Dr. Marc Tribble is board certified in Infectious Disease and has been treating HIV in patients for over 15 years. Dr. Tribble has been voted by D Magazine as the best infectious Disease doctor since 2007!
HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS.
There's no cure for HIV/AIDS, but medications can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.
The symptoms of HIV and AIDS vary, depending on the phase of infection.
Some people infected by HIV develop a flu-like illness within two to four weeks after the virus enters the body. This illness, known as primary (acute) HIV infection, may last for a few weeks. Possible signs and symptoms include:
- Muscle aches and joint pain
- Sore throat and painful mouth sores
- Swollen lymph glands, mainly on the neck
- Weight loss
- Night sweats
These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.
As the virus continues to multiply and destroy your immune cells — the cells in your body that help fight off germs — you may develop mild infections or chronic signs and symptoms such as:
- Swollen lymph nodes — often one of the first signs of HIV infection
- Weight loss
- Oral yeast infection (thrush)
- Shingles (herpes zoster)
Progression to AIDS: Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 8 to 10 years.
When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually cause illness in a person with a healthy immune system.
The signs and symptoms of some of these infections may include:
- Recurring fever
- Chronic diarrhea
- Swollen lymph glands
- Persistent white spots or unusual lesions on your tongue or in your mouth
- Persistent, unexplained fatigue
- Weight loss
- Skin rashes or bumps
How is HIV spread?
HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding.
To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways:
- By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity.
- By sharing needles. Sharing contaminated IV drug paraphernalia (needles and syringes) puts you at high risk of HIV and other infectious diseases, such as hepatitis.
- From blood transfusions. In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the blood supply for HIV antibodies, so this risk is very small.
- During pregnancy or delivery or through breast-feeding. Infected mothers can pass the virus on to their babies. Mothers who are HIV-positive and get treatment for the infection during pregnancy can significantly lower the risk to their babies.
You can't become infected with HIV through ordinary contact. That means you can't catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection.
HIV isn't spread through the air, water or insect bites.
How to test for HIV?
HIV can be diagnosed through blood or saliva testing. Available tests include:
- Antigen/antibody tests. These tests usually involve drawing blood from a vein. Antigens are substances on the HIV virus itself and are usually detectable — a positive test — in the blood within a few weeks after exposure to HIV.
- Antibodies are produced by your immune system when it's exposed to HIV. It can take weeks to months for antibodies to become detectable. The combination antigen/antibody tests can take two to six weeks after exposure to become positive.
- Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most rapid HIV tests, including self-tests done at home, are antibody tests. Antibody tests can take three to 12 weeks after you're exposed to become positive.
- Nucleic acid tests (NATs). These tests look for the actual virus in your blood (viral load). They also involve blood drawn from a vein. If you might have been exposed to HIV within the past few weeks, your doctor may recommend NAT. NAT will be the first test to become positive after exposure to HIV.
Talk to your doctor about which HIV test is right for you. If any of these tests are negative, you may still need a follow-up test weeks to months later to confirm the results.
There's no vaccine to prevent HIV infection and no cure for AIDS. But you can protect yourself and others from infection.
To help prevent the spread of HIV:
- Use treatment as prevention (TasP). If you're living with HIV, taking HIV medication can keep your partner from becoming infected with the virus. If you make sure your viral load stays undetectable — a blood test doesn't show any virus — you won't transmit the virus to anyone else. Using TasP means taking your medication exactly as prescribed and getting regular checkups.
- Use post-exposure prophylaxis (PEP) if you've been exposed to HIV. If you think you've been exposed through sex, needles or in the workplace, contact your doctor or go to the emergency department. Taking PEP as soon as possible within the first 72 hours can greatly reduce your risk of becoming infected with HIV. You will need to take medication for 28 days.
- Use a new condom every time you have sex. Use a new condom every time you have anal or vaginal sex. Women can use a female condom. If using a lubricant, make sure it's water-based. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a nonlubricated, cut-open condom or a dental dam — a piece of medical-grade latex.
- Consider preexposure prophylaxis (PrEP). The combination drugs emtricitabine plus tenofovir (Truvada) and emtricitabine plus tenofovir alafenamide (Descovy) can reduce the risk of sexually transmitted HIV infection in people at very high risk. PrEP can reduce your risk of getting HIV from sex by more than 90% and from injection drug use by more than 70%, according to the Centers for Disease Control and Prevention. Descovy hasn't been studied in people who have receptive vaginal sex.
- Your doctor will prescribe these drugs for HIV prevention only if you don't already have HIV infection. You will need an HIV test before you start taking PrEP and then every three months as long as you're taking it. Your doctor will also test your kidney function before prescribing Truvada and continue to test it every six months.
- You need to take the drugs every day. They don't prevent other STIs, so you'll still need to practice safe sex. If you have hepatitis B, you should be evaluated by an infectious disease or liver specialist before beginning therapy.
- Tell your sexual partners if you have HIV. It's important to tell all your current and past sexual partners that you're HIV-positive. They'll need to be tested.
- Use a clean needle. If you use a needle to inject drugs, make sure it's sterile and don't share it. Take advantage of needle-exchange programs in your community. Consider seeking help for your drug use.
- If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can significantly cut your baby's risk.
- Consider male circumcision. There's evidence that male circumcision can help reduce the risk of getting HIV infection.
If you've been diagnosed with HIV, it's important to have a specialist trained in diagnosing and treating HIV to help you:
- Determine whether you need additional testing
- Determine which HIV antiretroviral therapy (ART) will be best for you
- Monitor your progress and work with you to manage your health
If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of your disease and the best treatment, including:
- CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 T cell count dips below 200.
- Viral load (HIV RNA). This test measures the amount of virus in your blood. After starting HIV treatment the goal is to have an undetectable viral load. This significantly reduces your chances of opportunistic infection and other HIV-related complications.
- Drug resistance. Some strains of HIV are resistant to medications. This test helps your doctor determine if your specific form of the virus has resistance and guides treatment decisions.
Your doctor might also order lab tests to check for other infections or complications, including:
- Hepatitis B or hepatitis C virus infection
- Liver or kidney damage
- Urinary tract infection
- Cervical and anal cancer