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What is HIV?
HIV (Human Immunodeficiency Virus) is a virus that attacks the body’s immune system, specifically targeting CD4 cells (T cells), which help the body fight infections. If left untreated, HIV can progressively damage the immune system, leading to AIDS (Acquired Immunodeficiency Syndrome), the most advanced stage of HIV infection.
Unlike some other viruses, the human body cannot completely eliminate HIV once infected. However, with proper medical care and treatment, HIV can be controlled, allowing people with HIV to live long, healthy lives and prevent transmitting the virus to others.
If you’re concerned about HIV or other STDs, call (866) 566-8711 to learn about testing options.
How Common is HIV?
- Approximately 1.2 million people in the United States are living with HIV
- About 13% (1 in 8) of these individuals don’t know they have HIV
- Globally, an estimated 38.4 million people are living with HIV
- Approximately 34,800 new HIV infections occur annually in the U.S.
- Rates of new infections have declined by 8% in the U.S. from 2015 to 2019
- Certain populations are disproportionately affected:
- Men who have sex with men (MSM) account for 66% of new diagnoses
- Black/African Americans account for 42% of new diagnoses
- Hispanic/Latino individuals account for 27% of new diagnoses
- People aged 25-34 account for the highest percentage of new diagnoses
How HIV Spreads
HIV is transmitted through specific body fluids from a person with HIV who has a detectable viral load. These fluids must come into contact with a mucous membrane, damaged tissue, or be directly injected into the bloodstream for transmission to occur.
HIV is transmitted through:
- Blood
- Semen (including pre-seminal fluid)
- Rectal fluids
- Vaginal fluids
- Breast milk
Common transmission routes include:
- Anal or vaginal sex with someone who has HIV without using condoms or taking medicines to prevent or treat HIV
- Sharing injection drug equipment (needles, syringes) with someone who has HIV
- From mother to child during pregnancy, birth, or breastfeeding (perinatal transmission)
- Blood transfusions (extremely rare in countries with thorough blood screening)
- Healthcare exposures (needlestick injuries; very rare with modern precautions)
HIV is NOT transmitted through:
- Casual contact (handshakes, hugs, closed-mouth kissing)
- Air or water
- Mosquitoes, ticks, or other insects
- Saliva, tears, or sweat (unless mixed with blood)
- Sharing toilets, food, or drinks
- Sharing clothes, phones, or other personal items
HIV Symptoms
HIV symptoms vary widely depending on the stage of infection and individual factors:
- Not everyone experiences symptoms during acute infection
- Symptoms typically appear 2-4 weeks after exposure
- Often described as “the worst flu ever”
- Common symptoms include:
- Fever
- Chills
- Rash (often on chest)
- Night sweats
- Muscle aches
- Sore throat
- Fatigue
- Swollen lymph nodes
- Mouth ulcers
- Headache
- Joint pain
- Nausea, vomiting, or diarrhea
- Many people have no symptoms for years
- Some may experience:
- Persistent swollen lymph nodes
- Mild weight loss
- Low-grade fever
- Fatigue
- Recurrent minor infections
- Night sweats
- Skin problems
- Rapid weight loss
- Recurring fever or profuse night sweats
- Extreme and unexplained fatigue
- Prolonged swelling of lymph nodes
- Diarrhea lasting more than a week
- Sores in the mouth, anus, or genitals
- Pneumonia
- Red, brown, pink, or purplish blotches on or under the skin
- Memory loss, depression, and other neurological disorders
- Increased susceptibility to opportunistic infections
- Symptoms alone cannot diagnose HIV – testing is the only way to know for sure
- Many symptoms overlap with other conditions
- Some people remain asymptomatic for many years
- Women may experience additional symptoms like increased frequency of vaginal yeast infections
- With effective treatment, most people never progress to AIDS or experience AIDS-related symptoms
Stages of HIV Infection
HIV infection progresses through several stages if left untreated:
1. Acute HIV Infection (Primary Infection)
- Occurs within 2-4 weeks after infection
- Many people develop flu-like symptoms, which may include:
- Fever
- Chills
- Rash
- Night sweats
- Muscle aches
- Sore throat
- Fatigue
- Swollen lymph nodes
- Mouth ulcers
- Symptoms typically last 1-2 weeks
- Highly infectious period due to very high viral loads
- Antibody tests may not detect HIV during this window period
2. Chronic HIV Infection (Clinical Latency)
- Can last 10 years or longer without treatment
- HIV continues to replicate at lower levels
- Many people have no symptoms during this phase
- Still infectious even without symptoms
- CD4 cell count gradually declines over time
- Without treatment, eventually progresses to AIDS
- With effective treatment, can last indefinitely
3. AIDS (Acquired Immunodeficiency Syndrome)
- Most advanced stage of HIV infection
- Diagnosed when:
- CD4 cell count drops below 200 cells/mm³ (normal range is 500-1,600 cells/mm³) OR
- Development of one or more opportunistic infections regardless of CD4 count
- Without treatment, survival typically 3 years or less
- Common opportunistic infections and conditions:
- Pneumocystis pneumonia (PCP)
- Candidiasis (thrush)
- Tuberculosis
- Toxoplasmosis
- Cryptococcal meningitis
- Kaposi’s sarcoma
- Wasting syndrome
- Neurological complications
HIV Testing and Diagnosis
Early diagnosis of HIV is crucial for effective treatment and preventing transmission. Several types of HIV tests are available:
- Detect antibodies produced by the body in response to HIV
- Most common screening test
- Results typically available in 20-30 minutes (rapid tests) or a few days (laboratory tests)
- Can be performed on blood or oral fluid
- Window period: Usually 23-90 days after exposure
- Examples: Most rapid tests, many laboratory-based tests
- Detect both HIV antibodies and p24 antigen (a viral protein)
- Can detect HIV sooner than antibody-only tests
- Usually performed on blood from a vein
- Window period: Approximately 18-45 days after exposure
- Examples: Fourth-generation laboratory tests
- Detect HIV genetic material (RNA) directly
- Can detect HIV the earliest of all test types
- Expensive and not routinely used for screening
- Window period: Approximately 10-33 days after exposure
- Examples: HIV RNA PCR test, used for early infant diagnosis and acute infection detection
- Everyone aged 13-64 should be tested at least once
- Annual testing for those at higher risk
- Testing every 3-6 months for those at highest risk (e.g., MSM with multiple partners)
- All pregnant women should be tested
- Testing is confidential and widely available
- Home testing kits are available for privacy
- Confirmatory testing is usually performed
- Viral load testing determines the amount of virus in the blood
- CD4 count assesses immune system health
- Drug resistance testing guides treatment choices
- Regular monitoring of viral load and CD4 count
Understanding the history of HIV/AIDS provides context for current approaches:
- 1981: First cases of what would later be known as AIDS reported in the U.S.
- 1983: HIV identified as the cause of AIDS
- 1985: First HIV antibody test approved
- 1987: AZT becomes first FDA-approved antiretroviral medication
- 1995: First protease inhibitor approved, marking the beginning of combination therapy
- 1996: Introduction of highly active antiretroviral therapy (HAART) leads to dramatic decline in AIDS deaths
- 2006: CDC recommends routine HIV screening for all adults
- 2012: FDA approves Truvada as PrEP
- 2016: Studies confirm that U=U (Undetectable = Untransmittable)
- 2019: U.S. announces “Ending the HIV Epidemic” initiative
- 2021: Long-acting injectable HIV medication approved
- 2022: Injectable PrEP (Apretude) becomes available
The Biology of HIV
HIV is a complex retrovirus with unique characteristics:
- Belongs to the Retroviridae family, specifically lentiviruses
- Contains RNA as its genetic material instead of DNA
- Possesses reverse transcriptase enzyme that converts viral RNA into DNA
- Integrates its genetic material into the host cell’s DNA (as provirus)
- Two main types: HIV-1 (global pandemic) and HIV-2 (primarily West Africa)
- HIV-1 has multiple groups and subtypes:
- Group M (main) with subtypes A-K
- Group O (outlier)
- Group N (non-M, non-O)
- Group P (very rare)
- Primarily infects CD4+ T cells, but also macrophages and dendritic cells
- High mutation rate leading to genetic diversity and drug resistance
- Viral lifecycle includes:
- Attachment and entry into host cell
- Reverse transcription of RNA to DNA
- Integration into host genome
- Viral protein production
- Assembly and budding of new virions
HIV Treatment
Antiretroviral therapy (ART) has transformed HIV from a fatal diagnosis to a manageable chronic condition:
-
Major Classes of HIV Medications
-
Treatment Goals
-
Treatment Success
-
Treatment Challenges
- Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
- Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
- Protease Inhibitors (PIs)
- Integrase Strand Transfer Inhibitors (INSTIs)
- Entry Inhibitors (including CCR5 antagonists and fusion inhibitors)
- Post-attachment Inhibitors
- Reduce viral load to undetectable levels (<200 copies/mL)
- Increase CD4 cell count to normal levels
- Reduce HIV-related illnesses and complications
- Prevent transmission of HIV to others
- Improve quality of life and lifespan
- Most people achieve undetectable viral load within 3-6 months of starting treatment
- Treatment is lifelong – stopping can lead to viral rebound
- Regular monitoring ensures continued effectiveness
- Life expectancy approaches normal with early and consistent treatment
- Side effects are generally minimal with newer medications
- Adherence – consistent daily medication is essential
- Drug resistance – can develop if medication is not taken properly
- Side effects – vary by medication but generally well-tolerated
- Drug interactions – some HIV medications interact with other drugs
- Comorbidities – managing other health conditions alongside HIV
- Cost and access – can be barriers without insurance or assistance programs
HIV Prevention
HIV prevention has expanded beyond traditional methods to include biomedical approaches:
- Consistent and correct condom use
- Reducing number of sexual partners
- Regular HIV testing
- Not sharing needles or drug equipment
- Open communication with partners about HIV status
- Pre-exposure Prophylaxis (PrEP):
- Daily medication for HIV-negative people at risk
- Reduces risk of sexual transmission by about 99% when taken as prescribed
- Reduces risk among people who inject drugs by at least 74%
- Available as daily pill or bimonthly injection
- Post-exposure Prophylaxis (PEP):
- Medication taken within 72 hours after potential exposure
- Must be taken for 28 days
- Highly effective when started quickly
- Available through healthcare providers and emergency rooms
- Treatment as Prevention (TasP):
- People with HIV who maintain undetectable viral load through treatment cannot transmit HIV sexually
- Often referred to as “Undetectable = Untransmittable” or U=U
- Requires consistent adherence to treatment
- Prevention of Mother-to-Child Transmission:
- HIV testing during pregnancy
- Antiretroviral therapy during pregnancy and delivery
- Appropriate delivery methods
- Alternatives to breastfeeding when appropriate
- People Who Inject Drugs:
- Needle exchange programs
- Substance use treatment
- PrEP
- Regular testing
Living with HIV
With proper care and treatment, people with HIV can lead long, healthy lives:
Medical Management:
- Regular medical appointments to monitor health
- Consistent medication adherence
- Viral load and CD4 monitoring
- Screening for other conditions that are more common in people with HIV
- Vaccinations as recommended by healthcare providers
- Nutrition and exercise to support overall health
Disclosure and Relationships:
- Legal requirements for disclosure vary by state
- Strategies for disclosing to partners, family, and friends
- Dating and relationships are possible and fulfilling
- U=U message helps reduce stigma and fear
- Support groups can provide guidance and community
Mental and Emotional Health:
- Depression and anxiety are common after diagnosis
- Counseling and therapy can help address adjustment
- Peer support connects you with others living with HIV
- Stress management techniques support overall wellbeing
- Addressing stigma through education and advocacy
Practical Considerations:
- Insurance and medication assistance programs
- Legal protections against discrimination
- Employment rights under the Americans with Disabilities Act
- Family planning options for people with HIV
- Travel considerations including medication planning
HIV and Pregnancy
With proper medical care, women with HIV can have healthy pregnancies and HIV-negative babies:
- Achieving undetectable viral load before conception
- Evaluation of current HIV treatment for safety during pregnancy
- Discussion of conception options including natural conception with U=U
- Screening for other STIs and health conditions
- Folic acid supplementation
- Continued antiretroviral therapy throughout pregnancy
- More frequent viral load monitoring
- Regular prenatal care
- Monitoring for pregnancy complications
- Screening for gestational diabetes (more common with some HIV medications)
- Vaginal delivery is possible with undetectable viral load
- Cesarean section may be recommended for detectable viral load
- Intravenous antiretroviral medication during labor in some cases
- Early antiretroviral medication for the newborn
- Testing infants for HIV according to recommended schedule
- Antiretroviral prophylaxis for the infant
- Avoiding breastfeeding in settings where safe alternatives are available
- Continued HIV care for the mother
- Family planning discussion for future pregnancies
HIV and Aging
As people with HIV live longer, unique considerations for aging emerge:
- Earlier onset of some age-related conditions
- Higher rates of cardiovascular disease, osteoporosis, and certain cancers
- Medication interactions between HIV drugs and medications for other conditions
- Cognitive changes that may be related to HIV or aging
- Regular screening for age-related conditions
- Expanded support networks to address isolation
- Long-term survivor issues including grief and trauma
- Retirement planning
- Housing needs
- End-of-life planning
- Continued adherence to HIV medication
- Regular physical activity adjusted for ability level
- Nutrition that supports overall health
- Smoking cessation
- Limited alcohol consumption
- Mental stimulation through learning and social engagement
Currently, there is no cure for HIV. However, with proper antiretroviral treatment, the virus can be controlled to the point where it’s undetectable in the blood and cannot be transmitted sexually, allowing people with HIV to live long, healthy lives.
HIV is the virus that causes the infection. AIDS is the most advanced stage of HIV infection, diagnosed when the CD4 cell count drops below 200 cells/mm³ or when certain opportunistic infections develop. With modern treatment, many people with HIV never develop AIDS.
Most HIV tests can detect infection 23-90 days after exposure. Antigen/antibody tests can detect infection sooner (18-45 days), while nucleic acid tests (NATs) can detect HIV as early as 10-33 days after exposure. If you’re concerned about recent exposure, consult a healthcare provider about the most appropriate test.
The risk of HIV transmission through oral sex is extremely low but not zero. The risk is higher if there are cuts or sores in the mouth or on the genitals, or if the person with HIV has a high viral load.
PrEP is highly effective at preventing HIV when taken as prescribed, but it doesn’t protect against other STIs or pregnancy. Using condoms along with PrEP provides more complete protection.
Yes, people with HIV can have children with very low risk of transmitting HIV to their partners or babies. Options include natural conception (when the person with HIV has an undetectable viral load), sperm washing, assisted reproductive technologies, and adoption.
People who maintain an undetectable viral load through consistent treatment cannot transmit HIV to sexual partners. This is known as “Undetectable = Untransmittable” or U=U. However, it’s important to take medication as prescribed and get regular viral load testing.
With early diagnosis and consistent treatment, people with HIV can have a near-normal life expectancy. The key is early detection and maintaining treatment adherence.
Learn More About HIV Testing
If you’re concerned about HIV or want to get tested, call (866) 566-8711 to speak with a care advisor who can help you understand your testing options.
LocalSTDTesting is not a substitute for professional medical advice, diagnosis, or treatment.
Always seek the advice of your physician with any questions about medical conditions.
