AIDS is a chronic, life-threatening condition caused by the human immunodeficiency virus (HIV). Anyone of any age, race, sex or sexual orientation can be infected with HIV. By damaging your immune system, HIV interferes with your body’s ability to fight off viruses, bacteria and fungi that cause disease. HIV makes you more susceptible to certain types of cancers and to infections your body would normally resist, such as pneumonia and meningitis. The virus and the infection itself are known as HIV. “Acquired immunodeficiency syndrome (AIDS)” is the name given to the later stages of an HIV infection.
Normally, white blood cells and antibodies attack and destroy foreign organisms that enter your body. This response is coordinated by white blood cells known as CD4 lymphocytes. These lymphocytes are also the main targets of HIV, which attaches to the cells and then enters them. Once inside, the virus inserts its own genetic material into the lymphocytes and makes copies of itself. When the new copies of the virus break out of the host cells and enter the bloodstream, they search for other cells to attack. In the meantime, the old host cells and some uninfected CD4 cells die from the effects of the virus. The cycle repeats itself again and again. In the process, billions of new HIV particles are produced every day. Eventually, the number of CD4 cells in the body decreases, leading to severe immune deficiency, which means your body can no longer effectively fight off viruses and bacteria that cause disease.
HIV is diagnosed by testing your blood or oral mucus for the presence of antibodies to the virus. Everyone should be tested at least once, yearly testing is recommended only for people at high risk of infection.
Unfortunately, HIV tests aren’t accurate immediately after infection because it takes time for you to develop these antibodies — usually about 12 weeks. In rare cases, it can take up to six months for an HIV test to become positive.
For years, the only available test for HIV was the enzyme-linked immunosorbent assay (ELISA) test that looked for antibodies to the virus in a sample of your blood. If this test was positive — meaning you had antibodies to HIV — the same test was repeated. If the repeat test was also positive for HIV antibodies, you’d then have another confirming blood test called the Western blot test, which checks for the presence of HIV proteins. The Western blot test was important because you may have non-HIV antibodies that cause a false-positive result on the ELISA test. Combining the two types of tests helped ensure that the results were accurate, and you’d receive a diagnosis of HIV only if all three tests were positive.
Now, several rapid tests can give highly accurate information within as little as 20 minutes. These tests look for antibodies to the virus using a sample of your blood or fluids collected on a treated pad that’s rubbed on your upper and lower gums. The oral test is almost as sensitive as the blood test and eliminates the need for drawing blood. A positive reaction on a rapid test requires a confirming blood test. And because the tests are relatively new and were originally approved for use only in certified laboratories, they may not be available everywhere.
Currently, the Food and Drug Administration (FDA) has approved one HIV test for home use. The Home Access HIV-1 test, marketed by Home Access Health, is as accurate as a clinical test, and all positive results are automatically retested.
The symptoms of HIV and AIDS vary, depending on the phase of infection. When first infected with HIV, you may have no signs or symptoms at all, although it’s more common to develop a brief flu-like illness two to four weeks after becoming infected. Signs and symptoms may include:Fever, Headache, Sore throat, Swollen lymph glands, Rash.
Even if you don’t have symptoms, you’re still able to transmit the virus to others. Once the virus enters your body, your own immune system also comes under attack. The virus multiplies in your lymph nodes and slowly begins to destroy your helper T cells (CD4 lymphocytes) — the white blood cells that coordinate your entire immune system.
You may remain symptom-free for eight or nine years or more. But as the virus continues to multiply and destroy immune cells, you may develop mild infections or chronic symptoms such as:
- Swollen lymph nodes — often one of the first signs of HIV infection
- Weight loss
- Cough and shortness of breath
During the last phase of HIV — which occurs approximately 10 or more years after the initial infection — more serious symptoms may begin to appear, and the infection may then meet the official definition of AIDS. By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections. The signs and symptoms of some of these infections may include:
- Soaking night sweats
- Shaking chills or fever higher than 100 F (38 C) for several weeks
- Dry cough and shortness of breath
- Chronic diarrhea
- Persistent white spots or unusual lesions on your tongue or in your mouth
- Blurred and distorted vision
- Weight loss
You may also begin to experience signs and symptoms of later stage HIV infection itself, such as:
- Persistent, unexplained fatigue
- Soaking night sweats
- Shaking chills or fever higher than 100 F (38 C) for several weeks
- Swelling of lymph nodes for more than three months
- Chronic diarrhea
- Persistent headaches
If you’re infected with HIV, you’re also more likely to develop certain cancers, especially Kaposi’s sarcoma, cervical cancer and lymphoma, although improved treatments have reduced the risk of these illnesses. Children who are HIV-positive may experience:
- Difficulty gaining weight
- Difficulty growing normally
- Problems walking
- Delayed mental development
- Severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia and tonsillitis
You can become infected with HIV in several ways, including:
Sexual transmission. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. You can also become infected from shared sexual devices if they’re not washed or covered with a condom. The virus is present in the semen or vaginal secretions of someone who’s infected and enters your body through small tears that can develop in the vagina or rectum during sexual activity. If you already have another sexually transmitted disease, you’re at much greater risk of contracting HIV. Contrary to what researchers once believed, women who use the spermicide nonoxynol 9 also may be at increased risk. This spermicide irritates the lining of the vagina and may cause tears that allow the virus into the body.
Transmission through infected blood. In some cases, the virus may be transmitted through blood and blood products that you receive in blood transfusions. Since 1985, American hospitals and blood banks have screened the blood supply for HIV antibodies. This blood testing, along with improvements in donor screening and recruitment practices, has substantially reduced the risk of acquiring HIV through a transfusion.
Transmission through needle sharing. HIV is easily transmitted through needles and syringes contaminated with infected blood. Sharing intravenous drug paraphernalia puts you at high risk of HIV and other infectious diseases such as hepatitis. Your risk is greater if you inject drugs frequently and also engage in high-risk sexual behavior. Avoiding the use of injected drugs is the most reliable way to prevent infection. If that isn’t an option, you can reduce your risk by participating in a needle exchange program that allows you to trade used needles and syringes for sterile ones.
Transmission through accidental needle sticks. Transmission of the virus between HIV-positive people and health care workers through needle sticks is low. Experts put the risk at far less than 1 percent.
Transmission from mother to child. Each year, nearly 600,000 infants are infected with HIV, either during pregnancy or delivery or through breast-feeding. But if women receive treatment for HIV infection during pregnancy, the risk to their babies is significantly reduced. In the United States, most pregnant women are pre-screened for HIV, and anti-retroviral drugs are readily available. Not so in developing nations, where women seldom know their HIV status, and treatment is often limited or nonexistent. When medications aren’t available, Caesarean section is sometimes recommended instead of vaginal delivery. Other options, such as vaginal disinfection, haven’t proved effective.
Other methods of transmission. In rare cases, the virus may be transmitted through organ or tissue transplants or unsterilized dental or surgical equipment.
Ways HIV is not transmitted:
You can’t become infected through ordinary contact — hugging, kissing, dancing or shaking hands — with someone who has HIV or AIDS. To become infected with HIV, infected blood, semen or vaginal secretions must enter your body.
A number of medications have been developed to treat both HIV/AIDS and opportunistic infections. For many people, including children, these treatments have extended and improved their quality of life.
A panel of leading AIDS specialists has developed recommendations for the use of anti-retroviral medications in people with HIV. These recommendations are based on the best information available at the time they were developed. AIDSinfo, a program of the U.S. Department of Health and Human Services, regularly refines and updates the recommendations as knowledge about HIV infection evolves.
According to current guidelines, treatment should focus on achieving the maximum suppression of symptoms for as long as possible. This aggressive approach is known as highly active anti-retroviral therapy (HAART). The aim of HAART is to reduce the amount of virus in your blood to very low or even nondetectable levels, although this doesn’t mean the virus is gone. This is usually accomplished with a combination of three or more drugs.
But the treatment guidelines also emphasize the importance of quality of life. Thus the goal of AIDS treatment is to find the strongest possible regimen that is also simple and has the fewest side effects. If you have HIV/AIDS, it’s important that you take an active role in treatment decisions. You and your doctor should discuss the risks and benefits of all therapies so that you can make an informed decision about what will likely be a complex and long-term treatment.
Anti-retroviral drugs inhibit the growth and replication of HIV at various stages of its life cycle. Seven classes of these drugs are available:
- Nucleoside analogue reverse transcriptase inhibitors (NRTIs). NRTIs were the first anti-retroviral drugs to be developed. They inhibit the replication of an HIV enzyme called reverse transcriptase. They include zidovudine (Retrovir), lamivudine (Epivir), didanosine (Videx), stavudine (Zerit) and abacavir (Ziagen). A newer drug, emtricitabine (Emtriva), which must be used in combination with at least two other AIDS medications, treats both HIV and hepatitis B.
The major side effect of zidovudine is bone marrow suppression, which causes a decrease in the number of red and white blood cells. Approximately 5 percent of people treated with abacavir experience hypersensitivity reactions such as a rash, fever, fatigue, nausea, vomiting, diarrhea and abdominal pain. Symptoms usually appear within the first six weeks of treatment and generally disappear when the drug is discontinued. If you’ve had a hypersensitivity reaction to abacavir, avoid taking the drug again. Side effects of emtricitabine include skin discoloration.
- Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease. This causes HIV particles in your body to become structurally disorganized and noninfectious. Among these drugs are saquinavir (Invirase), ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), amprenavir (Agenerase), lopinavir/ritonavir (Kaletra), atazanavir (Reyataz) and tipranavir (Aptivus). Darunavir (Prezista) is intended for people who haven’t responded to treatment with other drugs. Darunavir is used with ritonavir and other anti-HIV medications. Protease inhibitors are usually prescribed with other medications, to help avoid drug resistance.
The most common side effects of protease inhibitors include nausea, diarrhea and other digestive tract problems. PIs can also cause a significant number of side effects when they interact with certain other medications. That’s because all PIs, to one degree or another, affect an enzyme system in your liver that is responsible for metabolizing a large number of drugs. Newer side effects have also appeared with the continuing and widespread use of protease inhibitors. These include elevated triglyceride levels and problems with sugar metabolism that may sometimes progress to diabetes.
There may also be abnormalities in the way fat is metabolized and deposited in your body. Some people lose much of their total body fat. Others gain excess fat on the back between their shoulders (buffalo hump) or in the stomach (protease paunch). No one knows exactly why these abnormalities occur. In fact, it’s not even certain whether these problems are a direct result of treatment with protease inhibitors or due to some other cause that has yet to be identified. Similar metabolic abnormalities have occurred in people on anti-retroviral therapy that doesn’t include PIs. Although these body changes can be distressing, the possibility they may occur should not stop you from getting treatment for HIV/AIDS.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs). These drugs bind directly to the enzyme reverse transcriptase. Four NNRTIs are approved for clinical use: nevirapine (Viramune), delavirdine (Rescriptor), efavirenz (Sustiva) and etravirine (Intelence). A major side effect of all NNRTIs is a rash. In addition, people taking efavirenz may have side effects such as abnormal and worsening of underlying mood disorders.
- Nucleotide reverse transcriptase inhibitors (NtRTIs). NtRTIs work much like nucleoside analogs: They interfere with the replication of reverse transcriptase and prevent the virus from inserting its genetic material into cells. But NtRTIs act more quickly than NRTIs do. The only approved drug in this class, tenofovir (Viread), inhibits both HIV and hepatitis B and appears to be effective in people who are resistant to NRTIs. The most common side effects of tenofovir, when used in combination with other anti-retrovirals, are nausea, vomiting, diarrhea and gas. As with all reverse transcriptase inhibitors, the possibility of severe, and even fatal, liver damage exists.
- Fusion inhibitors. One of the most alarming developments in the AIDS epidemic is the emergence of drug-resistant strains of HIV. Worldwide, a majority of people receiving treatment for HIV are resistant to at least one drug, and many don’t respond to a typical three-drug combination. But a drug called enfuvirtide (Fuzeon), the first in a new class of drugs called fusion inhibitors, appears to suppress resistant strains of HIV. Fusion inhibitors stop the virus from replicating by preventing its membrane from fusing with the membrane surrounding healthy cells. Fuzeon is used in combination with other HIV drugs for people who have advanced infection and who have developed resistance to other drugs. Doctors administer Fuzeon by injection.
- Integrase inhibitors. These drugs are aimed at treating those who become resistant to other treatments. The only drug in this class, raltegravir (Isentress), is intended to be used in combination with other anti-retroviral drugs rather than alone. This is the first class of drugs that blocks replication of the HIV integrase enzyme, which keeps HIV DNA from inserting itself into human DNA. Common side effects include diarrhea, nausea, headache and fever.
- Chemokine co-receptor inhibitors. Chemokine co-receptor inhibitors (CCR5 antagonists) make up a new class of drugs used to treat a particulapr type of HIV infection called CCR5-tropic HIV-1. The only drug in this class — maraviroc (Selzentry) — is for treatment of CCR5-tropic HIV-1 in adults. Maraviroc is the first drug that targets a human protein rather than components of the HIV virus itself.
Maraviroc is used in combination with other anti-retroviral drugs for the treatment of adults with CCR5-tropic HIV-1 who have elevated levels of HIV (high viral load) in their blood despite treatment with other HIV medications. Maraviroc reduces viral load by preventing HIV from entering uninfected white blood cells. It does this by blocking CCR5, a major route of entry into the cells. CCR5 is a protein found on the surface of some immune cells, and maraviroc blocks the CCR5 co-receptor from accepting HIV.
During two large clinical trials, approximately twice as many people with CCR5-tropic HIV-1 infection who received maraviroc had undetectable viral loads after 24 weeks as did those who received more standard therapy in the control groups.
Side effects of maraviroc may include liver and cardiovascular problems, as well as cough, fever, upper respiratory tract infections, rash and abdominal pain.
There’s no vaccine to prevent HIV infection and no cure for AIDS. But it’s possible to protect yourself and others from infection. That means educating yourself about HIV and avoiding any behavior that allows HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body.
If you’re HIV-negative the following measures can help keep you from being infected with HIV:
Educate yourself and others. Make sure you understand what HIV is and how the virus is transmitted. Just as important, teach your children about HIV.
Know the HIV status of any sexual partner. Don’t engage in unprotected sex unless you’re absolutely certain your partner isn’t infected with HIV.
Use a new latex or polyurethane condom every time you have sex. If you don’t know the HIV status of your partner, use a new latex condom every time you have anal or vaginal sex. Women can use a female condom. If you’re allergic to latex, use a plastic (polyurethane) condom. Avoid lambskin condoms — they don’t protect you from HIV. Use only water-based lubricants, not petroleum jelly, cold cream or oils. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a condom, dental dam — a piece of medical-grade latex — or plastic wrap. Remember that although condoms can reduce your risk of contracting HIV, they don’t eliminate the risk entirely. Condoms can break or develop small tears, and they may not always be used properly.
Use a clean needle. If you use a needle to inject drugs, make sure it’s sterile, and don’t share it. Take advantage of needle exchange programs in your community and consider seeking help for your drug use.
Be cautious about blood products in certain countries. Although the blood supply in the United States is now well screened, this isn’t always the case in other countries. If an emergency requires that you receive blood or blood products in another country, get tested for HIV as soon as you return home.
Get regular screening tests. If you are a woman, have a yearly Pap test. And if you’re a man or woman who has had sex with one or more new partners, be tested annually. Men and women who engage in anal sex should also have regular tests for anal cancer.
If you’re HIV-positive
If you’ve received a diagnosis of HIV/AIDS, the following guidelines can help protect others:
Follow safe-sex practices. The only foolproof way to protect others from infection is to avoid practices that expose them to blood, semen or vaginal secretions. Barring that, carefully follow guidelines for safe sex, including using a new latex condom every time you have vaginal or anal sex and using a dental dam, condom or piece of plastic wrap during oral sex. If you use sexual devices, don’t share them. It’s also important to avoid having unprotected sex with other HIV-positive people because of the risk of acquiring or passing on a drug-resistant strain of the virus.
Tell your sexual partners you have HIV. It’s important to tell anyone with whom you’ve had sex that you’re HIV-positive. Your partners need to be tested and to receive medical care if they have the virus. They also need to know their HIV status so that they don’t infect others.
Tell others who need to know. Although only you can decide whether to tell friends and family about your illness, you do need to inform your health care providers of your HIV status. This is not just to protect them, but also to ensure that you get the best possible medical care.
Don’t share needles or syringes. If you use intravenous drugs, never share your needles and syringes.
Don’t donate blood or organs. The virus will spread to other people.
Don’t share razor blades or toothbrushes. These items may carry traces of HIV-infected blood.
If you’re pregnant, get medical care right away. If you’re HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can cut your baby’s risk by as much as two-thirds.