Human Immunodeficiency Virus (HIV)

What is HIV?

Human immunodeficiency virus (HIV) is a virus that weakens the body’s immune system. HIV attacks and destroys the body’s CD4 cells (helper T cells), a type of white blood cell that fights infection. If you don’t have enough CD4 cells, your body can’t defend itself against germs that make you sick. 

Once you get HIV, it is a lifelong condition. There is currently no cure. But with proper treatment, the virus can be controlled and people can live a healthy life with HIV. 

If HIV is not treated, it can lead to acquired immune deficiency syndrome (AIDS), a condition where the body cannot protect itself from diseases.

HIV is passed person to person through blood or other body fluids. A mother with HIV can transmit the virus to her baby during pregnancy, birth, or while breastfeeding. Most babies born to mothers living with HIV do not get HIV if the mother has proper medical care.      

For children and teens, timely HIV treatment is especially important because their immune system is still developing. Treating HIV early is key to staying healthy and preventing problems.

Symptoms of HIV 

HIV symptoms can differ from person to person and can depend on age, the stage of HIV infection, and overall health. Signs and symptoms of HIV include:

• Swollen lymph nodes
• Abdominal (belly) swelling
• Oral thrush (white patches on cheeks and tongue caused by a fungal infection)
• Frequent infections or illnesses
• Slow growth or delayed development in children
• Diarrhea
• Long-lasting fevers
• Weight loss
• Headaches
• Not feeling well

Diagnosis of HIV

Your health care provider will do a physical exam and ask about symptoms and possible exposure to the virus.

Tests for HIV include:

• Antibody test: a blood or mouth swab test that checks for anti-HIV antibodies, or proteins your body makes to fight HIV. This test can take 3–12 weeks after exposure to show a positive HIV result.
• Antigen/antibody test: a blood test that checks for anti-HIV antibodies and a part of the HIV virus (antigen). This test can detect HIV about 2–6 weeks after exposure.
• Nucleic acid test (NAT): a blood test that checks for the presence of the genetic material (RNA) of the HIV virus in the blood. This test can detect HIV about 1–4 weeks after exposure.

An HIV test result may be positive or negative.

• HIV positive means that you are infected with the human immunodeficiency virus (HIV).
• HIV negative means that you are not infected with the human immunodeficiency virus (HIV).

Getting tested for HIV and diagnosed early is crucial for starting treatment and improving your health and quality of life.

Stages of HIV

HIV progresses through 3 stages:

Stage 1: Acute HIV infection

This early stage of HIV happens 2–4 weeks after infection as your body reacts to the virus. It may cause flu-like symptoms that can last from a few days to a few weeks. These symptoms can include fever, headache, muscle aches, swollen lymph nodes, and rash. During this stage, you may not have symptoms or know that you are infected.

Stage 2: Chronic HIV infection

This stage is also known as clinical latency. In this stage, the HIV virus is less active, but it can still reproduce in the body. You may have mild symptoms or no symptoms. Even if you do not have symptoms, you can still spread HIV to other people. With proper care, many people never move to the next stage of HIV (AIDS).

Stage 3: Acquired immune deficiency syndrome (AIDS)

This is the most severe stage of HIV. With AIDS, the immune system is very damaged and weak. The CD4 count decreases to less than 200. This leaves the body at risk of infection and AIDS-related health conditions including certain cancers.

Signs and symptoms of AIDS may include:

• Weight loss
• Fever and sweats
• Extreme tiredness
• Weakness
• Swollen lymph nodes
• Lung infection or other infections
• Diarrhea
• Skin problems
• Sores on mouth, anus, or genitals
• Yeast infections (oral or vaginal)
• Pelvic inflammatory disease (PID)
• Memory loss

Treatment of HIV

There is currently no cure for HIV infection. Once you are infected, you have HIV for life. Treatments can help you control the virus and prevent the spread to others.

Antiretroviral therapy (ART)

HIV treatment involves taking antiretroviral therapy (ART), medicines that help to keep the immune system healthy. These medicines help to lower the amount of HIV virus in the body. This is called “lowering the viral load” or “viral suppression.” The goal of treatment is for the viral load to be undectable.

Different types or classes of medicines are used to treat HIV. Some medicines work to keep HIV from making copies of itself. Other medicines keep the virus from infecting immune cells. HIV treatment often uses a combination of medicines.

Medicines for HIV include:

• Abacavir (Ziagen®)
• Abacavir, dolutegravir, and lamivudine (Triumeq®)
• Abacavir and lamivudine (Epzicom®)
• Atazanavir (Reyataz®)
• Bictegravir / emtricitabine / tenofovir alafenamide (Biktarvy®)
• Cabotegravir / rilpivirine (Cabenuva)
• Darunavir / cobicistat /emtricitabine / tenofovir alafenamide (Symtuza®)
• Dolutegravir (Tivicay®)
• Elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide (Genvoya®)
• Emtricitabine (Emtriva®)
• Emtricitabine / rilpivirine / tenofovir alafenamide (Odefsey®)
• Emtricitabine / tenofovir (Truvada®) 
• Emtricitabine / tenofovir alafenamide (Descovy®)
• Etravirine (Intelence®) 
• Lamivudine (Epivir®)
• Lopinavir / Ritonavir (Kaletra®)
• Nevirapine (Viramune®)
• Raltegravir (Isentress®)
• Rilpivirine (Edurant®)
• Rilpivirine / emtricitabine / tenofovir (Complera®)
• Ritonavir (Norvir®)
• Tenofovir (Viread®) 
• Zidovudine (Retrovir®)

The goal of ART is to get the amount of HIV in your body so low that the HIV virus does not show up on a blood test. If the amount of HIV is undetectable, it also may prevent transmission of HIV through sex. This may take being on ART for 3–6 months.

With lower amounts of HIV virus, the number of CD4 cells can increase so that the immune system works better.

It is important to take your medicines as prescribed and go to all follow-up visits for blood tests every 3–6 months.

How HIV spreads

HIV spreads through blood or body fluids like semen, seminal or vaginal fluids, or breast milk. HIV can spread from:

• Mother to child during pregnancy, birth, or breastfeeding
• Sharing needles, either in health care, drug use, or tattooing
• Unprotected sex with an HIV-positive person
• Blood transfusions, though this is very rare where HIV screening happens
• Contact with infected blood

Knowing how HIV spreads is important for stopping it, especially among younger people. Being aware of the ways HIV spreads is key to prevention. 

How to prevent HIV 

To prevent HIV, learn how to understand and lower your risks. Some ways to prevent HIV are:

• Get tested for HIV. Everyone over age 13 should be tested for HIV at least once. Get tested more often if you are sexually active or at higher risk.
• Consider taking pre-exposure prophylaxis (PrEP) if you are at high risk for HIV. PrEP is a medicine you take to prevent getting HIV. It is not for people who have HIV.
• Do not share razors.
• Do not inject drugs or share needles.
• Women who are pregnant or breastfeeding:
  • Take ART as directed to prevent spread of the virus to your baby.
  • Your doctor may recommend a cesarean section (C-section) instead of vaginal birth to reduce the risk of passing HIV to the baby from the birth canal.
  • Talk to your doctor about breastfeeding. It is generally not recommended that women with HIV breastfeed because the virus can be passed to the baby through breast milk.
• If you are sexually active:
  • Use a condom every time you have sex.
  • Talk openly with your partner. Discuss health and HIV status and steps you can take to stay safe.
  • Limit the number of sexual partners you have.
  • Get tested for HIV and other sexually transmitted infections (STIs).

Living with HIV

With proper medical care and support, people with HIV can live long, healthy, active lives. There are steps you can take to stay healthy.

If you have HIV or AIDS, it is important to do the following:

• Find a health care provider who is an expert in caring for patients with HIV.
• Keep all doctor appointments and stay in contact with your care team.
• Take your medicines as prescribed.
• Get follow-up blood tests as recommended.
• Talk to your care team about what HIV is, how it spreads, and what you can do to stay healthy.
• Get recommend vaccines and take steps to prevent infections and illnesses.
• Avoid smoking, vaping, drugs, and alcohol, which can make your symptoms and health worse.
• Exercise, eat healthy foods, get enough sleep, and manage stress.
• Take care of your mental health. You may have feelings such as worry, sadness, anger, isolation, or loss. A mental health provider can help you adjust to living with HIV.
• Join a support group to help with social and emotional challenges and connect you to others who understand what you are going through.

When to call your care team 

Call your care team if you:

• Have a fever over 100.9°F (38.3°C) by mouth or 99.9°F (37.7°C) under the arm
• Have new or worsening symptoms such as headache, cough, trouble breathing, extreme tiredness, weight loss, confusion, diarrhea, skin rash, mouth sores, sores on your skin, or white patches in your mouth
• Miss a dose or run out of your HIV medicine 
• Are planning to travel, especially if you are traveling outside the country
• Are pregnant or thinking about pregnancy 

Questions to ask your care team 

• What HIV medicines will I need to take, and how often?
• How often should I see my health care provider?
• What is my CD4 count and viral load?
• What happens if I don’t take my HIV medicines?
• If I have HIV, will I get AIDS?
• What lifestyle changes can help me stay healthy?
• What steps should I take to prevent the spread of HIV to others? 
• Are there new HIV treatments or clinical trials for HIV?
• How should I share my HIV diagnosis with friends and family?
• How will HIV affect my ability to have a healthy baby someday?
• How do I take care of my emotional health?

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