HIV and AIDS

What is AIDS?

It's a relatively new disease that first surfaced in 1981, when scientists discovered a previously unknown human retrovirus linked to the outbreak of a rare skin cancer among gay men. Researchers named the virus the human immunodeficiency virus (HIV), and called the disease it caused AIDS -- short for acquired immunodeficiency syndrome. Today AIDS is the fifth leading cause of death among American adults aged 25 to 44. According to statistics from the Centers for Disease Control, more than a million cases of AIDS have been reported since the disease's discovery, and as many as 1.1 million people in the United States may have the virus that causes it. AIDS has killed over 583,000 people in the United States since the epidemic began.

HIV works by attacking your body's immune system, multiplying rapidly and destroying the white blood cells that help fight off disease. These cells, called CD4+T lymphocytes (or T-cells), battle infections caused by bacteria and viruses -- but up to one billion of them may be killed by HIV every day. The virus causes AIDS when it destroys so many T-cells that it ruins your body's defense system, leaving you unable to fight off other illnesses (pneumonia, tuberculosis, or certain cancers, for instance). Complications caused by these opportunistic diseases are what kill people with AIDS, not HIV itself.

Until recently you could expect to live an average of only two years after being diagnosed as HIV-positive. For this reason, few diagnoses caused more fear and dismay. But a positive HIV test is no longer the certain death sentence it once was. Although there's still no cure for AIDS, experts have developed new medicines that make it harder for the virus to replicate itself, and allow HIV-infected people to live much longer and healthier lives than in the past.

How would I get AIDS?

HIV is spread through sexual contact (in the form of vaginal, anal, and oral sex) by an exchange of bodily fluids such as blood and semen. HIV-contaminated needles can also transmit it from one person to another during intravenous drug use. And it can be passed from a mother to her fetus in the course of pregnancy or breastfeeding after birth.

If I'm HIV-positive, what will cause me to develop AIDS?

A normal CD4 T-cell count can vary between 500 and 1,000. You're considered to have full-blown AIDS if your CD4 count drops below 200 or if you get one of 26 opportunistic ailments that typically attack people with the disease -- a signal that your immune system is severely depressed. Recently experts have begun using another blood test that measures viral load (the amount of HIV in your blood) to help determine the degree of infection by the virus.

If you receive no treatment, there's about a 50 percent chance that you'll develop AIDS within 10 years of contracting HIV. New antiretroviral drugs, however, have the ability to slow down the virus's replication in your body and allow you to live a comparatively long and healthy life.

What are the symptoms of HIV and AIDS?

In the early stages of HIV infection, you may have no symptoms at all. Or you may have isolated ones that resemble those of flu or a cold, but may last for weeks (for example, a prolonged fever or a sore throat without the other symptoms typical of a cold or flu). Additional symptoms that can appear during the first months or years of infection are diarrhea, night sweats, nausea and vomiting, fatigue and weakness, severe weight loss or "wasting," headaches, swollen lymph nodes at the back of the neck or in the armpits or groin, muscle aches and joint pain, easy bruising or bleeding, a cough you can't get rid of, and recurrent yeast infections of the mouth (this is known as thrush) or the vagina. If you develop AIDS, the symptoms become those of the various diseases that take advantage of your body's weakened state to attack and invade it. Some of the more common ones include the following:

  • Kaposi's sarcoma, a rare form of skin cancer characterized by purple lesions (this is most often seen in men)
  • Recurrent bacterial pneumonia
  • Pneumocystis jirovecii pneumonia
  • Tuberculosis
  • Meningitis
  • Cervical cancer
  • Cytomegalovirus, or CMV, infection
  • Herpes simplex infections
  • Cancer of the lymph nodes, or lymphoma

How is HIV diagnosed?

Two types of screening tests -- the ELISA (for enzyme-linked immunosorbent assay) and the Western Blot -- are used to detect antibodies to the HIV virus, and both can be administered at clinics or in your doctor's office. In November 2002, the Food and Drug Administration approved a new rapid HIV test that gives results in about 20 minutes, with 99.6 percent accuracy. Since, according to the FDA, about 8,000 people a year don't return for their HIV test results, this new test will help people learn about their illness and begin treatment immediately.

Beware of the home HIV tests you may see advertised. Only one such test, the "Home Access Express HIV-1 Test System," has been approved by the Food and Drug Administration. It allows you to collect samples at home, but they have to be mailed to a laboratory for analysis.

If your test results are negative, yet you think you may be infected, your doctor will probably recommend that you repeat the tests at a later date, when antibodies to HIV have had more time to develop.

If the second test confirms that you're HIV positive, your doctor should offer you counseling and support or put you in touch with a medical professional who can. You should be given a referral to a physician trained in the field, who will treat you for symptoms of HIV and for any related diseases. You'll also have additional blood tests so your doctor can determine how advanced the HIV infection is.

Be prepared to answer questions about your sexual history, as well as any drug use you may have engaged in. You'll need to notify your sexual partners about possible exposure to HIV. State health employees may notify people as well -- your doctor can help you contact your local health department to arrange this.

According to the Centers for Disease Control, 21 percent of the estimated 1,106,400 people in this country with HIV don't know they're infected. That's why the CDC issued new guidelines for doctors in July 2003, asking them to make sure that their patients have all the information they need to prevent the infection from spreading to others. Your doctor may give you some pamphlets, discuss risky behaviors with you, or hand out free condoms. He should also let you know about counseling and testing services available to your partner or partners.

Are all cases of AIDS caused by the same virus?

In actuality, two different kinds of HIV cause AIDS. HIV-1 occurs in the United States and the rest of the Western Hemisphere, as well as Asia and most of Africa. Another and somewhat less virulent variety, HIV-2, is found almost exclusively in West Africa. Unlike most viruses, these two are composed of the nucleic acid RNA. They use the RNA to produce new DNA, which then sneaks into the host's chromosome and goes on multiplying.

What are my treatment options?

HIV and AIDS treatment has advanced significantly since the early 1990s. Treatment with a single drug (such as AZT) is no longer recommended (although during pregnancy, single dose treatment with zidovudine/lamivudine is still common). Instead, doctors are getting good results with combinations of three different antiretroviral drugs -- mixtures that are often called "cocktails" or HAART (highly active antiretroviral therapies).

These drugs attack HIV at different stages of its development, suppressing the virus or at least slowing down its destruction of your T-cell lymphocytes and the consequent weakening of your immune system. Your doctor will do periodic blood tests to check both your T-cell count and your viral load (also known as the plasma HIV RNA level) and to monitor the drugs' effectiveness.

Depending on your symptoms and blood-test results, your doctor may recommend that you start antiretroviral drug therapy right away. If your T-cell lymphocyte count is below 350, if you have symptoms of advanced HIV infection, hepatitis B, or are pregnant the doctor will most likely recommend immediate antiretroviral therapy.

More recently a second class of drugs -- called protease inhibitors -- has been introduced to treat HIV infection. These drugs help prevent the virus from replicating, though they're not a cure.

If you show no symptoms and your viral load and T-cell count are at acceptable levels, it's still critical for you to continue working with your doctor to keep those levels in check. The more closely you adhere to your treatment, the longer you can expect to live.

The most important thing to remember during treatment is to keep your doctor's appointments and to follow your regimen exactly. If you miss doses, you may actually help the virus mutate and become resistant to drugs. And be sure to tell your doctor about any vitamins and supplements you're taking, because they may interact with your drug regimen. In one study, researchers from the National Institutes of Health found that garlic supplements greatly reduced the effectiveness of the anti-HIV drug saquinavir.

What else can I do to boost my immune system?

Since your weakened immune system may cause you to lose weight or suffer from diarrhea, a diet high in protein and total calories can help you keep your weight up. Smoking marijuana, which in some locales is legal for people with AIDS, may ease nausea and help combat AIDS-related wasting. You're likely to develop many nutritional deficiencies, so it may be helpful to take vitamin supplements. One study of HIV-infected men found that the disease progressed more slowly in those who took a multivitamin supplement than in those who didn't. Be sure to talk to your doctor first though, before adding supplements to your diet, since some vitamins interact negatively with AIDS medications.

Is AIDS always fatal?

There's still no cure for the disease. Since the antiretroviral drugs are relatively new, we don't know how long they might be able to suppress the replication of HIV, which has a tendency to mutate into drug-resistant forms. But researchers are hopeful that these medicines may halt the progress of AIDS indefinitely.

What are my chances of being infected if I have sex with someone who's HIV-positive?

If you use a latex condom every time you have sex, very slight. The greatest danger is from anal intercourse or other sexual practices that might cause small tears in the vagina or rectum. These openings allow the virus, carried in semen or other bodily fluid, to enter the bloodstream directly. There's also ample evidence that having genital warts can increase your chances of becoming infected. Other sexually transmitted diseases, including herpes, syphilis, and trichomoniasis, may also heighten your vulnerability to HIV.

Can HIV be spread through casual contact?

No. Sharing a towel or drinking glass or shaking hands with someone won't spread the virus. Theoretically, it could be transmitted in saliva or with a cough or sneeze, since the bodily fluids involved also carry the virus. But no such case of transmission has ever been reported.

What can I do to protect myself from HIV?

  • If you're in a monogamous relationship, both you and your sexual partner can be tested to make sure you aren't carrying the virus. (Remember, HIV may not show up in test results until as much as six months after infection, so if you or your partner has had unprotected sex within the last half-year, you'll need to have a second test six months afterward before you can be sure neither of you is infected.) Always use a latex condom during sex unless you are absolutely certain your partner doesn't have HIV; doing this will also help protect you from other sexually transmitted diseases. Don't use condoms made of lambskin -- they're too porous to offer protection against HIV. Avoid condoms that are lubricated with spermicides -- according to guidelines issued by the Centers for Disease Control, spermicides don't protect against HIV or other STDs. In fact, says the CDC, frequent use of spermicides containing nonoxynol-9 can cause genital lesions that may actually increase your risk of contracting HIV.
  • Unless you're absolutely sure your partner isn't HIV-positive, use a safeguard like thin plastic "dental dams" during oral sex. This type of sex is thought to be less risky than vaginal or anal intercourse, but the virus can easily be passed on if you or your partner has an open sore, such as a cold sore, in or on your mouth.
  • If you're thinking about having sex with someone new, ask that he or she be tested for HIV and other sexually transmitted diseases before you do.
  • If you're a man who has sex with men, the Centers for Disease Control recommends that you be tested annually for STDs, due to data showing a higher frequency of unprotected sex and a higher risk of STDs in this segment of the population.
  • If you're pregnant, get an HIV test as early in your pregnancy as possible; the HIV virus can infect your baby before birth or during breastfeeding. If your doctors know you have HIV, they can give you drugs to make it less likely that your child will be infected as well.
  • Avoid intravenous drug use, which carries a high risk of HIV infection through contaminated needles. If you do inject drugs, never share or reuse the needles. Many cities have needle-exchange programs in which you can exchange your dirty needles for clean ones. (If there's no needle-exchange program in your community and you do reuse needles, wash them in a solution of bleach and water first. This won't necessarily prevent infection with HIV, but it will reduce the risk.)

References

National Institute of Allergy and Infectious Diseases Fact Sheet. Treatment of HIV Infection. January 2002.

National Institute of Allergy and Infectious Diseases Fact Sheet. HIV Infection and AIDS: An Overview.

Piscitelli SC, et al. The effect of garlic supplements on the pharmacokinetics of saquinavir. Clin Infect Dis. 2002 Jan 15;34(2):234-8.

Centers for Disease Control. Sexually Transmitted Diseases Treatment Guidelines 2002.

FDA Approves New Rapid HIV Test. FDA News. November 7, 2002.

New Guidelines Aim to Help Health Care Providers Incorporate HIV Prevention into Ongoing Care of Persons Living with HIV. CDC Press Release. July 17, 2003

Basic Statistics. Divisions of HIV/AIDS Prevention. Centers for Disease Control and Prevention.

HIV/AIDS Statistics. National Institute of Allergy and Infectious Diseases. National Institutes of Health.

San Francisco AIDS Foundation. AIDS Statistics. March 2006.

Centers for Disease Control. HIV Transmission Rates in the United States. December 2008.

Centers for Disease Control. Basic Statistics. July 2010.

Centers for Disease Control. Pneumocystis jirovecii pneumonia.

Centers for Disease Control. Can I get HIV from oral sex? October 2006.

Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. November 3, 2008; 1-139.

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