HIV (human
immunodeficiency virus) is a virus that attacks the
immune system, the body's natural defense system.
Without a strong immune system, the body has trouble fighting off disease. Both
the virus and the infection it causes are called HIV.
White blood cells are an important part of the immune system. HIV invades and
destroys certain white blood cells called CD4+ cells. If too many CD4+ cells
are destroyed, the body can no longer defend itself against infection.
The last stage of HIV infection is
AIDS (acquired immunodeficiency syndrome). People with
AIDS have a low number of CD4+ cells and get infections or cancers that rarely
occur in healthy people. These can be deadly.
But having HIV does
not mean you have AIDS. Even without treatment, it takes a long time for HIV to
progress to AIDS-usually 10 to 12 years. If HIV is diagnosed before it becomes
AIDS, medicines can slow or stop the damage to the immune system. With
treatment, many people with HIV are able to live long and active lives.
What causes HIV?
HIV infection is caused by the
human immunodeficiency virus. You can get HIV from contact with infected blood,
semen, or vaginal fluids.
Most people get the virus by having
unprotected sex with someone who has HIV.
Another common way of
getting the virus is by sharing drug needles with someone who is infected with
HIV.
The virus can also be passed from a mother to her baby during
pregnancy, birth, or breast-feeding.
HIV doesn't survive well outside the body. So it cannot
be spread by casual contact such as kissing or sharing drinking glasses with an
infected person.
What are the symptoms?
HIV may not cause symptoms
early on. People who do have symptoms may mistake them for the
flu or
mono. Common early symptoms include:
Symptoms may appear from a few days to several weeks
after a person is first infected. The early symptoms usually go away within 2
to 3 weeks.
After the early symptoms go away, an infected person
may not have symptoms again for many years. Treatment usually keeps the virus
under control and helps the immune system stay healthy. But without treatment,
the virus continues to grow in the body and attacks the immune system. After a
certain point, symptoms reappear and then remain. These symptoms usually
include:
Swollen lymph nodes.
Extreme
tiredness.
Weight loss.
Fever.
Night
sweats.
A doctor may suspect HIV if these symptoms last and no
other cause can be found.
How is HIV diagnosed?
The U.S. Food and Drug
Administration (FDA) has approved tests that detect HIV
antibodies in urine, fluid from the mouth (oral
fluid), or blood. If a test on urine or oral fluid shows that you are infected
with HIV, you will probably need a blood test to confirm the results. If you
have been exposed to HIV, your immune system will make antibodies to try to
destroy the virus. Blood tests can find these antibodies in your blood.
Most doctors use two blood tests, called the ELISA and the Western blot
assay. If the first ELISA is positive (meaning that HIV antibodies are found),
the blood sample is tested again. If the second test is positive, the doctor
will do a Western blot to be sure.
It may take as long as 6 months
for HIV antibodies to show up in a blood sample. If you think you have been
exposed to HIV but you test negative for it:
Get tested again in 6 months to be sure you
are not infected.
Meanwhile, take steps to prevent the spread of
the virus. If you are infected, you can still pass HIV to another person during
this time.
Some people are afraid to be tested for HIV. But if there
is any chance you could be infected, it is very important to find out. HIV can
be treated. Getting early treatment can slow down the virus and help you stay
healthy. And you need to know if you are infected so you can prevent spreading
the infection to other people.
You can get HIV testing in most
doctors' offices, public health clinics, hospitals, and Planned Parenthood
clinics. You can also buy a home HIV test kit in a drugstore or by mail order.
But be very careful to choose only a test that has been approved by the FDA. If
a home test is positive, see a doctor to have the result confirmed and to find
out what to do next.
How is it treated?
The standard treatment for HIV
is a combination of medicines called highly active antiretroviral therapy
(HAART). Antiretroviral medicines slow the rate at which the virus multiplies.
Taking these medicines can reduce the amount of virus in your body and help you
stay healthy.
It may not be easy to decide the best time to start
treatment. There are pros and cons to taking HAART before you have symptoms.
Discuss these with your doctor so you understand your choices.
To
monitor the HIV infection and its effect on your immune system, a doctor will
do two tests:
Viral load, which shows the amount of virus
in your blood.
CD4+ cell count, which shows how well your immune system is
working.
If you have no symptoms and your CD4+ cell count is at a
healthy level, you may not need treatment yet. Your doctor will repeat the
tests on a regular basis to see how you are doing. If you have symptoms, you
should consider starting treatment, whatever your CD4+ count is.
After you start treatment, it is important to take your medicines exactly
as directed by your doctor. When treatment doesn't work, it is often because
HIV has become
resistant to the medicine. This can happen if you
don't take your medicines correctly. Ask your doctor if you have questions
about your treatment.
Treatment has become much easier to follow
over the past few years. New combination medicines include two or three
different medicines in one pill. Many people with HIV get the treatment they
need by taking just one or two pills a day.
To stay as healthy as
possible during treatment:
Don't smoke. People with HIV are more likely
to have a
heart attack or get lung cancer.1, 2 Smoking can increase these risks
even more.
Eat a healthy, balanced diet to keep your immune system
strong.
Get regular exercise to reduce stress and improve the
quality of your life.
Don't use illegal drugs, and limit your use
of alcohol.
Learn all you can about HIV so you can take an active
role in your treatment. Your doctor can help you understand HIV and how best to
treat it. Also, consider joining an HIV support group. Support groups can be a
great place to share information and emotions about HIV infection.
How can you prevent HIV?
HIV can be spread by
people who don't know they are infected. To protect yourself and others:
Practice safe sex. Use a condom every time
you have sex (including oral sex) until you are sure you and your partner are
not infected with HIV.
Don't have more than one sex partner at a
time. The safest sex is with one partner who has sex only with
you.
Talk to your partner before you have sex the first time. Find
out if he or she is at risk for HIV. Get tested together and retested 6 months
later. Use condoms in the meantime.
Don't drink a lot of alcohol
or use illegal drugs before sex. You might let down your guard and not practice
safe sex.
Don't share personal items, such as toothbrushes or
razors.
After
HIV is in the body, it attacks and destroys
CD4+ cells, which are the part of the body's
immune system that fights infection and disease. When
HIV weakens or destroys the immune cells, it may lead to certain
illnesses or diseases, such as some types of
pneumonia or cancer that are more likely to develop in
someone who has a
weakened immune system. These conditions are a sign
that HIV has progressed to
AIDS.
HIV is spread when blood,
semen, or vaginal fluids from an infected person enter
another person's body, usually through sexual contact, from sharing needles
when injecting drugs, or from mother to baby during birth.
HIV is
rarely spread by blood transfusions or organ transplants in the United States
because of improved screening procedures.
Symptoms
HIV infection
progresses in
stages. These stages are based on your symptoms and
the amount of the virus in your blood. Most people go through the following
stages after being infected with HIV:
Acute retroviral syndrome is an illness with symptoms like
mononucleosis. It often develops within a few days of
infection, but it may occur several weeks after the person is infected.
Symptoms may include:
Abdominal cramps, nausea, or
vomiting.
Diarrhea.
Enlarged
lymph nodes in the neck, armpits, and
groin.
Fever.
Headache.
Muscle aches and
joint pain.
Skin rash.
Sore throat.
Weight
loss.
These first symptoms can range from mild to severe and
usually disappear on their own after 2 to 3 weeks.
Chronic stage
It may take years for HIV symptoms
to develop. But even though no symptoms are present, the virus is multiplying
(or making copies of itself) in the body during this time. HIV multiplies so
quickly that the
immune system cannot destroy the virus. After years of
fighting HIV, the immune system starts to weaken.
A doctor may
suspect HIV if symptoms persist or if a cause of the symptoms (such as the flu)
cannot be identified. HIV may also be suspected when several of the following
symptoms are present:
Confusion
Diarrhea or other bowel
changes
Difficulty concentrating
Dry
cough
Fatigue
Fever
Loss of
appetite
Mouth sores
Nail changes
Night
sweats
Swollen
lymph nodes in the neck, armpits, and
groin
Children with HIV often have
different symptoms (for example, delayed growth or an
enlarged
spleen) than teens or adults.
Late stage
AIDS occurs
during the last
stage of infection with HIV. If HIV goes untreated,
AIDS develops in most people within 12 to 13 years after the initial infection.
With treatment for HIV, the progression to AIDS may be delayed or
prevented.
After your immune system starts to weaken, you are
more likely to develop certain infections or illnesses, called
opportunistic infections. Examples include some types
of
pneumonia or cancer that are more common when you have
a
weakened immune system.
A small number of people who are infected with HIV are
rapid progressors. They develop AIDS within a few years if they do not receive
treatment. It is not known why the infection progresses faster in these
people.
HIV-1, which causes almost all the cases of
AIDS worldwide
HIV-2, which causes
an AIDS-like illness. HIV-2 infection is uncommon in the United States.
How the disease is spread
HIV is spread when
blood,
semen, or vaginal fluids from an infected person enter
another person's body, usually through:
Sexual contact. The virus may enter the
body through a tear in the lining of the
rectum,
vagina,
urethra, or mouth. Between 75% and 80% of all cases of
HIV are transmitted by sexual contact.3
Infected blood. HIV can be spread when a
person:
Shares needles, syringes, cookers,
cotton, cocaine spoons, or eyedroppers used for injecting drugs or
steroids.
Is accidentally stuck with a needle or other sharp item
that is contaminated with HIV.
It is now extremely rare in the United States for HIV to
be transmitted by
blood transfusions or organ transplants. Blood and
organ donors are screened for risk factors. All donated blood and organs are
screened for HIV.
Health care workers are no longer
considered to be at high risk of exposure to HIV. Policies are in place in
health facilities that require protection from accidental exposure. Workers
must properly dispose of sharp objects and wear protective gloves, gowns, and
eye and face protection. These measures have been effective in protecting
health care workers from HIV.
Spread of HIV to babies
A woman who is infected
with HIV can spread the virus to her baby during pregnancy, delivery, or
breast-feeding.
Most children younger than 13 years who have
HIV were infected with the virus by their mothers.
The risk of a
woman spreading HIV to her baby can be greatly reduced if she is on medicine
that reduces her viral load (HIV RNA) to undetectable levels during pregnancy,
if she receives AZT (ZDV) before the baby is born, and if she does not
breast-feed her baby. The baby should also receive treatment after it is
born.
Ways HIV cannot be spread
HIV does not survive
well outside the body. Therefore,
HIV cannot be spread through casual contact-such as sharing drinking glasses
or by casual kissing-with an infected person. HIV is not transmitted through
contact with an infected person's saliva, sweat, tears, urine, or feces, or
through insect bites.
Contagious and incubation period
The incubation
period-the time between when a person is first infected with HIV and when early
symptoms develop-may be a few days to several weeks.
It can take
as little as 2 weeks or as long as 6 months from the time you become infected
with HIV for the antibodies to be detected in your blood. This is commonly
called the "window period," or
seroconversion period. During the window period, you
are contagious and can spread the virus to others. If you think you have been
infected with HIV but you test negative for it, you should be tested again 6
months later.
After you become infected with HIV, your blood,
semen, or vaginal fluids are always infectious, even if you receive treatment
for the HIV infection.
Stages of HIV
Most people go through the following
stages after being infected with HIV if the infection is not treated:
Acute retroviral syndrome, which has
symptoms similar to
mononucleosis. This often develops within a few days
of infection, but may occur several weeks after the person is infected.
HIV without symptoms (asymptomatic). It may take years for HIV
symptoms to develop. But even though no symptoms are present, the virus is
multiplying (or making copies of itself) in the body during this time. HIV
multiplies so quickly that the
immune system cannot destroy the virus. After years of
fighting HIV, the immune system starts to weaken.
HIV with symptoms
(symptomatic). After your immune system starts to weaken, you are more likely
to develop certain
infections or illnesses, such as some types of
pneumonia or cancer that are more common in people who
have a
weakened immune system.
AIDS, which occurs during the last
stage of infection with HIV. If HIV goes untreated,
AIDS develops in most people within 12 to 13 years after the initial infection.
With treatment for HIV, the progression to AIDS may be delayed or
prevented.
A small number of people who are infected with HIV are
rapid progressors. They develop AIDS within a few years if they do not receive
treatment. It is not known why the infection progresses faster in these
people.
Nonprogressors and HIV-resistant
A few people have
HIV that does not progress to more severe symptoms or disease. They are
referred to as
nonprogressors.
A small number of people
never become infected with HIV despite years of exposure to the virus. For
example, they may have repeated, unprotected sex with an infected person. These
people are said to be
HIV-resistant.
What Increases Your Risk
Most people get
HIV by having unprotected sex with someone who has
HIV. Another common way of getting the virus is by sharing needles with someone
who is infected with HIV when injecting drugs.
You have an
increased risk of becoming infected with HIV through sexual contact if
you:
Have unprotected sex (do not use
condoms).
Have multiple sex partners.
Are a man who has
sex with other men.
Have high-risk partner(s) (partner has multiple
sex partners, is a man who has sex with other men, or injects
drugs).
People who inject drugs or steroids, especially if they
share needles, syringes, cookers, or other equipment used to inject drugs, are
at risk of being infected with HIV.
Babies who are born to mothers
who are infected with HIV are also at risk of infection.
What to think about
HIV may be spread more easily
in the early
stage of infection, when the first flu-like symptoms
of HIV (acute retroviral syndrome) are present, and again
later, when symptoms of HIV-related illness develop.
The risk of
getting HIV from a
blood transfusion or organ transplant is extremely low
because all donated blood and organs in the United States are screened for
HIV.
When To Call a Doctor
Known HIV infection
If you are infected with
HIV or caring for someone who is, call 911 or other emergency services immediately if any of the following conditions
develop:
Personality changes or decline in mental ability,
such as confusion, disorientation, or an inability to do mental tasks that the
person has done in the past
Sores, bumps, rashes, blisters, or
warts that appear on or around the genital or anal areas
Suspected or known exposure to HIV and symptoms are present
Many people have a
flu-like illness 3 to 6 weeks after they are first
infected with HIV, but symptoms can occur within a few days of infection.
Symptoms of
acute retroviral syndrome (such as nausea and
headache), which are the first signs of HIV infection, are often mistaken for
symptoms of another viral infection.
Call your doctor to
determine whether HIV testing is needed if you suspect you have been exposed to
HIV, particularly if you engage in
high-risk behavior and develop any of the following
symptoms:
Abdominal cramps, nausea, or
vomiting
Diarrhea
Enlarged lymph nodes in the neck, armpits, and
groin
Initial symptoms of HIV infection may be mild to severe
and usually disappear on their own after 2 to 3 weeks.
Suspected or known exposure to HIV but symptoms are not present
If you have not been tested for HIV, call your doctor
if:
You suspect that you have been exposed to
HIV.
You have engaged in high-risk behavior and are concerned that
you were exposed to HIV.
Your sex partner engages in high-risk
behavior.
Your sex partner may have been exposed to
HIV.
Your sex partner has HIV.
You develop any of the
symptoms listed above.
Getting tested for HIV can be scary, but the condition
is treatable so it is important to get tested if you think you have been
exposed. Early detection and monitoring of HIV will help your doctor determine
whether the disease is progressing and when to start treatment.
Do not share needles,
syringes, cookers, cotton, cocaine spoons, or eyedroppers.
If you do not have symptoms of HIV even though you have
tested positive for the virus, you and your doctor may simply continue to watch
for symptoms to occur. If you do not show any signs of disease and your CD4+
cell count is more than 350 cells per microliter (mcL), you may not require
treatment. But during this time you still need regular checkups with a doctor
to monitor your
viral load and
CD4+ cell counts-these tests measure the amount of HIV
in your blood and detect how well your immune system is working.
Who To See
Health professionals who can diagnose and may treat
HIV include:
Public
health clinics and other organizations provide low-cost, confidential testing
and counseling about HIV and high-risk behavior. If you have questions about
the testing procedure, ask your doctor to explain the procedure to you.
If you do not have a doctor, contact one of the following for information
on HIV testing in your area:
Your county or state health
department
Local AIDS organization
Centers for Disease
Control and Prevention (CDC) 24-hour information hotline: 1-800-232-4636
(1-800-CDC-INFO) or see the CDC National HIV Testing Resources Web site:
www.hivtest.org
National Association of People with AIDS (NAPWA)
hotline: (240) 247-0880 or see the NAPWA Web site:
www.napwa.org
U.S. National Institutes of Health (NIH) toll-free
HIV hotline: 1-800-448-0440 or see the NIH AIDS Web site at
www.aidsinfo.nih.gov
Getting tested for
HIV can be scary, but the condition is treatable so it
is important to get tested if you think you have been exposed. If you test
positive, early detection and monitoring of HIV will help your doctor determine
whether the disease is progressing and when to start treatment.
Your doctor may recommend counseling before and after HIV testing, and it
is usually available at the hospital or clinic where you will be tested. This
will give you an opportunity to:
Discuss your fears about being
tested.
Learn how to reduce your risk of becoming infected if your
test is negative.
Learn how to keep from spreading HIV to others if
your test is positive.
Think about personal issues, such as how
having HIV will affect you socially, emotionally, professionally, and
financially.
Learn what you need to do to stay healthy as long as
possible.
HIV is diagnosed when
antibodies to HIV are detected in the blood. The two
primary blood tests used to detect the HIV antibodies are:
Western blot assay, used to confirm the results of a positive ELISA test.
HIV is diagnosed only after two or more positive ELISA tests are confirmed by one positive Western blot assay.
It can take as little as 2 weeks or as
long as 6 months from the time you become infected with HIV for the antibodies
to be detected in your blood. This is commonly called the "window period," or
seroconversion period. During the window period, you
are contagious and can spread the virus to others. If you think you have been
exposed to HIV but you test negative for it, you should be tested again 6
months later.
Testing positive for HIV infection
Testing
positive for HIV will probably make you anxious and afraid about your future.
The good news is that people being treated for HIV are living longer than ever
before with the help of medicines that slow the rate at which HIV progresses to
AIDS, or even prevent AIDS from developing. Your doctor can help you understand
your condition and how best to treat it.
If you test positive for
HIV, your doctor will complete a
medical history and physical examination. He or she
may order several lab tests to evaluate your overall health condition and
identify current or previous infections that may become more complicated
because of HIV. These tests include:
Some strains of HIV may be
resistant to certain medicines. If you tested positive
for HIV, your doctor may test you at this stage to see if you have been
infected with a drug-resistant strain of HIV. This will help him or her
determine which medicines to use when the infection is treated.
Your doctor will use the results of the physical exam and lab tests to
determine the progression of HIV at later exams.
What to think about
The Centers for Disease
Control and Prevention (CDC) recommends HIV screening as part of routine blood
testing. You and your doctor can decide if testing is right for you.
Most test facilities will have the ELISA test results in 2 to 4 days.
Results of the Western blot take longer-1 to 2 weeks. The OraQuick Rapid HIV-1
Antibody test gives results in as little as 20 minutes. Although the OraQuick
test is known to be very accurate, recently there have been more test results
that appear to show HIV when in fact HIV is not present (false-positive). Experts are not sure why this is
happening.
Call and ask for your HIV test results if you have not
been contacted within 1 to 2 weeks of being tested.
Denial, fear,
and
depression are common reactions to a diagnosis of HIV.
Don't be afraid to ask for the emotional support you need. If your family and
friends are unable to provide you with support, a
professional counselor can help.
Monitoring of established HIV infection
Two tests
will be done regularly to monitor how much HIV is in your blood (viral load),
and how the virus is affecting your
immune system. The results of these tests will help
you make decisions about starting
highly active antiretroviral therapy (HAART) or
switching to new medicines if the ones you are currently taking are not
effective.
CD4+ cell counts provide information about the health of your immune
system.
Viral load measures the amount of HIV in your
blood.
Testing for drug resistance
HIV often changes or
mutates in the body. Sometimes these changes make the virus resistant to a
particular medicine or class of medicines. This means the medicine can no
longer slow down or prevent the virus from multiplying or protect the immune
system.
Two blood tests are available to detect drug resistance in
the virus:
Genotyping assays,
which detect mutations in the viral
genes. Test results are generally available in 1 to 2
weeks.
Phenotyping assays, which measure the
ability of the virus to grow in cells with antiretroviral medicines. Test
results are generally available in 2 to 3 weeks.
The U.S. Department of Health and Human Services (DHHS)
recommends that HIV genotype testing should be done for everyone when first
diagnosed with HIV infection.4 The results can tell if
a person is infected with a resistant strain of HIV. This information helps
develop a treatment approach to use when treatment is started.
You
also may be tested for drug resistance when you are ready to begin treatment,
viral load numbers stop declining during treatment, or
viral load numbers become detectable after not being detectable while on
treatment.
Drug resistance can occur when:
There is a change in the way your body
absorbs the medicine.
There are interactions between two or more
medicines you are taking.
The virus changes and no longer responds
to the medicines you are taking.
You have been infected with a
drug-resistant strain of the virus.
You have not taken your
medicines as prescribed by your doctor.
Other medicines are available that may treat some
resistant strains of HIV.
How is AIDS diagnosed?
AIDS is the
last and most severe stage of HIV infection. It is diagnosed if the results of
your test show that you have:
A
CD4+ cell count of less than 200 cells per microliter
(mcL) of blood.
The U.S. Centers for Disease Control and
Prevention (CDC) recommends that everyone should get tested for HIV as part of
their regular medical care. In addition, the
United States Preventive Services Task Force (USPSTF)
recommends screening tests for HIV if:
You are pregnant.
Early treatment with highly active antiretroviral therapy (HAART) can reduce
the risk of passing HIV to your baby.
You have been to a sexually
transmitted disease (STD) clinic or a tuberculosis (TB) clinic.
Treatment Overview
The most effective treatment for
HIV is
highly active antiretroviral therapy (HAART)-a
combination of several antiretroviral medicines that aims to control the amount
of virus in your body. Other steps you can take include keeping your
immune system strong, taking medicines as prescribed,
and monitoring your
CD4+ (white blood cells) counts to check the effect of
the virus on your immune system. If HIV is not treated, it eventually
progresses to
AIDS, the last and most severe stage of HIV infection.
People with AIDS are more likely to develop certain illnesses, called
opportunistic infections. Examples include
tuberculosis and some cancers. These illnesses are
common in people who have weakened immune systems.
Treatment to prevent infection (postexposure prophylaxis)
Health care workers
who may be at risk for HIV because of an accidental needlestick or other
exposure to body fluids may need medicine to prevent infection.5 Medicine may also prevent HIV infection in a person who
has been raped or was accidentally exposed to the body fluids of a person who
may have HIV.6 This type of treatment is usually
started within 72 hours of the exposure.
Initial treatment
If you are diagnosed with
HIV infection during the initial symptoms of early HIV
(acute retroviral syndrome), discuss the use of
highly active antiretroviral therapy (HAART) with your
doctor. Information about treatment of early HIV from
clinical trials is very limited but suggests that
treatment of early HIV with antiretroviral medicines may have long-term
benefits.4 But more studies need to be done.
HAART medicines that are most often used to treat HIV infection
include:
Protease inhibitors (PIs), such as atazanavir,
saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir,
lopinavir/ritonavir, tipranavir, or darunavir.
The decision whether to start HAART before your health
starts to decline is complicated. Consider the potential benefits and risks of
early treatment and discuss all the issues with your doctor before starting
HAART.
Lower the risk of
drug resistance with complete viral suppression.
Reduce the risk
of HIV spreading.
Note:
Even with early treatment, the
risk of HIV transmission still exists. Antiretroviral therapy cannot substitute
for prevention measures, such as condom use and safer sex
practices.
Lead to the development of
drug resistance to antiretroviral medicines, which may limit future treatment
options.
Result in the need for continuing therapy
indefinitely.
Reduce future medication options when HIV disease risk is
highest.
If you do not have symptoms of HIV even though you have
tested positive for the virus, you and your doctor may simply continue to watch
for symptoms to occur. If you do not show any signs of disease and your CD4+
cell count is more than 350 cells per microliter (mcL), you may not require
treatment. But during this time you still need regular checkups with a doctor
to monitor your
viral load and
CD4+ cell counts-these tests measure the amount of HIV
in your blood and detect how well your immune system is working. For more
information, see:
Ongoing treatment for
HIV includes regular appointments with your doctor to
monitor the amount of virus in your blood (viral load) and
CD4+ cell counts. This is done with blood tests taken
every 3 to 4 months that show how much virus is in your blood and how it is
affecting your
immune system.4 The results
of these tests will help monitor your infection and help you make decisions
about starting antiretroviral medicines.
The most effective
treatment for HIV infection is antiretroviral medicines called
highly active antiretroviral therapy (HAART). HAART is
a combination of several antiretroviral medicines that aims to control the
amount of virus in your body. It interferes with the ability of the virus to
multiply and weaken your immune system.
HAART medicines that are
most often used to treat HIV infection include:
Protease inhibitors (PIs), such as atazanavir,
saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir,
lopinavir/ritonavir, tipranavir, or darunavir.
Treatment guidelines suggest the following for people
with HIV:4
When considering treatment, experts currently consider your
CD4+ cell count and the presence or absence of symptoms much more important
than your viral load.
If your
CD4+ cell count is below 350 cells per microliter
(mcL), you should begin treatment to stabilize and increase your CD4+ cell
count.
If your CD4+ cell count is more than 350 cells per
microliter, treatment may be offered to help keep your
immune system healthy and prevent AIDS.
If
treatment is not started, your condition will be monitored with frequent CD4+
cell counts.
If you have symptoms of HIV or AIDS, you should consider
starting treatment, whatever your CD4+ cell count is.
If you are
pregnant, you should be treated to prevent your unborn baby (fetus) from becoming infected with HIV.
If
you also have
hepatitis B and are starting treatment for it, you
should begin treatment for HIV as well.
Lifestyle choices that can help keep your immune system
strong include:
Quit smoking. People with HIV are more likely
to have a
heart attack or get lung cancer.1, 2 Cigarette smoking can increase
these risks even more. For more information, see the topic
Quitting Tobacco Use.
Limit your use of
alcohol. Abuse of alcohol increases the rate of HIV progression. For more
information, see the topic
Alcohol Abuse and Dependence.
Eat a healthy, balanced diet. Getting adequate protein and calories may help your immune system
fight the HIV infection and improve your overall health. For more information,
see the topic
Healthy Eating.
Do not use drugs.
Intravenous (IV) drug use also increases the risk of
HIV progression, though the reasons for this are not clear. The use of IV drugs
makes it more difficult to follow a treatment plan and increases the risk of
transmitting HIV to others. Abuse of marijuana, cocaine (crack), and other
drugs also can cause HIV to progress more rapidly.
Learning how to live with HIV infection may also keep
your immune system strong, while also preventing the spread of HIV to
others.
Learn how to
handle food properly to prevent the spread of food-borne infections. For more
information, see the topic
Food Poisoning and Safe Food Handling.
Counseling is another treatment that
can improve your quality of life while you are living with HIV. It can help you
manage
anxiety and
depression, which commonly occur with an HIV
diagnosis. For more information, see the topics
Anxiety and
Depression.
If your partner has
HIV:
Provide emotional support. Don't be
afraid to discuss the disease. Often, people with HIV need to
talk.
As
HIV progresses to an established or late stage,
treatment with three or more antiretroviral medicines (highly active antiretroviral therapy, or HAART) may be needed. The decision to treat
your HIV infection with HAART is based on your:
Ability to follow your
medicine schedule as prescribed, which is essential for successful treatment of
HIV.
Treatment guidelines suggest the following for people
with HIV:4
When considering treatment, experts currently consider your
CD4+ cell count and the presence or absence of symptoms much more important
than your viral load.
If your CD4+ cell count is below 350 cells per microliter
(mcL), you should begin treatment to stabilize and increase your CD4+ cell
count.
If your CD4+ cell count is more than 350 cells per microliter,
treatment may be offered to help keep your
immune system healthy and prevent AIDS.
If treatment is not started, your condition will be monitored with frequent
CD4+ cell counts.
If you have symptoms of HIV or AIDS, you should consider
starting treatment, whatever your CD4+ cell count is.
If you are pregnant, you should be treated to prevent your
unborn baby (fetus) from becoming infected with HIV.
If
you also have
hepatitis B and are starting treatment for it, you
should begin treatment for HIV as well.
When HIV has progressed to AIDS, treatment is
recommended.4
Measuring the effectiveness of medicine therapy
Your doctor will measure the effectiveness of your medicine treatment
plan by monitoring your
CD4+ cell count and
viral load.
Treatment failure
If your
viral load does not drop as expected, or your
CD4+ cell count starts to fall, your doctor will try
to identify why the medicines are not working.
There are two main
reasons that treatment fails:
The HIV has become
drug-resistant. The medicines no longer effectively
control virus multiplication nor protect the
immune system. Tests can determine whether drug
resistance has occurred. You may need a different combination of
medicines.
You did not take your medicine as prescribed. If you have
difficulty taking the medicines exactly as prescribed, talk with your
doctor.
Even though HIV treatment is now more successful at
prolonging life, when HIV progresses to AIDS, certain types of severe
infections develop that can lead to death. Left
untreated, AIDS is often fatal within 18 to 24 months after it develops. Death
may occur sooner in people who
rapidly progress through the stages of HIV or in young
children.
Many important end-of-life decisions can be made while
you are active and able to communicate your wishes. For more information, see
the topic
Care at the End of Life.
What To Think About
Denial, fear, and
depression are common reactions to a diagnosis of HIV.
Don't be afraid to ask for the emotional support you need. If your family and
friends are unable to provide you with support, a
professional counselor can help.
Treatment options for HIV are changing often, and experts debate which
treatment is best. Talk to your doctor about the treatment that may be best for
you.
Alternative and
complementary treatments for HIV need to be carefully
evaluated. Some people with HIV may use these types of treatment to help with
fatigue and weight loss caused by HIV infection and reduce the side effects
caused by HAART. Some alternative treatments for HIV or other illnesses (such
as
St. John's wort) may interfere with your HIV
medicines. It is important to discuss alternative treatments with your doctor
before trying them.
If you are a caregiver
of a person whose HIV has progressed, the following information may help
you:
Taking care of yourself, such as sharing your
frustrations with others who share a similar experience
Prevention
You can keep from getting
HIV by avoiding
behaviors that might result in contact with infected
blood,
semen, or vaginal fluids.
Practice safe sex to prevent HIV.
Always use a
condom during sexual activity, unless you are in a
relationship with one partner who does not have HIV or other sex
partners.
If you do have sex with someone who has HIV, it is
important to practice safe sex and to be regularly tested for
HIV.
Reduce your number of sex partners, preferably to one
partner.
Talk with your sex partner or partners about their sexual
history, as well as your own sexual history. Find out whether your partner has
engaged in
high-risk behaviors.
Avoid alcohol and
drugs, which can impair both your judgment and your
immune system. People who know and understand safer
sex practices may not practice them when they are under the influence of
alcohol or drugs.
Do not share
intravenous (IV) needles, syringes, cookers, cotton,
cocaine spoons, or eyedroppers with others if you use drugs.
If you are HIV-positive (infected with HIV) or have engaged
in sex or needle-sharing with someone who could be infected with HIV, take
precautions to avoid spreading the infection to others.
Tell your sex partner or partners about your
behavior and whether you are HIV-positive.
Follow safe sex
practices, such as using condoms.
Do not donate blood, plasma,
semen, body organs, or body tissues.
Do
not share personal items, such as toothbrushes, razors, or sex toys, that may
be contaminated with blood, semen, or vaginal fluids.
The risk of a woman spreading HIV to her baby can be
greatly reduced if she is on medicine that reduces her viral load (HIV RNA) to
undetectable levels during pregnancy, if she receives AZT (ZDV) before the baby
is born, and if she does not breast-feed her baby. The baby should also receive
treatment after it is born.
If you do not regularly engage in
high-risk behaviors for HIV, such as having unprotected sex or injecting drugs,
and you feel you have been exposed this way, contact your doctor as soon as
possible. He or she may recommend medicine if your exposure was within the past
72 hours.6
Home Treatment
If you are infected with
HIV, you can lead an active life for a long time.
There are many steps you can take to maintain your health and prevent the
spread of HIV.
Learn more about HIV to help you
actively participate in your health care decisions.
Get the
immunizations and the medication treatment you need to prevent certain
infections or illnesses, such as some types of
pneumonia or cancer that are more likely to develop in
people who have a weakened immune system.
Join a support group
to share your feelings and seek support from others who are in the same
situation.
Do not smoke. People with HIV are more likely to have a
heart attack or get lung cancer.1, 2 Cigarette smoking can raise these
risks even more.
Learn how to handle food properly to prevent the
spread of food-borne illness. For more information, see the topic
Food Poisoning and Safe Food Handling.
A skilled and knowledgeable caregiver can provide the
emotional, physical, and medical care that will improve the quality of life for
a person who has HIV. If your partner has HIV:
Take care of yourself by sharing your frustrations
with others and seeking help when you need it.
Provide home care by learning how to give medicine and seek help in an
emergency.
What to think about
Your doctor will consider
certain factors such as drug resistance and medicine side effects in
determining how best to treat your HIV infection. Treatment for HIV may help
you live longer. But HIV can be a progressive, fatal disease. Many important
end-of-life decisions can be made while you are active and able to communicate
your wishes. For more information, see the topic
Care at the End of Life.
Medications
Medicines are the primary treatment for
HIV. Your doctor will usually prescribe several
medicines-this is sometimes called an anti-HIV "cocktail"-that keeps HIV from
multiplying and helps keep the
immune system healthy. In the past a person had to
take several doses of HIV medicine every day, which was difficult for some
people. But over the past few years this routine has become much simpler, and
many people take their medicine for HIV only once or twice a day.
Medicines used to treat HIV are called antiretrovirals, and several of
these are combined for treatment called
highly active antiretroviral therapy, or HAART. Using
HAART reduces your risk of developing
resistance to HIV medicines. Resistance is more likely
to develop in people who are treated with only one antiretroviral
medicine.
When choosing antiretroviral medicines, your doctor will
consider certain factors, such as:
The medicines' effectiveness in reducing
viral load.
The likelihood that the virus
will become
resistant to a certain class of medicine. If you have
already been treated with a certain antiretroviral medicine, you or your doctor
may already know whether you have a resistance to medicines in that
class.
Medicine side effects and your willingness to tolerate
them.
Protease inhibitors (PIs), such as atazanavir,
saquinavir, ritonavir, indinavir, nelfinavir, fosamprenavir,
lopinavir/ritonavir, tipranavir, or darunavir.
Integrase inhibitors. The only integrase inhibitor
approved by the U.S. Food and Drug Administration (FDA) for HIV treatment is
raltegravir (Isentress). This medicine also is used with other HIV medicines
for adults whose current treatments are no longer controlling virus
activity.
If your viral load does not
drop as expected, or if your CD4+ cell count starts to fall, your doctor will
try to determine why the treatment was not effective.
There are
two main reasons that treatment fails:
The virus that causes HIV has become
resistant. The medicine no longer effectively controls virus multiplication nor
protects your immune system. Tests can determine whether resistance has
occurred. You may need a different combination of medicines.
You did not take your medicine as prescribed. If you have
difficulty taking the medicines exactly as prescribed, talk with your
doctor.
What To Think About
You will have frequent blood
tests to monitor your CD4+ cell count and viral load while you are taking
medicines to treat HIV.
Taking your medicines as prescribed can keep HIV from
multiplying and will help prevent other infections. This also can help keep the
virus from becoming resistant to the medicines and prevent problems that can
limit future treatment options.
Your medicines may have
unpleasant side effects, which sometimes make you feel worse than you did
before you started taking them. Talk to your doctor about your side effects. He
or she may be able to adjust your medicines or prescribe a different
one.
You may be able to take several medicines combined into one
pill. This reduces the number of pills you have to take each day.
People with HIV may need
surgery for other conditions. You can have surgery if you are HIV-positive. But
you may have a more difficult time healing after surgery if you have a
weakened immune system.
Other Treatment
HIV can cause emotional, social, and financial
stresses that significantly add to the stress of being ill. Accepting that
these stresses are present and getting the education and support you need may
help you manage them and improve your quality of life, as well as the lives of
your caregivers.
Other Treatment Choices
Counseling may help with the strong
emotions associated with an HIV diagnosis and can reduce the
anxiety and
depression that often occur with HIV. For more
information, see the topics
Anxiety and
Depression.
Reducing stress can help you
better manage the HIV illness. Some methods of stress reduction include:
Relaxation, which involves breathing and muscle
relaxation exercises.
Guided imagery, a series of thoughts and suggestions
that help you relax.
Biofeedback, which teaches you to relax through
learning to control a body function that is not normally under conscious
control, such as heart rate or skin temperature.
Problem solving, which focuses on any current problems
in your life and helps you solve them.
Acupuncture, which
involves the insertion of very thin needles into the skin to stimulate energy
flow throughout the body. It may also help reduce the side effects of HIV
medicines.
What To Think About
Alternative and
complementary treatments for HIV need to be carefully
evaluated. Some people with HIV may use these types of treatment to help with
fatigue and weight loss caused by HIV infection and reduce the side effects
caused by HAART. Some complementary therapies for other problems may actually
be harmful-for example,
St. John's wort decreases the effectiveness of certain prescription
medicines for HIV. It is important to discuss complementary therapies with your
doctor before trying them.
Other Places To Get Help
Online Resource
National HIV and STD Testing Resources
Centers for Disease Control and Prevention
(CDC)
Web Address:
www.hivtest.org
The National HIV and STD Testing Resources Web site
includes a national database of testing sites as well as answers to many
questions about HIV, STDs, and testing.
Organizations
AIDS Alliance for Children, Youth and
Families
1600 K Street NW
Suite 200
Washington, DC 20006
Phone:
1-888-917-AIDS (1-888-917-2437) (202) 785-3564
Fax:
(202) 785-3579
E-mail:
info@aids-alliance.org
Web Address:
www.aids-alliance.org
AIDS Alliance for Children, Youth and Families is a nonprofit
organization created to improve the lives of women, children, youth, and
families living with HIV/AIDS. The organization works to make sure women,
children, youth, and families affected by the disease-and their care
providers-are heard. They do this through education and training, research, and
advocacy.
AIDSinfo
P.O. Box 6303
Rockville, MD 20849-6303
Phone:
1-800-HIV-0440 (1-800-448-0440) (301) 519-0459
Fax:
(301) 519-6616
TDD:
1-888-480-3739
E-mail:
contactus@aidsinfo.nih.gov
Web Address:
www.aidsinfo.nih.gov
The AIDSinfo hotline and Web site are sponsored by the
U.S. Department of Health and Human Services. They provide information on
HIV/AIDS treatment, prevention, and research. The hotline provides information
in English and in Spanish.
CDC HIV/AIDS Information line
Phone:
1-800-232-4636 (1-800-CDC-INFO)
TDD:
1-888-232-6348
Web Address:
www.cdc.gov/hiv
This hotline provides general information and referrals to local
organizations, clinics, counseling and test sites, legal resources, and support
groups. It also provides written information regarding all aspects of HIV or
AIDS. It is open 7 days a week, 24 hours a day. Information is provided in
English and in Spanish.
National Association of People With
AIDS
8401 Colesville Road
Suite 750
Silver Spring, MD 20910
Phone:
(240) 247-0880
Fax:
(240) 247-0574
E-mail:
info@napwa.org
Web Address:
www.napwa.org
NAPWA advocates for people with HIV and AIDS when the nation's
policy decisions affect the lives of people with HIV and AIDS. NAPWA has
programs, such as education and community development and training.
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This information does not replace the advice of a doctor. Healthwise disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.
Triant VA, et al. (2007). Increased acute myocardial
infarction rates and cardiovascular risk factors among patients with HIV
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http://jcem.endojournals.org/cgi/rapidpdf/jc.2006-2190v1 (e-pub ahead of
print).
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HIV/AIDS Surveillance Report, 17. Available online:
http://www.cdc.gov/hiv/stats/hasrlink.htm.
U.S. Department of Health and Human Services (2007).
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http://www.aidsinfo.nih.gov/guidelines/GuidelineDetail.aspx?MenuItem=Guidelines&Search=Off&GuidelineID=7&ClassID=1.
Centers for Disease Control and Prevention (2005).
Updated U.S. Public Health Services guidelines for the management of
occupational exposures to HIV and recommendations for postexposure prophylaxis.
MMWR, 50(RR-09): 1-17. Available online:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5409a1.htm.
Centers for Disease Control and Prevention (2005). Antiretroviral postexposure prophylaxis after sexual, injection-drug use, or other nonoccupational exposure to HIV in the United States. Recommendations from the U.S. Department of Health and Human Services. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm.
Braithwaite RS, et al. (2008). Influence of
alternative thresholds for initiating HIV treatment on quality-adjusted life
expectancy: A decision model. Annals of Internal Medicine, 148(3): 178-185.
