an exposure to prevent getting HIV. PEP needs to be taken as soon as possible after the exposure; it should be taken no later than 72 hours after exposure, but ideally before then.
Another way to prevent getting HIV is pre-exposure prophylaxis (PrEP). A combination of HIV drugs taken before potential exposure to HIV, PrEP can lower the risk of contracting or spreading HIV when taken consistently.
Early symptoms of HIV
The first few weeks after someone contracts HIV is called the acute infection stage. During this time, the virus reproduces rapidly. The person’s immune system responds by producing HIV antibodies. These are proteins that fight infection.
During this stage, some people have no symptoms at first. However, many people experience symptoms in the first month or two after contracting the virus, but often don’t realize they’re caused by HIV.
This is because symptoms of the acute stage can be very similar to those of the flu or other seasonal viruses. They may be mild to severe, they may come and go, and they may last anywhere from a few days to several weeks.
Early symptoms of HIV can include:
- swollen lymph nodes
- general aches and pains
- skin rash
- sore throat
- upset stomach
Because these symptoms are similar to common illnesses like the flu, the person with them might not think they need to see a healthcare provider. And even if they do, their healthcare provider might suspect the flu or mononucleosis and might not even consider HIV.
Whether a person has symptoms or not, during this period their viral load is very high. The viral load is the amount of HIV found in the bloodstream. A high viral load means that HIV can be easily transmitted to someone else during this time.
Initial HIV symptoms usually resolve within a few months as the person enters the chronic, or clinical latency, stage of HIV. This stage can last many years or even decades with treatment.
What are the symptoms of HIV?
After the first month or so, HIV enters the clinical latency stage. This stage can last from a few years to a few decades. Some people don’t have any symptoms during this time, while others may have minimal or nonspecific symptoms.
A nonspecific symptom is a symptom that doesn’t pertain to one specific disease or condition. These nonspecific symptoms may include:
- headaches and other aches and pains.
- swollen lymph nodes
- recurrent fevers
- night sweats
- weight loss
- skin rashes
- recurrent oral or vaginal yeast infections
As with the early stage, HIV is still infectious during this time even without symptoms and can be transmitted to another person. However, a person won’t know they have HIV unless they get tested. If someone has these symptoms and thinks they may have been exposed to HIV, it’s important that they get tested.
Treatment options for HIV
Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load. The main treatment for HIV is antiretroviral therapy, a combination of daily medications that stop the virus from reproducing. This helps protect CD4 cells, keeping the immune system strong enough to fight off disease.
Antiretroviral therapy helps keep HIV from progressing to AIDS. It also helps reduce the risk of transmitting HIV to others. When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in test results. However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again and the HIV can again start attacking CD4 cell.
More than 25 antiretroviral therapy medications are approved to treat HIV. They work to prevent HIV from reproducing and destroying CD4 cells, which help the immune system fight infection. This helps reduce the risk of developing complications related to HIV, as well as transmitting the virus to others. These antiretroviral medications are grouped into six classes:
- nucleoside reverse transcriptase inhibitors (NRTIs).
- non-nucleoside reverse transcriptase inhibitors (NNRTIs).
- protease inhibitors.
- fusion inhibitors.
- CCR5 antagonists, also known as entry inhibitors.
- integrase strand transfer inhibitors.
Although many researchers are working to develop one, there’s currently no vaccine available to prevent the transmission of HIV. However, taking certain steps can help prevent the spread of HIV.
The most common way for HIV to spread is through anal or vaginal sex without a condom. This risk can’t be completely eliminated unless sex is avoided entirely, but the risk can be lowered considerably by taking a few precautions. A person concerned about their risk of HIV should:
- Get tested for HIV. It’s important they learn their status and that of their partner.
- Get tested for other sexually transmitted infections (STIs). If they test positive for one, they should get it treated, because having an STI increases the risk of contracting HIV.
- Use condoms. They should learn the correct way to use condoms and use them every time they have sex, whether it’s through vaginal or anal intercourse. It’s important to keep in mind that pre-seminal fluids (which come out before male ejaculation) can contain HIV.
- Limit their sexual partners. They should have one sexual partner with whom they have an exclusive sexual relationship.
- Take their medications as directed if they have HIV. This lowers the risk of transmitting the virus to their sexual partner.
Other steps to help prevent the spread of HIV include:
- Avoid sharing needles or other drug paraphernalia. HIV is transmitted through blood and can be contracted by using contaminated materials.
- Consider PEP. A person who has been exposed to HIV should contact their healthcare provider about obtaining post-exposure prophylaxis (PEP). PEP can reduce the risk of contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should be started as soon as possible after exposure, but before 36 to 72 hours have passed.
- Consider PrEP. A person at a high risk of HIV should talk to their healthcare provider about pre-exposure prophylaxis (PrEP). If taken consistently, it can lower the risk of contracting HIV. PrEP is a combination of two drugs available in pill form.
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