HIV

General Info

If you think you have a Sexually Transmitted Infection (STI) or that you have been exposed to an STI, such as HIV, STOP having sex immediately until you are tested and/or treated by a medical provider.

For more information about Human Immunodeficiency Virus (HIV), visit: http://www.cdc.gov/hiv/basics/index.html

What is it?

  • HIV stands for Human Immunodeficiency Virus.
  • It is the virus that can lead to Acquired Immunodeficiency Syndrome, or AIDS.
  • The human body cannot get rid of HIV - that means that once you have HIV, you have it for life.
  • No safe and effective cure currently exists. With proper medical care, HIV can be controlled.
  • HIV affects specific blood cells of the immune system, called CD4 cells, or T cells. Over time, HIV can destroy so many of these cells that the body can’t fight off infections and disease. When this happens, HIV infection leads to AIDS.
  • AIDS is the stage of infection that occurs when your immune system is badly damaged; you become vulnerable to infections and infection-related cancers called opportunistic illnesses. When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood, you are considered to have progressed to AIDS.

How do I get it?

Only certain fluids—blood, semen (cum), pre-seminal fluid (pre-cum), rectal fluids, vaginal fluids, and breast milk—from an HIV-infected person can transmit HIV.
These fluids must come in contact with a mucous membrane (inside the rectum, the vagina, the opening of the penis, and the mouth) or damaged tissue, or be directly injected into the bloodstream (from a needle or syringe), for transmission to possibly occur.

In the United States, HIV is spread mainly by:
  • Having unprotected sex (sex without a condom) with someone who has HIV.
    • Anal sex is the highest-risk sexual behavior. Receptive anal sex (bottoming) is riskier than insertive anal sex (topping).
    • Vaginal sex is the second highest-risk sexual behavior.
    • Having multiple sex partners or having other sexually transmitted infections can increase the risk of infection through sex.
  • Sharing needles, syringes, rinse water, or other equipment (works) used to prepare injection drugs with someone who has HIV.
Less commonly, HIV may be spread by:
  • Being born to an infected mother. HIV can be passed from mother to child during pregnancy, birth, or breastfeeding.
  • Being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers.
  • Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This risk is extremely small because of rigorous testing of the US blood supply and donated organs and tissues.
  • Being bitten by a person with HIV. There is no risk of transmission if the skin is not broken or traumatized with extensive tissue damage and the presence of blood.
  • Using the mouth to stimulate the penis, vagina, or anus during oral sex. Giving mouth-to-penis oral sex and having the person ejaculate (cum) in your mouth is riskier than other types of oral sex.
  • Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids. These reports have also been extremely rare.
  • Deep, open-mouth kissing if the person with HIV has sores or bleeding gums and blood is exchanged. Transmission through kissing alone is extremely rare.

 

HIV is not spread though saliva.
HIV is not spread through shaking hands, hugging, or a casual kiss.
HIV is not spread by day-to-day contact in the workplace, schools, or social settings.
You cannot become infected from a toilet seat, a drinking fountain, a door knob, dishes, drinking glasses, food, cigarettes, pets, or insects.
HIV is not spread through the air, and it does not live long outside the body.

How common is it?

  • About 50,000 people get infected with HIV each year.  In 2010, there were around 47,500 new HIV infections in the U.S.
  • About 1.1 million people in the U.S. were living with HIV at the end of 2009, the most recent year this information was available.
    • Of those people, about 18% do not know they are infected.
  • African Americans are most affected by HIV.
    • In 2010, African Americans made up only 12% of the U.S. population, but had 44% of all new HIV infections.
  • Hispanic/Latinos are also strongly affected, making up 17% of the US population, but had 21% of all new HIV infections.
  • Men who have sex with men (MSM) are most at risk.
    • In 2010, MSM had 63% of all new HIV infections, even though they made up around 2% of the population.
  • Individuals infected through heterosexual sex made up 25% of all new HIV infections in 2010.
  • Young people, aged 13-24 are especially affected by HIV.
    • They comprise 16% of the US population, but account for 26% of all new HIV infections in 2010.
    • Young MSM accounted for 72% of all new infections in people age 13-24.
      •  Young African American MSM are even more severely affected.

What happens if I get it?

  • HIV disease has a well-documented progression.
  • Untreated HIV is almost universally fatal because it eventually overwhelms the immune system and results in AIDS.
  • HIV treatment helps people at all stages of the disease, and treatment can slow or prevent progression from one stage to the next.

A person can transmit HIV to others during any of these stages:

Acute infection:
  • Within 2 to 4 weeks after infection with HIV, you may feel sick with flu-like symptoms.
  • This is called acute retroviral syndrome (ARS) or primary HIV infection. It’s the body’s natural response to the HIV infection.
  • (Not everyone develops ARS, however—and some people may have no symptoms.)
  • During this period of infection, large amounts of HIV are being produced in your body. The virus uses and destroys CD4 cells to make copies of itself - and the CD4 count can fall quickly.
  • Your ability to spread HIV is highest during this stage because the amount of virus in the blood is very high.
  • Eventually, your immune response will begin to bring the amount of virus in your body back down to a stable level - your CD4 count will then begin to increase, but it may not return to pre-infection levels.
Clinical latency (inactivity or dormancy):
  • This period is sometimes called asymptomatic HIV infection or chronic HIV infection.
  • HIV is still active, but reproduces at very low levels.
  • You may not have any symptoms or get sick during this time.
  • People who are on antiretroviral therapy (ART) may live with clinical latency for several decades.
  • For people who are not on ART, this period can last up to a decade, but some may progress through this phase faster.
  • You are still able to transmit HIV to others during this phase even if you are treated with ART, although ART greatly reduces the risk.
  • Toward the middle and end of this period, your viral load begins to rise and your CD4 cell count begins to drop.
  • You may begin to have symptoms of HIV infection as your immune system becomes too weak to protect you .
AIDS (acquired immunodeficiency syndrome):
  • This is the stage of infection that occurs when your immune system is badly damaged and you become vulnerable to infections and infection-related cancers.
  • When the number of your CD4 cells falls below 200 cells per cubic millimeter of blood, you are considered to have progressed to AIDS.
  • You can also be diagnosed with AIDS if you develop one or more opportunistic illnesses, regardless of your CD4 count.
  • Without treatment, people who are diagnosed with AIDS typically survive about 3 years.
  • Once someone has an opportunistic illness, life expectancy without treatment falls to about 1 year.
  • People with AIDS need medical treatment to prevent death.

Signs and Symptoms

  • The only way to know if you are infected with HIV is to be tested.
  • You cannot rely on symptoms to know whether you have HIV.
  • Many people who are infected with HIV do not have any symptoms at all for 10 years or more.
  • Some people who are infected with HIV report having flu-like symptoms (“the worst flu ever”) 2 to 4 weeks after exposure.
Symptoms can include:
  • Fever
  • Enlarged lymph nodes
  • Sore throat
  • Rash

These symptoms can last anywhere from a few days to several weeks.

During this time, HIV infection may not show up on an HIV test, but people who have it are highly infectious and can spread the infection to others.

The only way to determine whether you are infected is to be tested for HIV infection.

Diagnosis and Treatment

  • Getting an HIV test is the only way to know if you have HIV.
  • CDC recommends that everyone between the ages of 13 and 64 gets tested at least once as part of routine health care.
  • Almost one in five people in the United States who have HIV do not know they are infected.

HIV is spread through unprotected sex and drug-injecting behaviors, so people who engage in these behaviors should get tested more often.

If you answer yes to any of the following questions, you should definitely get an HIV test:

  • Have you had unprotected sex (sex without a condom)—anal, vaginal, or oral—with men who have sex with men or with multiple partners since your last HIV test?
  • Have you injected drugs (including steroids, hormones, or silicone) and shared equipment (or works, such as needles and syringes) with others?
  • Have you exchanged sex for drugs or money?
  • Have you been diagnosed with or sought treatment for hepatitis, tuberculosis (TB), or a sexually transmitted infection (STI) like syphilis?
  • Have you had unprotected sex with someone who could answer yes to any of the above questions or someone whose history you don’t know?

If you continue having unsafe sex or sharing injection drug equipment, you should get tested at least once a year.

Sexually active gay and bisexual men may benefit from more frequent testing (e.g., every 3 to 6 months).

You should also get tested if:

  • You have been sexually assaulted.
  • You are a woman who is planning to get pregnant or who is pregnant.
Antibody Screening Test:
  • The most common HIV test is the antibody screening test (immunoassay), which tests for the antibodies that your body makes against HIV.
  • The test may be conducted in a lab or as a rapid test at the testing site.
  • It may be performed on blood or oral fluid (not saliva).

Because the level of antibody in oral fluid is lower than it is in blood, blood tests tend to find infection sooner after exposure than do oral fluid tests. In addition, most blood-based lab tests find infection sooner after exposure than rapid HIV tests. Newer immunoassay tests can find HIV as soon as 3 weeks after exposure to the virus. Several lab tests now in use can detect both antibodies and antigen (part of the virus itself), so find recent infection earlier than tests that detect only antibodies.

The rapid test is an immunoassay used for screening, and it produces quick results, in 20 minutes or less. Rapid tests use blood or oral fluid to look for antibodies to HIV. If an immunoassay (lab test or rapid test) is conducted during the window period  (i.e., the period after exposure but before the test can find antibodies), the test may not find antibodies and may give a false-negative result. All immunoassays that are positive need a follow-up test to confirm the result.

Follow-up diagnostic testing:
  • This testing is performed if the first immunoassay result is positive.
  • Follow-up  tests include; an antibody differentiation test, which distinguishes HIV-1 from HIV-2; an HIV-1 nucleic acid test, which looks for virus directly, or the Western blot or indirect immunofluorescence assay, which detect antibodies.

Immunoassays are generally very accurate, but follow-up testing allows you and your health care provider to be sure the diagnosis is right. If your first test is a rapid test, and it is positive, you will be directed to a medical setting to get follow-up testing. If your first test is a lab test, and it is positive, the lab will conduct follow-up testing, usually on the same blood specimen as the first test.

False-positive tests are rare. If tests are conducted during the window period, they can give a false-negative result.

RNA tests:
  • RNA tests detect the virus directly (instead of the antibodies to HIV) and thus can detect HIV at about 10 days after infection—as soon as it appears in the bloodstream, before antibodies develop.
  • These tests cost more than antibody tests and are generally not used as a screening test, although your doctor may order one as a follow-up test, after a positive antibody test, or as part of a clinical workup.
Where can I get tested for HIV?
  • Many places offer HIV testing: health departments, doctors' offices, hospitals, and sites specifically set up to provide HIV testing.
  • You can find a testing site near you by calling CDC-INFO (formerly the CDC National AIDS Hotline) at 1-800-CDC-INFO (1-800-232-4636) 24 Hours/Day.
  • You can also find a testing site online here: http://www.cdc.gov/std/hiv/default.htm.
  • You do not have to give any personal information about yourself to use these services to find a testing site.
  • IWTK does not currently test for HIV.
What is the treatment for HIV?
  • Antiretroviral (ARV) or highly active antiretroviral therapy (HAART) are terms used to describe medications that inhibit the reproduction of HIV in the body.
  • These medications are usually given as a combination of at least three drugs.
  • If ARV/HAART is effective, the deterioration of the immune system and the onset of AIDS can be delayed for years.
  • Even among people who respond well to HAART, the treatment does not rid the body of HIV.
  • The virus continues to reproduce at a slower pace, so it is important for HIV-infected persons to recognize that they could still spread the infection even if the while blood cell (CD4 count) and amount of virus (viral load) show their immune system is healthy.
Is there a cure or a vaccine for HIV?
  • There are currently no cures or vaccines for HIV.

Prevention

The best way to prevent HIV infection is to avoid behaviors that would involve exposure to infected body fluids (blood, semen, vaginal fluid, and breast milk). HIV is most commonly passed from one person to another through unprotected anal or vaginal sex, and through sharing needles or other equipment to inject drugs.

Follow these guidelines:

  • Obtain medical treatment immediately if you think you were exposed to HIV. Sometimes, HIV medications can prevent infection if they are started quickly.
  • Know your HIV status. Everyone between the ages of 13 and 64 should be tested for HIV at least once.
  • If you are at increased risk for HIV, you should be tested for HIV at least once each year.
  • Abstain from sexual intercourse, or be in a long-term mutually monogamous relationship with an uninfected partner..
  • Use a latex condom correctly, every time you have sexual intercourse (vaginal, anal, or oral), with every partner.
  • Limit your sex partners. The more sex partners you have, the greater your risk of encountering someone who has HIV or another STI.
  • Do not inject drugs; if you do inject drugs, get counseling and treatment to stop or reduce your drug use.
  • Do not share needles and works, or stop sharing immediately. Use clean needles when injecting.
  • If you are pregnant and have HIV, treatments are available to reduce the chance that your baby will hve HIV.
  • If you are infected, your sexual and needle-sharing partner(s) should also be tested.
  • Having a low viral load decreases your chance of spreading HIV - protect your partners by keeping yourself healthy.
    • If you are infected, take all of your medications and get tested and treated for other STIs.
    • Do not share items that may have your blood on them, such as razors or toothbrushes.
  • Male circumcision has been shown to reduce the risk of HIV transmission from women to men during vaginal sex.