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What Is HIV?

HIV stands for Human Immunodefciency Virus. To understand what that


means, lets break it down:
H Human This !articular "irus can only infect human bein#s.
I Immunodefciency HIV weakens your immune system by destroyin#
im!ortant cells that f#ht disease and infection. $ %defcient% immune system
can&t !rotect you.
V Virus $ "irus can only re!roduce itself by takin# o"er a cell in the
body of its host.
HIV is a lot like other "iruses, includin# those that cause the %'u% or the
common cold. (ut there is an im!ortant di)erence o"er time, your immune
system can clear most "iruses out of your body. That isn&t the case with HIV
the human immune system can&t seem to #et rid of it. That means that once
you ha"e HIV, you ha"e it for life.
*e know that HIV can hide for lon# !eriods of time in the cells of your body
and that it attacks a key !art of your immune system your T+cells or ,-.
cells. /our body has to ha"e these cells to f#ht infections and disease, but
HIV in"ades them, uses them to make more co!ies of itself, and then
destroys them.
0"er time, HIV can destroy so many of your ,-. cells that your body can&t
f#ht infections and diseases anymore. *hen that ha!!ens, HIV infection can
lead to $I-1, the fnal sta#e of HIV infection.
Howe"er, not e"eryone who has HIV !ro#resses to $I-1. *ith !ro!er
treatment, called antiretro"iral thera!y 2$3T4, you can kee! the le"el of HIV
"irus in your body low. $3T is the use of HIV medicines to f#ht HIV infection.
It in"ol"es takin# a combination of HIV medicines e"ery day. These HIV
medicines can control the "irus so that you can li"e a lon#er, healthier life
and reduce the risk of transmittin# HIV to others. (efore the introduction of
$3T in the mid+5667s, !eo!le with HIV could !ro#ress to $I-1 in 8ust a few
years. Today, a !erson who is dia#nosed with HIV and treated before the
disease is far ad"anced can ha"e a nearly normal life e9!ectancy.
:o safe and e)ecti"e cure for HIV currently e9ists, but scientists are workin#
hard to fnd one, and remain ho!eful.
What Is AIDS?
$I-1 stands for $c;uired Immunodefciency 1yndrome. To understand what
that means, lets break it down:
$ $c;uired $I-1 is not somethin# you inherit from your !arents. /ou
ac;uire $I-1 after birth.
I Immuno /our body&s immune system includes all the or#ans and cells
that work to f#ht o) infection or disease.
- -efciency /ou #et $I-1 when your immune system is %defcient,% or
isn&t workin# the way it should.
1 1yndrome $ syndrome is a collection of sym!toms and si#ns of disease.
$I-1 is a syndrome, rather than a sin#le disease, because it is a com!le9
illness with a wide ran#e of com!lications and sym!toms.
$s noted abo"e, $I-1 is the fnal sta#e of HIV infection, and not e"eryone
who has HIV ad"ances to this sta#e. <eo!le at this sta#e of HIV disease ha"e
badly dama#ed immune systems, which !ut them at risk for o!!ortunistic
infections 20Is4.
/ou are considered to ha"e !ro#ressed to $I-1 if you ha"e one or more
s!ecifc 0Is, certain cancers, or a "ery low number of ,-. cells. If you ha"e
$I-1, you will need medical inter"ention and treatment to !re"ent death.
How Do You Get HIV?
,ertain body 'uids from an HIV+infected !erson can transmit HIV.
These body 'uids are:
(lood
1emen 2cum4
<re+seminal 'uid 2!re+cum4
3ectal 'uids
Va#inal 'uids
(reast milk
directly in8ected into your bloodstream 2by a needle or syrin#e4 for
transmission to !ossibly occur. =ucous membranes are the soft, moist areas
8ust inside the o!enin#s to your body. They can be found inside the rectum,
the "a#ina or the o!enin# of the !enis, and the mouth.
>or more information, see ,-,s HIV (asics: HIV Transmission.
HOW is hiv spread?
$!!ro9imately ?7,777 new HIV infections occur in the @nited 1tates each
year. In the @.1., HIV is s!read mainly by:
Having sex with someone who has HIV. In general
254 $nal se9 2!enis in the anus of a man or woman4 is the hi#hest+risk
se9ual beha"ior. 3ece!ti"e anal se9 2bottomin#4 is riskier than inserti"e
anal se9 2to!!in#4.
2A4 Va#inal se9 2!enis in the "a#ina4 is the second hi#hest+risk se9ual
beha"ior.
2B4 Ha"in# multi!le se9 !artners or ha"in# se9ually transmitted
infections can increase the risk of HIV infection throu#h se9.
2.4 1harin# needles, syrin#es, rinse water, or other e;ui!ment 2works4
used to !re!are in8ection dru#s with someone who has HIV.
!ess "ommonl#$ HIV ma# %e spread %#
(ein# born to an infected mother. HIV can be !assed from mother to child
durin# !re#nancy, birth, or breastfeedin#.
(ein# stuck with an HIV+contaminated needle or other shar! ob8ect. This is
a risk mainly for health care workers.
3ecei"in# blood transfusions, blood !roducts, or or#anCtissue trans!lants
that are contaminated with HIV. This risk is e9tremely small because of
ri#orous testin# of the @1 blood su!!ly and donated or#ans and tissues.
Datin# food that has been !re+chewed by an HIV+infected !erson. The
contamination occurs when infected blood from a care#i"ers mouth mi9es
with food while chewin#, and is "ery rare.
(ein# bitten by a !erson with HIV. Dach of the "ery small number of
documented cases has in"ol"ed se"ere trauma with e9tensi"e tissue dama#e
and the !resence of blood. There is no risk of transmission if the skin is not
broken.
0ral se9Eusin# the mouth to stimulate the !enis, "a#ina, or anus 2fellatio,
cunnilin#us, and rimmin#4. Fi"in# fellatio 2mouth to !enis oral se94 and
ha"in# the !erson e8aculate 2cum4 in your mouth is riskier than other ty!es of
oral se9.
,ontact between broken skin, wounds, or mucous membranes and HIV+
infected blood or blood+contaminated body 'uids. These re!orts ha"e also
been e9tremely rare.
-ee!, o!en+mouth kissin# if the !erson with HIV has sores or bleedin#
#ums and blood is e9chan#ed. HIV is not s!read throu#h sali"a. Transmission
throu#h kissin# alone is e9tremely rare.
HIV is &O' spread %#
$ir or water
Insects, includin# mos;uitoes or ticks
1ali"a, tears, or sweat
,asual contact, like shakin# hands, hu##in# or sharin# dishesCdrinkin#
#lasses
-rinkin# fountains
Toilet seats
HIV is not s!read throu#h the air and it does not li"e lon# outside the human
body.
Ha"in# an undetectable "iral load #reatly lowers the chance that a !erson
li"in# with HIV can transmit the "irus to a !artner, but there is still some risk.
Viral load refers to the amount of HIV in an infected !ersons blood. $n
undetectable "iral load is when the amount of HIV in a !ersons blood is so
low that it cant be measured. antiretro"iral thera!y 2$3T4 reduces a !ersons
"iral load, ideally to an undetectable le"el, when taken consistently and
correctly. Howe"er, a !erson with HIV can still !otentially transmit HIV to a
!artner e"en if they ha"e an undetectable "iral load, because:
HIV may still be found in a !ersons #enital 'uids 2e.#., semen, "a#inal 'uids4.
The "iral load test only measures "irus in a !ersons blood.
$ !ersons "iral load may #o u! between tests. *hen this ha!!ens, they
may be more likely to transmit HIV to !artners.
1e9ually transmitted diseases 21T-s4 increase "iral load in a !ersons
#enital 'uids.
HOW DO YO( G)' AIDSG
The terms HIV and $I-1 can be confusin# because both terms refer to the
same disease. Howe"er, HIV refers to the "irus itself, and $I-1 refers to
the late sta#e of HIV infection, when an HIV+infected !ersons immune system
is se"erely dama#ed and has diHculty f#htin# diseases and certain cancers.
(efore the de"elo!ment of certain medications, !eo!le with HIV could
!ro#ress to $I-1 in 8ust a few years. (ut today, most !eo!le who are HIV+
!ositi"e do not !ro#ress to $I-1. Thats because if you ha"e HIV and you take
antiretro"iral thera!y 2$3T4 consistently, you can kee! the le"el of HIV in your
body low. This will hel! kee! your body stron# and healthy and reduce the
likelihood that you will e"er !ro#ress to $I-1. It will also hel! lower your risk
of transmittin# HIV to others
What are the S#mptoms o* HIV?
The sym!toms of HIV "ary, de!endin# on the indi"idual and what sta#e of the
disease you are in.
Darly 1ta#e of HIV: 1ym!toms
*ithin A+. weeks after HIV infection, many, but not all, !eo!le e9!erience 'u+
like sym!toms, often described as the worst 'u e"er. This is called acute
retro"iral syndrome 2$314 or !rimary HIV infection, and its the bodys
natural res!onse to the HIV infection.
S#mptoms "an in"lude
>e"er 2this is the most common sym!tom4
1wollen #lands
1ore throat
3ash
>ati#ue
=uscle and 8oint aches and !ains
Headache
These sym!toms can last anywhere from a few days to se"eral weeks.
Howe"er, you should not assume you ha"e HIV if you ha"e any of these
sym!toms. Dach of these sym!toms can be caused by other illnesses.
,on"ersely, not e"eryone who is infected with HIV de"elo!s $31. =any
!eo!le who are infected with HIV do not ha"e any sym!toms at all for 57
years or more.
/ou cannot rely on sym!toms to know whether you ha"e HIV. The only way to
know for sure if you are infected with HIV is to #et tested. If you think you
ha"e recently been e9!osed to HIVEif you ha"e had oral, "a#inal or anal se9
without a condom with a known HIV !ositi"e !erson or a !artner whose HIV
status you do not know or shared needles to in8ect dru#sE#et an HIV test.
Traditional HIV tests detect HIV antibodies. (ut durin# this early sta#e your
body is not yet !roducin# these antibodies. $ new HIV test was a!!ro"ed in
A75B that can detect the !resence of HIV in your body durin# this early sta#e
of infection. 1o no matter where you #et tested, it is "ery im!ortant to let
your !ro"ider know that you may ha"e been recently infected with HIV and
you would like to be tested for acute HIV. @se the HIVC$I-1 Testin# and
1er"ices Iocator to fnd a HIV testin# site near you or enter your location
here:
It is im!ortant to remember that with or without sym!toms, you are at
!articularly hi#h risk of transmittin# HIV to your se9ual or dru# usin# !artners
durin# this time because the le"els of HIV in your blood stream are "ery hi#h.
>or this reason, it is "ery im!ortant to take ste!s to reduce your risk of
transmission.
'he +lini"al !aten"# Stage
$fter the early sta#e of HIV infection, the disease mo"es into a sta#e called
the clinical latency sta#e. Iatency means a !eriod where a "irus is li"in#
or de"elo!in# in a !erson without !roducin# sym!toms. -urin# the clinical
latency sta#e, !eo!le who are infected with HIV e9!erience no HIV+related
sym!toms, or only mild ones. 2This sta#e is sometimes called asym!tomatic
HIV infection or chronic HIV infection.4
-urin# the clinical latency sta#e, the HIV "irus re!roduces at "ery low le"els,
althou#h it is still acti"e. If you take antiretro"iral thera!y 2$3T4, you may li"e
with clinical latency for se"eral decades because treatment hel!s kee! the
"irus in check. 23ead more about HIV treatment.4 >or !eo!le who are not on
$3T, this clinical latency sta#e lasts an a"era#e of 57 years, but some !eo!le
may !ro#ress throu#h this !hase faster.
It is im!ortant to remember that !eo!le in this sym!tom+free !eriod are still
able to transmit HIV to others e"en if they are on $3T, althou#h $3T #reatly
reduces the risk of transmission.
$#ain, the only way to know for sure if you are infected with HIV is to #et
tested. Tests are a"ailable that can detect the "irus at this sta#e. @se the
HIVC$I-1 Testin# and 1er"ices Iocator to fnd a HIV testin# site near you.
<ro#ression to $I-1: 1ym!toms
If you ha"e HIV and you are not takin# HIV medication 2antiretro"iral
thera!y4, e"entually the HIV "irus will weaken your bodys immune system.
The onset of sym!toms si#nals the transition from the clinical latency sta#e
to $I-1 2$c;uired Immunodefciency 1yndrome4.
-urin# this late sta#e of HIV infection, !eo!le infected with HIV may ha"e the
followin# sym!toms:
3a!id wei#ht loss
3ecurrin# fe"er or !rofuse ni#ht sweats
D9treme and une9!lained tiredness
<rolon#ed swellin# of the lym!h #lands in the arm!its, #roin, or neck
-iarrhea that lasts for more than a week
1ores of the mouth, anus, or #enitals
<neumonia
3ed, brown, !ink, or !ur!lish blotches on or under the skin or inside the
mouth, nose, or eyelids
=emory loss, de!ression, and other neurolo#ic disorders.
Dach of these sym!toms can be related to other illnesses. 1o, as noted
abo"e, the only way to know for sure if you are infected with HIV is to #et
tested.
=any of the se"ere sym!toms and illnesses of HIV disease come from the
o!!ortunistic infections that occur because your bodys immune system has
been dama#ed. 23ead more about o!!ortunistic illnesses.4
'#pes o* HIV 'ests
Anti%od# 'ests The most common HIV tests look for HIV antibodies in
your body, rather than lookin# for HIV itself:
)n,#me immunoassa# -)IA. tests use blood, oral 'uid, or urine to
detect HIV antibodies. 3esults for these tests can take u! to two weeks.
/apid HIV anti%od# tests also use blood, oral 'uid, or urine to detect
HIV antibodies. 3esults for these tests can take 57A7 minutes.
If you #et a !ositi"e result from either of these tests, you will need to take
another test, called a *estern blot test, to confrm that result. It can take u!
to two weeks to confrm a !ositi"e result.
Antigen 'ests
These tests are not as common as antibody tests, but they can be used to
dia#nose HIV infection earlierEfrom 5+B weeks after you are frst infected
with HIV. $nti#en tests re;uire a blood sam!le.
0+/ 'est -0ol#merase "hain rea"tion test.
This test detects the #enetic material of HIV itself, and can identify HIV in the
blood within A+B weeks of infection.
(abies born to HIV+!ositi"e mothers are tested with a s!ecial <,3 test,
because their blood contains their mother&s HIV antibodies for se"eral
months. This means they would test HIV+!ositi"e on a standard antibody test
Ebut a <,3 test can determine whether the babies ha"e HIV themsel"es.
(lood su!!lies in most de"elo!ed countries are screened for HIV usin# <,3
tests. <,3 tests are also used to measure "iral loads for !eo!le who are HIV+
!ositi"e.
Home testin# kits are HIV antibody tests that you can take in the !ri"acy of
your own home. ,urrently only one test, the Home $ccess HIV+5 Test 1ystem,
is a!!ro"ed by the >-$ for this !ur!ose. This is not a true HIV testin# kit, but
a sam!le+collection kit. /ou collect a sam!le of your blood by stickin# your
fn#er with a sterile lancet, !ut the blood on a s!ecial collection card in the
kit, and send it back to laboratory for testin#. $t a later date, you call the lab
for your results
1irst Steps to 'reatment
/ou may feel a little o"erwhelmed when you frst be#in treatment for your HIV
disease. -urin# your frst a!!ointment, your healthcare !ro"ider should ask
you ;uestions about your medical history, conduct a !hysical e9am, and
order "arious medical tests. This is also a #ood time to ask all of the
;uestions you may ha"e about li"in# with HIV and "arious treatment o!tions
a"ailable to you.
The initial medical tests your !ro"ider may order will #i"e a better
understandin# of how the HIV "irus is a)ectin# your immune system. Two of
the most im!ortant tests will be a ,-. count and a "iral load test. /ou may
also take a dru# resistance test to determine the best medication o!tions for
you. The results of all of these tests will !ro"ide a baseline measurement for
future tests.
Your provider ma# also order some other tests
,om!lete blood count
(lood chemistry !rofle 2includin# li"er and kidney function tests4
@rinalysis
Tests for other se9ually transmitted diseases 21T-s4
Tests for other infections, such as he!atitis, tuberculosis, or to9o!lasmosis
$n HI$+(J?K75 test: ,hecks to see if you ha"e a sensiti"ity to a s!ecifc
HIV medication 2abaca"ir4 and should a"oid takin# it.
,orece!tor tro!ism assay: ,hecks to see if a s!ecifc ty!e of HIV
medication is a!!ro!riate for you. This test is usually used only if your body
has shown resistance to other medications.
Other &eeds and Servi"es
*hen you are be#innin# treatment for HIV, you may need other ser"ices
andCor su!!ort. -urin# your initial few "isits your healthcare !ro"ider or case
mana#er may ask you if you need access to the followin#:
Housin#
1u!!orti"e care and in+home health care
=ental health care
>ood assistance
1u!!ort #rou!s
$cti"ity #rou!s
<harmacy+assisted medication mana#ement !ro#rams
Its !ossible that you will ha"e to com!lete additional forms or show that you
meet eli#ibility re;uirements to #et access to these !ro#rams. Talk with your
!ro"ider to determine which !ro#rams may be ri#ht for you.
'reatment *or HIV
In 56LK, a dru# called $MT became the frst a!!ro"ed treatment for HIV
disease. 1ince then, a!!ro9imately B7 dru#s ha"e been a!!ro"ed to treat
!eo!le li"in# with HIVC$I-1, and more are under de"elo!ment.
/ou may ha"e heard these dru#s called many di)erent names, includin#:
%The ,ocktail%
$ntiretro"irals 2$3Vs4
Hi#hly $cti"e $ntiretro"iral Thera!y 2H$$3T or $3T4
There are currently f"e di)erent %classes% of HIV dru#s. Dach class of dru#
attacks the "irus at di)erent !oints in its life cycleEso if you are takin# HIV
meds, you will #enerally take B di)erent antiretro"iral dru#s from A di)erent
classes.
This re#imen is standard for HIV careEand its im!ortant. Thats because no
dru# can cure HIV, and takin# a sin#le dru#, by itself, wont sto! HIV from
harmin# you. Takin# B di)erent HIV meds does the best 8ob of controllin# the
amount of "irus in your body and !rotectin# your immune system.
Takin# more than one dru# also !rotects you a#ainst HIV dru# resistance.
*hen HIV re!roduces, it can make co!ies of itself that are im!erfectEand
these mutations may not res!ond to the dru#s you take to control your HIV. If
you follow the B+dru# re#imen, the HIV in your body will be less likely to make
new co!ies that dont res!ond to your HIV meds.
%,lass% $ction
Dach HIV medication is !retty !owerful by itselfEand the key to treatin# your
HIV disease successfully is to !ick the ri#ht combination of dru#s from the
di)erent classes of HIV meds.
$ntiretro"irals are se!arated into di)erent classes by the way an indi"idual
dru# sto!s HIV from re!licatin# in your body. The classes include:
&u"leoside2&u"leotide /everse 'rans"riptase Inhi%itors
-&/'Is. 1ometimes called %nukes.% These dru#s work to block a "ery
im!ortant ste! in HIVs re!roduction !rocess. :ukes act as faulty buildin#
blocks in !roduction of "iral -:$ !roduction. This blocks HIVs ability to use a
s!ecial ty!e of enNyme 2re"erse transcri!tase4 to correctly build new #enetic
material 2-:$4 that the "irus needs to make co!ies of itself.
&on3&u"leoside /everse 'rans"riptase Inhi%itors -&&/'Is.
These are called %non+nukes.% They work in a "ery similar way to %nukes.%
:on+nukes also block the enNyme, re"erse transcri!tase, and !re"ent HIV
from makin# co!ies of its own -:$. (ut unlike the nukes 2which work on the
#enetic material 4, non+nukes act directly on the enNyme itself to !re"ent it
from functionin# correctly.
0rotease Inhi%itors -0Is. *hen HIV re!licates inside your cells, it
creates lon# strands of its own #enetic material. These lon# strands ha"e to
be cut into shorter strands in order for HIV to create more co!ies of itself. The
enNyme that acts to cut u! these lon# strands is called !rotease. <rotease
inhibitors 2sto!!ers4 block this enNyme and !re"ent those lon# strands of
#enetic material from bein# cut u! into functional !ieces.
)ntr#21usion Inhi%itors These medications work to block the "irus from
e"er enterin# your cells in the frst !lace. HIV needs a way to attach and bond
to your ,-. cells, and it does that throu#h s!ecial structures on cells called
rece!tor sites. 3ece!tor sites are found on both HIV and ,-. cells 2they are
found on other ty!es of cells too4. >usion inhibitors can tar#et those sites on
either HIV or ,-. cells and !re"ent HIV from %dockin#% into your healthy
cells.
Integrase Inhi%itors HIV uses your cells #enetic material to make its
own -:$ 2a !rocess called re"erse transcri!tion4. 0nce that ha!!ens, the
"irus has to inte#rate its #enetic material into the #enetic material of your
cells. This is accom!lished by an enNyme called inte#rase. Inte#rase
inhibitors block this enNyme and !re"ent the "irus from addin# its -:$ into
the -:$ in your ,-. cells. <re"entin# this !rocess !re"ents the "irus from
re!licatin# and makin# new "iruses.
1ixed3dose "om%inations: These are not a se!arate class of HIV
medications but combinations of the abo"e classes and a #reat ad"ancement
in HIV medicine. They include antiretro"irals which are combinations of A or
more medications from one or more di)erent classes. These antiretro"irals
are combined into one sin#le !ill with s!ecifc f9ed doses of these medicines.
>or a com!lete descri!tion of HIV dru#s 2includin# !hotos and brand names4,
see $I-1meds.coms Treatments for HIV and $I-1 D9it -isclaimer.
Whi"h medi"ations are right *or #ou?
/our !ro"ider will take many thin#s into account when considerin# which HIV
medications to !rescribe for you. These will include your !references 2number
of !ills, once a day "ersus twice, etc.4, the #eneral state of your health
2includin# your ,-. count4 !ossible side e)ects, your medical and !sychiatric
history, etc. /ou should talk with your !ro"ider about the choice of
medications, includin# !ossible side e)ects and how you should take them.
Other medi"ations
1ometimes your HIV medications may be only a !art of the whole !acka#e of
meds you may take. If you are at risk for o!!ortunistic infections, your
healthcare !ro"ider may also !ut you on daily or weekly medications to
!re"ent your #ettin# sick with a s!ecifc kind of infection. This ty!e of
treatment is known as !ro!hyla9is.
In addition, you may take other medications to !re"ent side+e)ects. These
can include meds to !re"ent diarrhea, nausea, or !ain. If you ha"e other
health !roblems 2like hi#h blood !ressure or diabetes4, you may also need to
take medications to treat those conditions. $ll of these medications work
to#ether to kee! you as healthy as !ossible while com!lementin# your
treatment for HIV.
It is im!ortant to discuss $II of your medications when you see your
!ro"ider, because each one is im!ortant to the success of your whole
treatment !lan
How to 0rote"t Yoursel*
It is incredibly rare for HIV to be transmitted in a household settin#. In a "ery
few cases, HIV has been transmitted when there was un!rotected contact
between infected blood and broken skin or mucous membranes.
To !re"ent e"en such rare occurrences, you should take the followin#
!recautions when carin# for someone li"in# with HIV:
*ear #lo"es if you are #oin# to ha"e contact with blood or other body 'uids
that could !ossibly contain "isible blood, such as urine, feces, or "omit.
,o"er cuts, sores, or breaks in the skin with banda#es. This a!!lies to both
you and the !erson li"in# with HIVC$I-1.
*ash your hands and other !arts of your body immediately after contact
with blood or other body 'uids. -isinfect surfaces soiled with blood.
$"oid !ractices that increase the likelihood of blood contact, such as
sharin# of raNors and toothbrushes.
@se needles and other shar! instruments only when medically necessary
and handle them accordin# to recommendations for healthcare settin#s. 2-o
not !ut ca!s back on needles by hand or remo"e needles from syrin#es.
-is!ose of needles in !uncture+!roof containers out of the reach of children
and "isitors.4

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