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Basics

What is HIV?

HIV stands for the human immunodeficiency virus:

H - Human. This virus infects human beings.

I - Immunodeficiency. This virus attacks a person's immune system. The immune system is the body's defense against infections, such as bacteria and viruses. Once attacked by HIV, the immune system becomes deficient and doesn't work properly.

V - Virus. A virus is a type of germ too small to be seen even with a microscope.

HIV is a virus. Some viruses, like the ones that cause colds or flu, stay in the body for only a few days. HIV, however, never goes away. A person who is infected with HIV is said to be "HIV positive." Once a person is HIV positive, that person will always be HIV positive.

What does the virus do?

All viruses must infect living cells to reproduce. HIV takes over certain immune system cells that are supposed to defend the body. These cells are called CD4 cells, or T cells.

When HIV takes over a CD4 cell, it turns the cell into a virus factory. It forces the cell to produce thousands of copies of the virus. These copies infect other CD4 cells. Infected cells don't work well and die early. Over time, the loss of CD4 cells weakens the immune system, making it harder for the body to stay healthy.

What is AIDS?

AIDS was first reported in the United States in 1981 and has since become a major worldwide epidemic. AIDS stands for acquired immunodeficiency syndrome:

A - Acquired. This condition is acquired, meaning that a person becomes infected with it.

I - Immuno. This condition affects a person's immune system, the part of the body that fights off germs such as bacteria or viruses.

D - Deficiency. The immune system becomes deficient and does not work properly.

S - Syndrome. A person with AIDS may experience other diseases and infections because of a weakened immune system.

AIDS is the most advanced stage of infection caused by HIV. Most people who are HIV positive do not have AIDS. An HIV-positive person is said to have AIDS when his or her immune system becomes so weak it can't fight off certain kinds of infections and cancers.

Even without one of these infections, an HIV-positive person is diagnosed with AIDS if his or her immune system becomes severely weakened. This is measured by a lab test that determines the number of CD4 cells a person has. A CD4 cell count less than 200 in an HIV-infected person counts as a diagnosis of AIDS. It can take between 2 to 10 years, or longer, for an HIV-positive person to develop AIDS, even without treatment.

How is HIV spread?

HIV is spread though four body fluids:

  • semen
  • vaginal fluid
  • blood
  • breast milk

HIV is NOT spread through:

  • tears
  • sweat
  • feces
  • urine

How is HIV spread through sex?

You can get infected from sexual contact with someone who is infected with HIV. Sexual contact that can transmit HIV includes:

  • vaginal sex (penis in the vagina)
  • anal sex (penis in the anus of either a man or a woman)
  • oral sex (penis in the mouth)

If you have sex, the best thing to do is to practice "safer sex" all the time. To do so, always use a condom, dental dam, or other latex barrier and avoid "rough sex" or other activities that might cause bleeding. If you use lube with a condom, make sure it is water based, not oil-based. Oil-based lube causes latex condoms to break.

If you have unprotected sex with someone who is infected, it doesn't mean that you will be infected, too. But there is always a chance. Using a condom reduces your risk.

HIV is NOT spread by:

  • hugging or massage
  • masturbation
  • fantasizing
  • dry kissing
  • phone sex
  • cyber sex
  • sex toys you don't share
  • daily living with someone who has HIV

For more information, see Sex and Sexuality (http://www.hiv.va.gov/sex-01-00) in the Daily Living section.

How is HIV spread through blood?

You can become infected if you have contact with the blood of someone who is infected with HIV. Blood-borne infection with HIV can occur through:

  • sharing needles when shooting drugs
  • tattoos or body piercings with unsterilized needles
  • accidental needle sticks
  • blood transfusions
  • splashing blood in your eyes

HIV is NOT spread by blood passed through insect bites.

Can mothers give HIV to their babies?

Pregnant women who are HIV positive can give the virus to their babies in the womb and during birth. Taking anti-HIV drugs during pregnancy and childbirth can help lower the risk, but there is no sure way to prevent infection.

After birth, mothers can give their babies HIV through breast milk. The highest risk may be in the early months after birth. New mothers should try to bottle-feed their babies rather than breast-feed.

If you are an HIV-positive woman and intend to become pregnant, or you find out that you are HIV positive during your pregnancy, talk to your doctor about ways to reduce the chances that your baby will become infected, too.

What are the symptoms?

You can't tell if a person is HIV positive by looking at them. Most people with HIV infection don't look sick. Even so, when a person first becomes infected, he or she may get certain symptoms. This period of early infection is called acute HIV infection.

Symptoms can be different for each person. Sometimes there are no symptoms at all. Other times symptoms are strong. You may feel as if you have a cold or the flu. You may experience:

  • fever
  • headache
  • sore throat
  • swollen lymph nodes, usually on the neck
  • fatigue
  • rash
  • sores in the mouth

If symptoms appear, they usually do so within days or weeks after infection, and end after 1 to 2 weeks.

The only way to tell if your symptoms are from a cold, the flu, or HIV is to have an HIV test.

What is an HIV test?

The HIV test is designed to determine whether you have been infected with HIV--the virus that causes AIDS.

When you get infected with HIV, your body sees the virus as an invader and begins to produce cells and particles to fight it. These particles are called antibodies. The HIV antibodies are different from antibodies for the flu, a cold, or other infections. If you have HIV antibodies, then you have been infected with HIV.

The HIV test detects antibodies to HIV. It requires a small sample of blood from a vein or a finger-stick, although some newer tests use fluid from your mouth. Because it can take the body several months to make antibodies, your test results might be negative if you get tested too soon after becoming infected. Most infected persons test positive within 2-8 weeks after infection, and almost all (97%) will test positive at 3 months after infection. A very few won't test positive until 6 months after infection.

The HIV test does not tell you if you have AIDS, how long you have been infected, or how sick you might be.

Should you get tested?

Most experts recommend that everyone who is sexually active be tested for HIV. People who are infected will be diagnosed early. That way, they can get the most benefits from treatment. They also can take steps to avoid spreading the disease to others. For example, a woman who tests positive for HIV during a pregnancy can take medication to help prevent her baby from becoming infected. Or, a man who thought he was HIV negative but finds out he is infected can take steps to avoid infecting his sex partner.

Are you at risk?

If you can answer "yes" to any of the following questions, you are at above-average risk of HIV. As of 2006, guidelines from the U.S. Centers for Disease Control and Prevention recommend that any sexually active person aged 13-64 be tested for HIV every year even if that person is at low risk.

  • Have you ever had "unprotected" oral, vaginal, or anal sex (sex without a condom or other latex barrier)?
  • Have you ever had sex with someone who was an IV drug user or had HIV?
  • Have you ever had a sexually transmitted disease (STD) such as herpes, chlamydia, gonorrhea, trichomoniasis, or hepatitis?
  • Have you ever had an unplanned pregnancy?
  • Have you ever been sexually assaulted (raped, or forced or talked into having sex when you didn't want to)?
  • Have you ever passed out or forgotten what happened after you were drinking or getting high?
  • Have you ever shared needles or other equipment to inject drugs or pierce the skin, such as tattooing?
  • Have you ever received a blood transfusion? (The risk is very low in the United States, but can vary in other countries.)
  • Did your mother have HIV when you were born, or did she die of AIDS?

How is HIV treated?

There are many treatments now that can help people with HIV. As a result, many people with HIV are living much longer and healthier lives than before.

Currently, medicines can slow the growth of the virus or stop it from making copies of itself. Although these drugs don't kill the virus, they keep the amount of virus in the blood low. The amount of virus in the blood is called the viral load, and it can be measured by a test.

The lower the viral load, the longer a person can stay healthy and fight off infections.

There are several types of anti-HIV drugs. Each type attacks the virus in its own way. It's similar to the way the military plans an attack using the different strengths of the Army, Navy, Air Force, and Marines.

How are the drugs taken?

Most people who are getting treated for HIV take 3 or more drugs. This is called combination therapy or "the cocktail." (It also has a longer name: Highly Active Anti-Retroviral Therapy, or HAART.) Combination therapy is the most effective treatment for HIV.

People who are HIV positive need to work closely with their doctors to decide when to start treatment and which drugs to take.

Is it hard to take these drugs?

HIV medicines have become much easier to take in recent years. Some newer drug combinations package 3 separate medicines into only 1 or 2 pills, taken once a day, with minimal side effects. Still, taking medicine for HIV can be complicated. On one hand, some of the drugs are difficult to take, can cause serious side effects, and don't work for everyone. Even when a drug does help a particular person, it may become less effective over time or stop working altogether. On the other hand, the drugs help keep HIV under control, and let people infected with HIV live longer and healthier lives.

Once on medications, patients must work with their doctors to monitor how well the drugs are working, deal with side effects, and decide what to do if the drugs stop working.

The good news is that experts are learning more about the virus and creating new treatments for HIV, making it easier to take these medicines.

Do you have to be treated for the rest of your life?

Right now, there is no cure for HIV infection or AIDS. So, once you start treatment, you have to continue to be sure the virus doesn't multiply out of control.

Are there long-term effects?

Over time, HIV-positive people may experience symptoms from the infection and side effects from their anti-HIV drugs. Sometimes it is not clear whether the virus or the medications are causing the problems.

One long-term effect that some people experience is a change in the way their bodies handle fats and sugars. For example, they may gain or lose a lot of fat in unusual areas of the body, or they may develop heart disease or diabetes.

Eventually, people may get sick with other infections or cancers because their weakened immune system can't protect the body anymore. They may reach the advanced stage of infection called AIDS.

What causes body fat changes?

Many types of changes happen to people who are taking HIV medications and living longer. Some people have experienced visible changes in body shape and appearance. This condition is called either lipoatrophy or lipoaccumulation ("lipo" means fat; "atrophy" means shinkage, "accumulation" means increase).

Possible changes in body appearance include:

  • increased fat in the belly
  • increased fat in neck, shoulders, breasts, or face
  • fatty bumps on the body
  • loss of fat in the face, legs, or arms

People with or without body shape changes may experience changes in how sugar and fats are processed in the body. In some cases, these changes can raise the person's risk for heart disease and diabetes.

Experts aren't sure whether these changes in body fat are due to HIV itself, or to the anti-HIV drugs. There are no proven cures at this time, but there are steps people can take to reduce the effects. These include changes in diet, exercise, medication, even plastic surgery. For more information, go to Body Shape Changes (http://www.hiv.va.gov/diag-03-00) in the Just Diagnosed section.

What is an opportunistic infection?

Over time, HIV infects and kills off immune cells. This leaves the body unable to fight certain kinds of serious, sometimes deadly, infections. These are called opportunistic infections because they take the opportunity to attack when a person's immune system is weak. Having HIV can also increase the risk of getting certain cancers.

A person is said to have AIDS if the immune system becomes so weakened that the person becomes sick from one of these infections or cancers.

People can be diagnosed with AIDS even if they don't get sick. This happens if their immune systems become very weak, which can be measured by the person's "CD4 count." (CD4 cells are the cells that HIV kills.) A normal CD4 count ranges from 600 to 1,200. When the CD4 count drops below 200, a person is diagnosed with AIDS.

Is HIV always fatal?

Most people with HIV probably will have the virus in their body when they die since there is currently no way to get rid of it. Whether or not HIV will be what causes someone's death, however, is not always clear.

What many people want to know is whether it is possible to get HIV and have a normal, relatively healthy life. HIV is often thought of as an incurable, fatal illness, and it certainly can be--especially after a person's immune system is weakened to the point that he or she has AIDS.

Without treatment, most people with HIV will eventually develop AIDS and die. When someone dies of AIDS, it is usually because of an opportunistic infection or other long-term effect of having HIV.

Since 1996, improved treatments have given renewed hope to many HIV-positive people. While the treatments are not a cure, and are far from perfect, they may help to keep people with HIV healthy for a long time.

How long? No one knows, really. Some people may do very well for many, many years. Others may eventually get sick and die despite being treated. Recent studies suggest that people who take the treatments can gain, on average, 24 extra years of life. There is a great need for research to find new and better treatments for HIV.

What is HIV/hepatitis C coinfection?

Coinfection is a medical term meaning that you have two or more infections in your body at the same time. If you have HIV and hepatitis C coinfection, then you have both HIV and hepatitis C. These illnesses are very different, so it is important that you learn about both of them.

HIV is spread mainly through the blood and through sexual contact. It can wear down your body's immune system, making it hard for your body to fight off dangerous infections.

Hepatitis C is a disease that affects your liver. It is caused by a virus called the hepatitis C virus and it is spread mainly by blood, but rarely by sex. In many cases, if you have hepatitis C, it never goes away. Over time, it can cause other health problems, such as cirrhosis (or scarring of the liver) and liver cancer.

How does being coinfected affect your health?

HIV affects your whole immune system, including your body's ability to fight off hepatitis C. As a result, you might develop a case of hepatitis C that is worse than it would be if you didn't have HIV.

If you have both diseases, your treatments can be affected, too. Some HIV treatments can damage your liver, so your doctor may want you to try other treatments. And if you have HIV, you might experience worse side effects or other problems when you take medicines for hepatitis C.

What can you do to slow down your HIV and hepatitis C infections?

The best way to keep your coinfection from becoming a serious health problem is to keep yourself and your liver healthy by following these guidelines:

Respect your body.
Eat healthy food, drink plenty of water, and get restful sleep. Try to exercise every day.

Do not drink alcohol.
Alcohol weakens your immune system and damages your liver even when you are healthy. Drinking alcohol when you have HIV and hepatitis C makes the damage much worse. Remember, there is no "safe" amount of alcohol you can drink when you have HIV and hepatitis C. It doesn't help to switch from "hard" liquor to beer, cider, or wine. If you need help to stop drinking alcohol, talk to your doctor.

Don't have unsafe sex.
Practicing safer sex is the best way to keep other people from getting HIV. Hepatitis C isn't spread as easily as HIV by having sex. But you can still give hepatitis C to someone you have sex with, if you're not careful. If you have sex, the best thing to do is practice safer sex all the time. To do so, always use a condom, dental dam, or other latex barrier and avoid "rough sex" or other activities that might cause bleeding.

Do not use injection drugs.
Remember that drugs like heroin, cocaine, and speed (crystal, meth, crank, Tina) can make your illness worse. The best thing to do, especially if you have hepatitis C or HIV, is not use drugs. If you use drugs, make sure that your needle and works are clean (or brand new) every time and never share them with anyone else. Sharing needles or works to inject drugs is one of the easiest ways to spread hepatitis C and HIV. By sharing needles or works, you can even spread both of these viruses at the same time. Talk to your doctor about getting help to stop.

Get support.
Talk with your doctor if you can't stop drinking, taking drugs, or having unsafe sex. Ask your doctor where you can get support in your area. If you already get services from an AIDS organization, ask about support groups for people who have HIV and hepatitis C.

Stay informed.
HIV and hepatitis C are two of the most important medical issues today. Try to educate yourself about them. Ask your doctor if you need help making sense of anything you hear on the news or read in the newspapers.

Follow your doctor's advice.
Follow all instructions you get from your doctor. Try to keep all of your appointments. Call your doctor immediately if you have any problems.

Get vaccinated against other hepatitis viruses.
Having hepatitis C does not mean that you can't get other kinds of hepatitis. Talk to your doctor about getting vaccinations (or shots) to protect you from hepatitis A and B.

Avoid taking medicines, supplements or natural or herbal remedies that might cause more damage to your liver.
Even ordinary pain relievers can cause liver problems in some people. Check with your doctor before you take any natural or herbal remedy, supplement, prescription, or non-prescription medicine. And, make sure your doctor knows all the medicines you are taking for HIV and hepatitis C.

Resources

More information

Related Web sites

  • AIDSinfo
    (http://www.aidsinfo.nih.gov/)
    An official U.S. Department of Health and Human Services (DHHS) site featuring treatment guidelines, information on clinical trials and treatment issues, and links to U.S. government HIV/AIDS resources. AIDSinfo Site is the result of a merger of two previous DHHS projects--the HIV/AIDS Treatment Information Service (ATIS) and the AIDS Clinical Trials Information Service (ACTIS).
  • aidsmap
    (http://www.aidsmap.com/)
    A site from the UK featuring a large database of HIV prevention and treatment information for a general audience, as well as a searchable global HIV/AIDS resource directory. Produced by the National AIDS Manual (NAM Publications) in collaboration with the British HIV Association and the International HIV/AIDS Alliance.
  • The Body
    (http://www.thebody.com/)
    Community-oriented commercial site with information on prevention and treatment, coverage of major HIV/AIDS conferences, online community discussion threads, and an extensive ask-the-experts feature. Also maintains a companion site, The Body Pro (http://www.thebodypro.com) , with information for health care providers.
  • Centers for Disease Control and Prevention
    (http://www.cdc.gov/hiv/dhap.htm)
    (CDC) The site of the Division of HIV/AIDS Prevention of the CDC's National Center for HIV, STD and TB Prevention includes recommendations, guidelines, fact sheets, FAQs, statistics, and materials for prevention and research partners. CDC also maintains the National Prevention Information Network (http://www.cdcnpin.org/) (CDC NPIN), which features a daily Prevention News Update, reference materials, referral and distribution services for information on HIV/AIDS, sexually transmitted diseases, and tuberculosis; as well as the CDC Global AIDS Program (http://www.cdc.gov/nchstp/od/gap/) .
  • Johns Hopkins AIDS Service
    (http://www.hopkins-aids.edu/)
    Johns Hopkins University's clinician-oriented HIV/AIDS site. Highlights include the online Medical Management of HIV Infection clinical handbook, the Hopkins HIV Report newsletter, and expert question-and-answer forums for both providers and patients. See also JHU's Center for Communication Programs (http://www.jhuccp.org) , which designs and implements HIV/AIDS behavior change projects in over 30 countries.
  • Project Inform
    (http://www.projectinform.org/)
    Project Inform is a community-based organization that offers information to people living with HIV, their caregivers and their healthcare and service providers about the treatment and monitoring of HIV disease.
  • Hepatitis Web Sites
    (http://www.hiv.va.gov/vahiv?page=ptli-rc-04)
    A list of Web sites that offer information on viral hepatitis, including HIV/hepatitis C co-infection.
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