HIV – What Should I Know?

If you or a loved one has been diagnosed with HIV infection, you probably have many questions. Read on to learn what HIV is, how it is transmitted, and what types of treatments are available.

What is HIV?

Human immunodeficiency virus (HIV) is a virus that attacks and destroys important immune system cells in the body. If left untreated, HIV can destroy enough of the immune system to lead to AIDS (acquired immunodeficiency syndrome).

HIV emerged as an epidemic in the United State in the 80s. Since then, the rate of new infections has been reduced by more than two-thirds. It is estimated that roughly 34,800 new HIV infections occurred in 2019, according to HIV.gov.

Right now in the United States, approximately 1.2 million people have HIV, but about 13% of those people may not be aware of their status.

What are the Symptoms of HIV?

A person infected with HIV may not have any symptoms at all. The only true way to know if you have HIV is to get tested.

If you do have symptoms, they may occur in a predictable progression.

Stage 1: Acute Infection

About two to four weeks after being infected with HIV, a person may experience flu-like symptoms. This may include developing a fever, chills, rash, night sweats, body aches, fatigue, and swollen lymph nodes.

This period can last from a few days to several weeks. These symptoms alone are not enough to indicate that you have HIV infection. These symptoms can represent other illnesses.

Keep in mind that during this acute stage, there may not be any symptoms at all.

Stage 2: Clinical Latency

During this stage of the infection, a person still has the virus multiplying but at low levels. There may not be any symptoms during this stage either.

Sometimes this is referred to as a chronic HIV infection. People with chronic HIV infection can stay in this stage for up to 15 years.

During this time, if your HIV infection is well-controlled by medication, you will have a low risk of transmitting the virus to others.

Depending on other health factors, you may progress faster to stage 3.

Stage 3: AIDS

If an HIV infection is discovered, diagnosed, and treated, a person will usually not develop AIDS if treated quickly and appropriately.

If a person is unaware that they have an HIV infection, or do not take their medications as prescribed, their risk for developing AIDS is much higher.

Damage to the immune system leads to serious health symptoms. Symptoms of AIDS include:

• Recurring fevers
• Chronic swollen lymph glands
• Night sweats
• Rapid weight loss
• Chronic diarrhea
• Sores or lesions of the mouth or genitals
• Neurological problems like memory loss and brain fog

A secondary infection that you would normally not develop if you did not have AIDS is called an opportunistic infection. Opportunistic infections that are common with AIDS include Candidiasis, cervical cancers, lymphoma, tuberculosis, and pneumonia.

It is usually these opportunistic infections that can be life-threatening.

How Does a Person Become Infected with HIV?

HIV transmission occurs when certain bodily fluids are exchanged. The most common transmission routes are by anal or vaginal sex, and sharing needles.

Anal sex is the riskiest type of sex for HIV transmission. HIV can enter the body through the rectum or the opening at the tip of the penis.

Vaginal sex is less risky, however, either partner is also able to get HIV in this scenario. Vaginal fluids and semen are both capable of carrying HIV.

People who inject drugs and share needles with others are at high risk of getting HIV. Used needles carry the blood of the person who previously used the syringe.

Less common methods of transmission include from a mother to a baby during pregnancy, birth, or breastfeeding. Usually, during prenatal care, a mother will be tested for HIV and begin medications that can reduce the risk of transmission to less than 1%.

It is extremely rare for transmission to occur from oral sex or kissing but is possible if the person has open sores or bleeding gums in the mouth.

Safe Practices

HIV is not transmitted through saliva, tears, or sweat. You cannot get HIV by hugging, shaking hands, or even closed-mouth kissing.

HIV does not survive for extended periods outside of the human body and cannot be transmitted on surfaces.

It also is not transmitted through the air.

Mosquitoes, ticks, and other insects that may bite a person and exchange blood have not been found to transmit HIV from person to person.

To reduce your risk of transmission, it is advised to use condoms during sex and be tested regularly for STDs.

It is also advised not to share needles or syringes with others for any reason.

HIV Testing and Treatments

Receiving a positive result can invoke a variety of emotions in a patient such as anger, fear, and sadness. Knowing your status is an important first step in receiving the appropriate medical care.

Unfortunately, no HIV test can detect HIV immediately after exposure. There are several types of tests available for HIV detection.

A nucleic acid-based test can usually detect HIV 10 to 33 days after exposure.

An antigen/antibody test has a slightly different window, detecting HIV 18 to 45 days after exposure.

An antibody test has the longest window, taking anywhere from 23 to 90 days to detect an HIV infection post-exposure.

A negative test may be a false negative if your exposure falls in the window period of the chosen test. A patient may need to be retested even if they receive a negative result.

If you receive a positive result, you should be retested to confirm the result.

Medications

Anyone who receives a positive HIV result should begin taking medication as soon as possible. HIV medication is called antiretroviral therapy (ART). These medications work by stopping the virus from replicating.

By maintaining low levels of virus in the body, the immune system is protected and illness can be suppressed.

HIV medications have the ability to reduce the amount of virus in the body to such a low level that it is no longer detectable. This is called an undetectable viral load.

Usually, HIV is treated with at least two different medications. This is because the virus has the ability to mutate with the body and so attacking it with multiple drugs has been shown to control HIV most effectively.

Sometimes, these drugs are combined into a single combination drug so that a patient is able to make multiple medications within the same pill or tablet.

Multiple drugs are FDA approved to treat HIV. Your healthcare provider will recommend certain drugs based on a patient’s personal circumstances including:

• Viral load
• Immune system T-cell count
• How severe their case is
• The strain of HIV detected
• Patient comorbidities

ART drugs used to treat HIV include subclasses of drugs that each target different parts of the virus. Below are some of the most common prescriptions in each class listed:

• Integrase strand transfer inhibitors (INSTIs)
  • Dolutegravir
  • Elvitegravir
  • Raltegravir

• Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
  • Didanosine
  • Lamivudine
  • Stavudine
  • Zalcitabine
  • Zidovudine

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Efavirenz
  • Delavirdine
  • Nevirapine

• Protease inhibitors (PIs)
  • Atazanavir
  • Saquinavir
  • Lopinavir/ritonavir
  • Darunavir

Depending on the medication, doses may also be administered in shots by a healthcare provider. This usually applies to patients maintaining an undetectable viral load.

Treatment as Prevention

By taking medications regularly and as prescribed, viral loads can be well controlled. With an undetectable viral load, not only will you as the patient stay healthy but you will protect others by greatly reducing your ability to transmit the virus.

Although having an undetectable viral load is the goal, medications must be continued to maintain low levels of the virus. Missing medications gives the virus the opportunity to multiply and viral levels can quickly increase again, making you sick.

Working closely with your healthcare provider will lead to the best outcomes and most people infected with HIV are able to live normal, healthy lives.

Living with HIV

If you are HIV positive, it is recommended that you take extra care to live a healthy lifestyle to support your overall wellness.

This includes eating well, getting regular exercise and proper sleep.

Living with HIV can cause stress and lead to other mental health issues like depression. If you are struggling with these feelings, there are resources available to help. Supporting your mental health is just as critical as supporting your physical health.

Being diagnosed with HIV is a life-changing event but with proper medical care, you can live a long and healthy life.