HIV is a condition that gradually attacks the immune system. There is currently no cure for HIV, but medications can control it to the point where it is not transmissible.

HIV can be considered a chronic disease state, like high blood pressure, for example, if a person takes their antiretroviral medication every day, as prescribed.

Once a person has been diagnosed with HIV, they have it for life.

In the past, HIV used to progress to AIDSwithin a few years, but the availability of effective treatment means that very few people now develop AIDS. With treatment, a person with HIV can now live almost as long as a person without the condition.

The Centers for Disease Control and Prevention (CDC) report that there were 39,782 cases of HIV in the United States in 2016, down from 45,700 in 2008. From 2011 to 2015, new diagnoses fell by 5 percent.

What is HIV?

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HIV attacks the body's immune cells, specifically targeting the white blood cells called CD4 cells, which are an important subset of T cells.

CD4 cells help the body's immune system to fight infections.

If HIV is not treated, the body finds it difficult to fight disease.

People with HIV have a higher chance of getting certain infections and also immunodeficiency-related cancers, and these risks significantly increase when someone is not receiving treatment.

Transmission

HIV is classified as a sexually transmitted disease (STD), but it can be transmitted in other ways.

It is passed on through contact between some bodily fluids and mucous membrane or damaged body tissue.

These fluids are:

  • semen or preseminal fluid
  • vaginal fluid
  • blood
  • rectal fluid
  • breast milk

Transmission can happen as a result of:

  • vaginal, anal, or oral sex
  • contact with blood, semen, cervical, or vaginal fluids where the virus is present
  • a mother passing the virus to her child during pregnancy, labor, delivery, and breast-feeding
  • sharing of needles and other paraphernalia for injecting drugs or medications
  • accidental puncture by a needle that has the virus on it, for example, as a health worker

It cannot be passed on through:

  • air or water
  • saliva, sweat, tears, or kissing
  • insects or pets
  • sharing bathroom facilities, food, drinks, crockery, or cutlery

To acquire the virus, these bodily fluids must come into direct contact with a mucous membrane or damaged tissue. The rectum, vagina, penis, and mouth all contain mucous membranes.

To be transmitted by a needle or syringe, the virus must be directly injected into the bloodstream.

Symptoms

Symptoms of HIV can vary from person to person.

Some people develop a flu-like illness 2 to 4 weeks after the virus has been transmitted.

Others notice swelling of their lymph nodes, most commonly under the arms, around the throat, or in the groin area. There may also be a rash.

Some people do not experience any symptoms for many years. The only way to be sure is to undergo a test for HIV. Anyone who thinks they may have the virus should speak with a health provider.

The symptoms of HIV vary depending on the stage.

At stage 1, the acute stage, there may be symptoms of illness, as with other viruses. After this, the virus remains in the body, but it is dormant. With treatment, the person may not experience symptoms again.

    The symptoms of each stage are as follows:

    Stage 1: Acute

    Within 2-4 weeks, people who have the virus may begin to experience the symptoms previously mentioned. This is often the body's natural response to an infection.

    At this stage, the virus is rapidly replicating throughout the body. High levels of the virus will be present in the blood and other bodily fluids, and the virus is contagious at this time.

    However, symptoms can be mild and may go unnoticed. People often do not realize they have the virus.

    Specific symptoms include:

    • a fever or a rise in body temperature
    • a body rash that usually does not itch
    • additional flu-like symptoms such as muscle aches, severe tiredness, night sweats, and sore throat
    • swollen glands for instance in the throat, groin, and armpits
    • sores or ulcers in the mouth or the genitals
    • nausea, vomiting, or both
    • ulcers on the genitals or mouth

    In this stage, HIV antibody detection tests may be negative.

    This period of about 1 to 2 weeks, when a test is negative but HIV has been transmitted, is commonly referred to as "the window period."

    Those who have HIV develop antibodies to HIV antigens anywhere from 3 weeks to 3 months after being contracting the virus. Even if tested, the antibodies may not give a positive test until 6 weeks.

    Stage 2: Asymptomatic (dormant)

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    Stage 2 HIV symptoms include fever, tiredness, and weight loss.

    This stage is also referred to as chronic HIV. The virus is still active but reproduces at lower levels. There may not be any visible symptoms, and the person may not get sick.

    People who are regularly taking antiretroviral medication may remain in this stage for several decades. They may never experience any further symptoms.

    Antiretroviral medication can now reduce the viral load until it is so small that it is undetectable.

    Those who have undetectable levels of HIV in their blood will not transmit the virus.

    Undetectable = untransmissable

    People with HIV who take antiretroviral medication as prescribed by their provider have a better chance of having lower levels of HIV in their body.

    Without treatment, the person may spend a decade or longer in the dormant phase. For some people, this phase may progress faster.

    However, even without symptoms, the virus continues to multiply and destroy immune cells. Some people may develop mild infections or symptoms, including:

    • fever and night sweats
    • tiredness
    • swollen glands in the armpit, groin, and neck
    • weight loss
    • diarrhea
    • severe psoriasis
    • thrush
    • blood count abnormalities such as anemia or low white blood cell counts

    People who take their medication regularly have dormant HIV, and they are unlikely to develop AIDS, which is a more dangerous condition.

    However, according to the CDC, the complications of HIV-related illness can still be life-threatening.

    What is AIDS?

    Without treatment, HIV can lead to AIDS after around 10 years, or possibly before. AIDS is a severe syndrome. The complications can be fatal.

    At this point, there is severe damage to the body's immune system and there may be complications with other organs like the liver, lungs, kidneys, or brain.

    A number of severe illnesses and infections may occur that the person can no longer fight off because their immune system is compromised.

    The likelihood of developing AIDS after HIV depends on a number of factors, including the use of antiretrovital medication, age, genetic factors, and the strain of the virus.

    With antiretroviral medication a person can maintain a low viral load, and a normal life expectancy is possible.

    Signs and symptoms of AIDS include:

    • frequent soaking night sweats
    • recurring fever
    • long-term diarrhea
    • unexplained, rapid weight loss
    • persistent unexplained fatigue
    • skin rashes
    • swollen glands in the armpit, neck, and groin
    • neurological changes, including memory loss and confusion
    • unusual spots and sores in the mouth or on the skin

    Without treatment, people with AIDS can expect to survive for around 3 years.

    Those with AIDS see their CD4-T cell counts drop below 200 cells per millimeter of blood. For reference, a person without HIV would normally have around 500 to 1,600 cells per millimeter of blood. As in stage 1, they often have a high amount of the virus in their blood and the virus can easily be passed on at this time.

    Diagnosis of HIV

    The best way to determine if a person has HIV is through a blood test. HIV blood tests work by detecting certain proteins called antibodies that are present in the blood. The body automatically makes these proteins in response to the presence of HIV. Some blood tests also detect proteins produced by HIV, called antigens.

    Oral swab tests can also detect the presence of HIV.

    People who have shared needles or had sex without a condom should be sure to get tested.

    Some STDs can mimic HIV symptoms and increase the body's chance of contracting HIV. STDs that cause open sores on the genitals such as syphilis, herpes, or genital warts can increase the chance of developing HIV.

    Preventing HIV

    In 2015, the CDC estimate that 1.1 million people were living with HIV in the U.S. Around 1 in 7, or 15 percent, were thought to be unaware they had the virus.

    People can protect themselves from HIV by learning about the dangers and how to avoid them.

    • Use a condom for protection from a range of STDs when engaging in sexual activity.
    • Remember that if a person uses their medication correctly and tests show that their viral load is undetectable, the virus cannot be transmitted.
    • Always use clean needles and never share them with others.

    Another prevention method is preexposure prophylaxis, or PrEP. This is a daily pill for people who have a high risk of HIV. So far, the U.S. Food and Drug Administration (FDA) have approved one formulation of tenofovir disoproxil fumarate and emtricitabine.

    The U.S. Preventive Services Task Force issued new guidelines in 2019, stating that doctors can only recommend PrEP for those with a recent negative HIV test.