Human Immunodeficiency Virus (HIV)

HIV infection is caused by the human immunodeficiency virus. HIV is spread when blood, semen, or vaginal fluids from an infected person enter another person's body. This is usually through sexual contact, from sharing needles when injecting drugs, or from mother to baby during birth.

HIV may not cause symptoms early on. People who do have symptoms may mistake them for the flu or mono. Early symptoms of HIV are called acute retroviral syndrome. The symptoms may include:

• Fatigue.
• Muscle aches.
• Skin rash.
• Headache.
• Sore throat.
• Enlarged lymph nodes in the neck, armpits, and groin.
• Joint pain.
• Night sweats.
• Diarrhea.

These first symptoms can range from mild to severe and usually disappear on their own after 2 to 3 weeks. But many people don't have symptoms or they have such mild symptoms that they don't notice them at this stage.

Untreated HIV infection progresses in stages. These stages are based on your symptoms and the amount of the virus in your blood.

Later symptoms. After the early symptoms go away, an infected person may not have symptoms again for many years. But if untreated, serious symptoms appear and remain. These symptoms usually include:

• Fatigue.
• Night sweats.
• Loss of appetite or unexplained weight loss.
• Swollen lymph nodes in the neck, armpits, and groin.
• Diarrhea or other bowel changes.
• Dry cough or shortness of breath.
• Nail changes.
• Pain when swallowing.
• Repeated outbreaks of cold sores or genital herpes sores.
• Mouth sores or a yeast infection of the mouth (thrush).

You're at greater risk of getting infected with HIV if you:

• Have unprotected vaginal, anal, or oral sex. (You don't use condoms or don’t use them correctly).
• Are a man who has sex with other men. (If you or your partner[s] don’t identify with the sex you were assigned at birth, talk to your doctor about your risk.)
• Have more than one sex partner.
• Have a high-risk partner. This is someone who has more than one sex partner, has HIV or another sexually transmitted infection (STI), or injects drugs.
• Have (or recently had) an STI, such as syphilis or active herpes.
• Inject drugs or steroids. This is especially true if you share needles, syringes, or other equipment used to inject drugs.

Being born to a mother who has HIV increases the risk of infection. Most children younger than 13 years who have HIV were infected before or during birth or during breastfeeding.

Your doctor may suspect HIV if your symptoms last and no other cause can be found. If you have been exposed to HIV, your immune system will make antibodies to try to destroy the virus. Doctors use tests to find these HIV antibodies or antigens in urine, saliva, or blood.

Most doctors use a blood test called the ELISA. If the test finds HIV antibodies or antigens, a test to look for HIV DNA or RNA will be done to make sure.

HIV antibodies or antigens usually show up in the blood within 3 months. If you think you've been exposed to HIV but you test negative for it, get tested again.

You can use a home test kit. If it's positive, see a doctor to confirm the result and to find out what to do next.

Generally, infection with HIV doesn't make people sick, except for the flu-like illness that may develop shortly after they become infected. Most people who are infected with HIV get sick because their immune systems become weak and cannot fight off other infections. So preventing opportunistic infections is an important part of treatment for HIV.

• Get immunized. Make sure that you and your partner are up to date on the following immunizations:
  • Flu (influenza) inactivated vaccine, given yearly. You should not get the nasal vaccine, since it is a live vaccine.
  • Hepatitis A vaccine, given in a series of 2 shots.
  • Hepatitis B vaccine, given in a series of 3 shots.
  • Combination hepatitis A and hepatitis B vaccine, given in a series of 3 shots.
  • Pneumococcal vaccines: PCV and PPSV.
  • Polio (IPV) (inactivated) vaccine. You should not get the live vaccine.
  • Tetanus and diphtheria (Td) and Tetanus, diphtheria, and pertussis (Tdap) vaccines
• Ask your doctor if you need other vaccinations.
  • Check to see if you need the measles, mumps, and rubella (MMR) vaccine or the human papillomavirus (HPV) vaccine, or both.
  • Talk with your doctor about getting the shingles shot. If your CD4+ count is too low, you should not get this vaccine.
• Work with your doctors to decide which medicines to use, based on:
  • The type of infection that is present or likely to develop.
  • Which other medicines you are already taking and the possibility that one medicine might make another less effective (negative interaction).
  • The side effects of the medicines.

HIV is treated with a mix of medicines. This is called antiretroviral therapy (ART). ART aims to control the amount of virus in your body. These medicines slow the rate at which the virus grows. Taking them can reduce the amount of virus in your body and help you stay healthy.

Experts suggest that people start treatment for HIV as soon as they know that they're infected. Treatment is especially important during pregnancy and for people who have other infections.

Make sure you take your medicines exactly as directed. When treatment doesn't work, it's often because the virus has become resistant to the medicine. This can happen if you don't take your medicines in the right way.

Treatment may also include counseling. People with HIV have a greater risk of depression. Counseling can help with this. It can also help you deal with the emotional aspects of having HIV.

Taking ART will not cure HIV. But it may help you stay healthy for a long time. And it can help prevent the spread of HIV to others.

When choosing medicines, your doctor will think about:

• How well the medicines reduce the amount of HIV in your blood.
• How likely it is that the virus will become resistant to a certain type of medicine.
• The cost of medicines.
• Medicine side effects and how willing you are to live with them.

Over time, it's possible that your medicines will stop working to control the virus or protect your immune system. This is called resistance. Using ART reduces your risk of having this happen.

Medicines used in ART include:

• Nucleoside/nucleotide reverse transcriptase inhibitors.
• Nonnucleoside reverse transcriptase inhibitors (NNRTIs).
• Protease inhibitors (PIs).
• Entry inhibitors.
• Integrase inhibitors.

When you have HIV, there are things you can do to feel better and lead an active life. Here's how.

• Make healthy lifestyle choices.
  • Eat a healthy, balanced diet to keep your immune system strong. Heart-healthy eating can help prevent some of the problems, such as high cholesterol, that can be caused by treatment for HIV. Heart-healthy eating includes eating more fruits and vegetables and choosing foods low in saturated and trans-fat.
  • Learn how to deal with the weight loss that HIV infection can cause.
  • Learn how to handle food properly to avoid getting food poisoning.
  • Reduce stress.
  • Exercise regularly to reduce stress and improve the quality of your life. If you tire easily, talk to your doctor about HIV-related fatigue.
  • Don't use illegal drugs. And limit your use of alcohol.
• Try alternative treatments to reduce stress. These include:
  • Muscle relaxing.
  • Guided imagery.
  • Biofeedback.
  • Problem solving.
  • Acupuncture.
• Think about getting counseling.
  This may help you deal with strong emotions and reduce anxiety and depression.
• Don't smoke.
  People with HIV are more likely to have a heart attack or get lung cancer., Cigarette smoking can raise these risks even more.
• Join a support group.
  Support groups are often good places to share information, problem-solving tips, and emotions related to HIV infection. You may be able to find a support group by searching the internet. Or you can ask your doctor to help you find one.
• Prevent other illnesses.
  Get the immunizations and the medicine 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.