What is HIV?

HIV is a virus that attacks the immune system, which is our body’s natural defence against illness. The virus destroys a type of white blood cell in the immune system called a T-helper cell, and makes copies of itself inside these cells. T-helper cells are also referred to as CD4 cells.

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As HIV destroys more CD4 cells and makes more copies of itself, it gradually breaks down a person’s immune system. This means someone living with HIV, who is not receiving treatment, will find it harder and harder to fight off infections and diseases.

If HIV is left untreated, it may take up to 10 or 15 years for the immune system to be so severely damaged it can no longer defend itself at all. However, the speed HIV progresses will vary depending on age, health and background.

The earlier you have HIV diagnosed, and start treatment, the better your likely long-term health.

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Not everyone who has HIV progresses to AIDS. A person with HIV who is on antiretroviral (ARV) medication and in ongoing medical care can live a normal, healthy lifespan and have children without HIV. In addition to improving health, ARVs also prevent the spread of the virus.

Basic facts about HIV

  • HIV stands for human immunodeficiency virus
  • There is effective antiretroviral treatment available so people with HIV can live a normal, healthy life
  • The earlier HIV is diagnosed, the sooner treatment can start – leading to better long term health. So regular testing for HIV is important
  • HIV is found in semen, blood, vaginal and anal fluids, and breast milk
  • HIV cannot be transmitted through sweat, saliva or urine
  • Using male condoms or female condoms during sex is the best way to prevent HIV and other sexually transmitted infections
  • If you inject drugs, always use a clean needle and syringe, and never share equipment
  • If you are pregnant and living with HIV, the virus in your blood could pass into your baby’s body, or after giving birth through breastfeeding

What is AIDS?

AIDS, or Acquired Immunodeficiency Syndrome is not a virus but a set of symptoms (or syndrome) caused by the HIV virus. A person is said to have AIDS when their immune system is too weak to fight off infection, and they develop certain defining symptoms and illnesses. This is the last stage of HIV, when the infection is very advanced, and if left untreated will lead to death.

An AIDS diagnosis is determined when the number of healthy immune system cells (also known as one’s CD4 or T-cell count) drops to a low level or when someone with HIV develops certain illnesses, called opportunistic infections, which result from a weakened immune system. These may include Kaposi’s sarcoma, tuberculosis, lymphoma, pneumonia, and other cancers such as invasive cervical cancer. Someone with HIV may receive an AIDS diagnosis from a health care provider if they have one or more specific opportunistic infections, certain cancers, or a very low number of healthy immune system cells.

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Once someone receives an AIDS diagnosis, it is not reversed – meaning that person will always be considered to have AIDS – but an individual’s condition can improve with proper treatment.

A person with HIV who is on antiretroviral (ARV) medication and in ongoing medical care can live a normal, healthy lifespan and have children without HIV. In addition to improving health, ARVs also prevent the spread of the virus.

It’s important to understand that HIV and AIDS are not the same thing. AIDS is not a virus or disease in its own right – it is a particular set of symptoms. If a person develops certain serious opportunistic infections or diseases (as a result of damage to their immune system from advanced stage 3 HIV infection), they are said to have AIDS. There isn’t a test for AIDS and you can’t inherit it.

Basic facts about AIDS

  • AIDS stands for acquired immune deficiency syndrome
  • AIDS is also referred to as advanced HIV infection or late-stage HIV
  • AIDS is a set of symptoms and illnesses that develop as a result of advanced HIV infection which has destroyed the immune system
  • Treatment for HIV means that more people are staying well, with fewer people developing AIDS
  • Although there is currently no cure for HIV with the right treatment and support, people with HIV can live long and healthy lives

Symptoms and stages of HIV infection

The symptoms of HIV can differ from person-to-person and some people may not get any symptoms at all for many years. Without treatment, the virus will get worse over time and damage your immune system. Early diagnosis and treatment improves health and prevents the spread of the virus.

There are three broad stages of HIV infection, with different possible effects.

Stage 1: Acute primary infection

Around one to four weeks after becoming infected with HIV, some people will experience symptoms that can feel a lot like flu. This may not last long (a week or two) and you may only get some of the flu symptoms – or none at all. Experiencing these symptoms alone is not a reliable way of diagnosing HIV.

You should always visit your doctor if you are worried you have been at risk of HIV infection, even if you don’t feel unwell or have any of the following symptoms. They can then arrange for you to have an HIV test.

Symptoms can include:

  • fever (raised temperature)
  • body rash
  • sore throat
  • swollen glands
  • headache
  • upset stomach
  • joint aches and pains
  • muscle pain
  • Chills
  • Night sweats
  • Fatigue
  • Mouth ulcers

These symptoms can happen because your body is reacting to the HIV virus. Cells that are infected with HIV are circulating throughout your blood system. Your immune system, in response, tries to attack the virus by producing HIV antibodies. This process is called seroconversion. Timing varies but it can take up to a few months to complete.

It may be too early to get an accurate HIV test result at this stage (depending on the type of HIV test, it can take anything from a few weeks to a few months for HIV to show up), but the levels of virus in your blood system are very high at this stage. Condoms are the best way way to protect yourself from HIV when having sex. Using a condom is especially important if you think you have been exposed to HIV.

Stage 2: The asymptomatic stage

Once the seroconversion stage is over, many people start to feel better. In fact, the HIV virus may not reveal any other symptoms for up to 10 or even 15 years (depending on age, background and overall health). However, the virus will still be active, infecting new cells and making copies of itself. Over time this will cause a lot of damage to your immune system.

Stage 3: Symptomatic HIV infection

By the third stage of HIV infection there has been a lot of damage to your immune system. At this point, you are more likely to get serious infections or bacterial and fungal diseases that you would otherwise be able to fight off. These infections are referred to as ‘opportunistic infections’.

Symptoms that you may have during this time can include:

  • weight loss
  • chronic diarrhoea
  • night sweats
  • a fever
  • a persistent cough
  • mouth and skin problems
  • regular infections
  • serious illnesses or diseases

How Is HIV Transmitted?

You can get or transmit HIV only through specific activities. Most commonly, people get or transmit HIV through sexual behaviors and needle or syringe use.

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

In the United States, HIV is spread mainly by:

  • Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV.
    • For the HIV-negative partner, receptive anal sex (bottoming) is the highest-risk sexual behavior, but you can also get HIV from insertive anal sex (topping).
    • Either partner can get HIV through vaginal sex, though it is less risky for getting HIV than receptive anal sex.
  • Sharing needles or syringes, rinse water, or other equipment (works) used to prepare drugs for injection with someone who has HIV. HIV can live in a used needle up to 42 days depending on temperature and other factors.

Less commonly, HIV may be spread:

  • From mother to child during pregnancy, birth, or breastfeeding. Although the risk can be high if a mother is living with HIV and not taking medicine, recommendations to test all pregnant women for HIV and start HIV treatment immediately have lowered the number of babies who are born with HIV.
  • By being stuck with an HIV-contaminated needle or other sharp object. This is a risk mainly for health care workers.

In extremely rare cases, HIV has been transmitted by:

  • Oral sex—putting the mouth on the penis (fellatio), vagina (cunnilingus), or anus (rimming). In general, there’s little to no risk of getting HIV from oral sex. But transmission of HIV, though extremely rare, is theoretically possible if an HIV-positive man ejaculates in his partner’s mouth during oral sex.
  • Receiving blood transfusions, blood products, or organ/tissue transplants that are contaminated with HIV. This was more common in the early years of HIV, but now the risk is extremely small because of rigorous testing of the US blood supply and donated organs and tissues.
  • Eating food that has been pre-chewed by an HIV-infected person. The contamination occurs when infected blood from a caregiver’s mouth mixes with food while chewing. The only known cases are among infants.
  • Being bitten by a person with HIV. Each of the very small number of documented cases has involved severe trauma with extensive tissue damage and the presence of blood. There is no risk of transmission if the skin is not broken.
  • Contact between broken skin, wounds, or mucous membranes and HIV-infected blood or blood-contaminated body fluids.
  • Deep, open-mouth kissing if both partners have sores or bleeding gums and blood from the HIV-positive partner gets into the bloodstream of the HIV-negative partner. HIV is not spread through saliva.

HIV Prevention

There are more options than ever to prevent the spread of HIV, including:

  • Condoms: When used consistently and correctly, condoms are highly effective in protecting against HIV, as well as many other sexually transmitted diseases (STDs). Condoms are also the only method of protection that prevents both pregnancy and disease. Like male condoms, female condoms are another barrier method of protection. Female condoms are inserted into the vagina.
  • PrEP: This daily pill for people who do not have HIV is highly effective when taken as prescribed in protecting against infection.
  • Treatment as Prevention: In addition to improving health, antiretrovirals (ARVs), the medications used to treat HIV, also prevent the spread of the virus to others.
  • Clean injection equipment: Needle-exchange programs in many cities offer free, clean syringes and provide a safe means of disposal of used ones. Only use syringes that come from a reliable source.

Is there a cure?

There is no cure for HIV and AIDS yet. However, treatment can control HIV and enable people to live a long and healthy life.

If you think you’ve been at risk of HIV, it’s important to get tested to find out your HIV status. Testing is the only way to know if you have the virus.

A person with HIV today who is on ongoing antiretroviral (ARV) medication and in medical care can live a normal, healthy lifespan. HIV treatment also can prevent passing HIV from mother to child.

ARVs work to lower the amount of virus in the body, often to levels that are undetectable by standard lab tests. In addition to improving health, getting and keeping a low viral load also prevents the spread of the virus to others.

To get the full health and preventive benefits of ARVs, it is important that an individual with HIV stays connected to medical care and takes their medications as prescribed, even if they do not feel sick.

If you’ve already been for a test and your result came back positive, you will be advised to start treatment immediately. Treatment is the only way to manage your HIV and prevent it from damaging your immune system. It also reduces the risk of you passing on HIV to your sexual partners.