Actor Charlie Sheen recently revealed he is HIV positive and has been living with the virus for the past 4 years.
Image credit: Angela George
Of the 1.1 million who are living with HIV (human immunodeficiency virus) in the US, almost 1 in 8 do not even realize they have the infection, meaning they are at increased risk of death due to lack of treatment.
And the lack of HIV awareness and testing is even more of a concern among low- and middle-income countries, where the disease is most prevalent. In 2012, only 35% of infants living in these countries who were born to mothers with HIV received an HIV test in the first 2 months of life, indicating that more needs to be done on a global scale to ensure people with the virus receive diagnosis and treatment.
In this Spotlight, we look at the signs and symptoms of HIV, the testing procedures available, whether there is still stigma associated with the virus, and how this may be preventing at-risk individuals from being tested.
HIV is a virus that weakens the human immune system by destroying T cells or CD4 cells that normally fight infection and disease. The virus uses these cells to make copies of itself, enabling it to spread.
Once the virus has destroyed a large number of these immune cells, this can lead to AIDS (acquired immunodeficiency syndrome) - the final stage of the HIV infection - in which the body is no longer able to stave off life-threatening infection.
Although not all people experience symptoms in the early stages of HIV infection, many people can experience flu-like symptoms within the first 2-4 weeks, such as fever, swollen glands, sore throat, headache, fatigue, rash and aches and pains in the muscles or joints. This is referred to as acute retroviral syndrome (ARS) or primary HIV infection.
Following the early stages of HIV infection is what is referred to as the "clinical latency" stage, or chronic HIV infection. During this stage, the infection may not cause any symptoms at all or very mild ones.
During the later stages of infection - as it is progressing toward AIDS - symptoms may include rapid weight loss, chronic fatigue, prolonged diarrhea, pneumonia, sores of the mouth, anus or genitals, memory loss, depression and blotches under the skin or inside the mouth, nose or eyelids. However, antiretroviral therapy (ART) - a combination of at least three antiretroviral drugs - may slow the development of such symptoms.
Many people with HIV can live with infection for more than 10 years without any symptoms developing and only experience symptoms - such as sickness - when they are progressing toward AIDS. Therefore, it is important to know the risk factors for HIV and undergo testing for the infection as early as possible.
How can HIV be transmitted?
A person who is infected with HIV can transmit the virus through certain bodily fluids, such as blood, semen, rectal fluids, vaginal fluids and breast milk. In order to transmit infection, the fluids must come into contact with a mucous membrane (found inside the vagina, rectum, mouth and opening of the penis), damaged tissue or receive an injection directly through the blood stream from a needle or syringe.
In the US, the virus is most commonly contracted through unprotected sex with an HIV-infected partner, and sharing needles, syringes or other injection-drug tools with a person infected with HIV.
HIV may also be transmitted to a child by an infected mother through pregnancy, birth or breastfeeding, or a person may become infected through receiving blood products or organ/tissue transplants contaminated with HIV, though such incidences are rare.
As stated previously, many people with HIV may not experience any symptoms, or the symptoms may even be mistaken for other illnesses. If a person believes they are at risk of HIV, the best way to find out is to undergo an HIV test.
The US Centers for Disease Control and Prevention (CDC) recommend that every individual between the ages of 13 and 64 undergo an HIV test as part of routine medical care. People at high risk of HIV infection - such as those who have had unprotected sex, or who have sex in exchange for money or drugs - are recommended to have an HIV test at least once a year.
There are three main tests that can detect HIV: the HIV antibody test, the HIV RNA test and the Western blot test.
There are three main tests that can detect HIV. The most common is the HIV antibody test, which can detect HIV antibodies - proteins produced in response to HIV infection - in urine, blood or mouth fluids. This test is not usually carried out until 3-6 months after potential HIV infection, as it can take this long for antibodies to be produced.
The HIV RNA test, however, may detect whether HIV is present in a person's blood within 9-11 days of infection, and test results can be available within a few days to weeks.
The Western blot test is usually carried out if results from the HIV RNA or HIV antibody tests are positive. It is used to confirm whether HIV is present in the blood.
There are also two home tests available that have been approved by the US Food and Drug Administration (FDA). One of these involves taking a blood sample and sending it to a laboratory for testing, while the other involves taking a swab of the gums with a device to obtain a sample of oral fluids before inserting the sample into a test solution. If the results of these tests are positive, they must be followed up with a Western blot test.
On the next page we look at how lack of early testing hinders the benefits of ART and investigate the stigma that remains attached to HIV.