A Comprehensive Guide to HIV and AIDS

HIV is a virus that damages the immune system. Untreated HIV affects and kills CD4 cells, which are a type of immune cell called T cell.

Over time, as HIV kills more CD4 cells, the body is more likely to get various types of conditions and cancers.

HIV is transmitted through bodily fluids that include:

• blood
• semen
• vaginal and rectal fluids
• breast milk

The virus isn’t transferred in air or water, or through casual contact.

Because HIV inserts itself into the DNA of cells, it’s a lifelong condition and currently there’s no drug that eliminates HIV from the body, although many scientists are working to find one.

However, with medical care, including treatment called antiretroviral therapy, it’s possible to manage HIV and live with the virus for many years.

Without treatment, a person with HIV is likely to develop a serious condition called the Acquired Immunodeficiency Syndrome, known as AIDS.

At that point, the immune system is too weak to successfully respond against other diseases, infections, and conditions.

Untreated, life expectancy with end stage AIDS is about 3 yearsTrusted Source. With antiretroviral therapy, HIV can be well-managed, and life expectancy can be nearly the same as someone who has not contracted HIV.

It’s estimated that 1.2 million Americans are currently living with HIV. Of those people, 1 in 7 don’t know they have the virus.

HIV can cause changes throughout the body.

AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV. But just because a person has HIV doesn’t mean AIDS will develop.

HIV kills CD4 cells. Healthy adults generally have a CD4 count of 500 to 1,600 per cubic millimeter. A person with HIV whose CD4 count falls below 200 per cubic millimeter will be diagnosed with AIDS.

A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or cancer that’s rare in people who don’t have HIV.

An opportunistic infection such as Pneumocystis jiroveci pneumonia is one that only occurs in a severely immunocompromised person, such as someone with advanced HIV infection (AIDS).

Untreated, HIV can progress to AIDS within a decade. There’s currently no cure for AIDS, and without treatment, life expectancy after diagnosis is about 3 yearsTrusted Source.

This may be shorter if the person develops a severe opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing.

If AIDS does develop, it means that the immune system is severely compromised, that is, weakened to the point where it can no longer successfully respond against most diseases and infections.

That makes the person living with AIDS vulnerable to a wide range of illnesses, including:

• pneumonia
• tuberculosis
• oral thrush, a fungal condition in the mouth or throat
• cytomegalovirus (CMV), a type of herpes virus
• cryptococcal meningitis, a fungal condition in the brain
• toxoplasmosis, a brain condition caused by a parasite
• cryptosporidiosis, a condition caused by an intestinal parasite
• cancer, including Kaposi sarcoma (KS) and lymphoma

The shortened life expectancy linked with untreated AIDS isn’t a direct result of the syndrome itself. Rather, it’s a result of the diseases and complications that arise from having an immune system weakened by AIDS.

The first few weeks after someone contracts HIV is called the acute infection stage.

During this time, the virus reproduces rapidly. The person’s immune system responds by producing HIV antibodies, which are proteins that take measures to respond against infection.

During this stage, some people have no symptoms at first. However, many people experience symptoms in the first month or so after contracting the virus, but they often don’t realize HIV causes those symptoms.

This is because symptoms of the acute stage can be very similar to those of the flu or other seasonal viruses, such as:

• they may be mild to severe
• they may come and go
• they may last anywhere from a few days to several weeks

Early symptoms of HIV can include:

• fever
• chills
• swollen lymph nodes
• general aches and pains
• skin rash
• sore throat
• headache
• nausea
• upset stomach

Because these symptoms are similar to common illnesses like the flu, the person who has them might not think they need to see a healthcare provider.

And even if they do, their healthcare provider might suspect the flu or mononucleosis and might not even consider HIV.

Whether a person has symptoms or not, during this period their viral load is very high. The viral load is the amount of HIV found in the bloodstream.

A high viral load means that HIV can be easily transmitted to someone else during this time.

Initial HIV symptoms usually resolve within a few months as the person enters the chronic, or clinical latency, stage of HIV. This stage can last many years or even decades with treatment.

HIV symptoms can vary from person to person.

After the first month or so, HIV enters the clinical latency stage. This stage can last from a few years to a few decades.

Some people don’t have any symptoms during this time, while others may have minimal or nonspecific symptoms. A nonspecific symptom is a symptom that doesn’t pertain to one specific disease or condition.

These nonspecific symptoms may include:

• headaches and other aches and pains
• swollen lymph nodes
• recurrent fevers
• night sweats
• fatigue
• nausea
• vomiting
• diarrhea
• weight loss
• skin rashes
• recurrent oral or vaginal yeast infections
• pneumonia
• shingles

As with the early stage, HIV is still transferable during this time even without symptoms and can be transmitted to another person.

However, a person won’t know they have HIV unless they get tested. If someone has these symptoms and thinks they may have been exposed to HIV, it’s important that they get tested.

HIV symptoms at this stage may come and go, or they may progress rapidly. This progression can be slowed substantially with treatment.

With the consistent use of this antiretroviral therapy, chronic HIV can last for decades and will likely not develop into AIDS, if treatment was started early enough.

Many people with HIV experience changes to their skin. Rash is often one of the first symptoms of an HIV infection. Generally, an HIV rash appears as multiple small red lesions that are flat and raised.

Rash related to HIV

HIV makes someone more susceptible to skin problems because the virus destroys immune system cells that take measures against infection. Co-infections that can cause rash include:

• molluscum contagiosum
• herpes simplex
• shingles

The cause of the rash determines:

• how it looks
• how long it lasts
• how it can be treated depends on the cause

Rash related to medication

While rash can be caused by HIV co-infections, it can also be caused by medication. Some drugs used to treat HIV or other conditions can cause a rash.

This type of rash usually appears within a week or 2 weeks of starting a new medication. Sometimes the rash will clear up on its own. If it doesn’t, a change in medications may be needed.

Rash due to an allergic reaction to medication can be serious.

Other symptoms of an allergic reaction include:

• trouble breathing or swallowing
• dizziness
• fever

Stevens-Johnson syndrome (SJS) is a rare allergic reaction to HIV medication. Symptoms include fever and swelling of the face and tongue. A blistering rash, which can involve the skin and mucous membranes, appears and spreads quickly.

When 30 percentTrusted Source of the skin is affected, it’s called toxic epidermal necrolysis, which is a life threatening condition. If this develops, emergency medical care is needed.

While rash can be linked with HIV or HIV medications, it’s important to keep in mind that rashes are common and can have many other causes.

Symptoms of HIV vary from person to person, but they’re similar in men and women. These symptoms can come and go or get progressively worse.

If a person has been exposed to HIV, they may also have been exposed to other sexually transmitted infections (STIs). These include:

• gonorrhea
• chlamydia
• syphilis
• trichomoniasis

Men, and those with a penis, may be more likely than women to notice symptoms of STIs such as sores on their genitals. However, men typically don’t seek medical care as often as women.

For the most part, symptoms of HIV are similar in men and women. However, symptoms they experience overall may differ based on the different risks men and women face if they have HIV.

Both men and women with HIV are at increased risk for STIs. However, women, and those with a vagina, may be less likely than men to notice small spots or other changes to their genitals.

In addition, women with HIV are at increased risk for:

• recurrent vaginal yeast infections
• other vaginal infections, including bacterial vaginosis
• pelvic inflammatory disease (PID)
• menstrual cycle changes
• human papillomavirus (HPV), which can cause genital warts and lead to cervical cancer

While not related to HIV symptoms, another risk for women with HIV is that the virus can be transmitted to a baby during pregnancy. However, antiretroviral therapy is considered safe during pregnancy.

Women who are treated with antiretroviral therapy are at very low risk for transmitting HIV to their baby during pregnancy and delivery. Breastfeeding is also affected in women with HIV. The virus can be transferred to a baby through breast milk.

In the United States and other settings where formula is accessible and safe, it’s recommended that women with HIV not breastfeed their babies. For these women, use of formula is encouraged.

Options besides formula include pasteurized banked human milk.

For women who may have been exposed to HIV, it’s important to know what symptoms to look for.

AIDS refers to acquired immunodeficiency syndrome. With this condition, the immune system is weakened due to HIV that’s typically gone untreated for many years.

If HIV is found and treated early with antiretroviral therapy, a person will usually not develop AIDS.

People with HIV may develop AIDS if their HIV is not diagnosed until late or if they know they have HIV but don’t consistently take their antiretroviral therapy.

They may also develop AIDS if they have a type of HIV that’s resistant to (doesn’t respond to) the antiretroviral treatment.

Without proper and consistent treatment, people living with HIV can develop AIDS sooner. By that time, the immune system is quite damaged and has a harder time generating a response to infection and disease.

With the use of antiretroviral therapy, a person can maintain a chronic HIV diagnosis without developing AIDS for decades.

Symptoms of AIDS can include:

• recurrent fever
• chronic swollen lymph glands, especially of the armpits, neck, and groin
• chronic fatigue
• night sweats
• dark splotches under the skin or inside the mouth, nose, or eyelids
• sores, spots, or lesions of the mouth and tongue, genitals, or anus
• bumps, lesions, or rashes of the skin
• recurrent or chronic diarrhea
• rapid weight loss
• neurologic problems such as trouble concentrating, memory loss, and confusion
• anxiety and depression

Antiretroviral therapy controls the virus and usually prevents progression to AIDS. Other infections and complications of AIDS can also be treated. That treatment must be tailored to the individual needs of the person.

Anyone can contract HIV. The virus is transmitted in bodily fluids that include:

• blood
• semen
• vaginal and rectal fluids
• breast milk

Some of the ways HIV is transferred from person to person include:

• through vaginal or anal sex — the most common route of transmission
• by sharing needles, syringes, and other items for injection drug use
• by sharing tattoo equipment without sterilizing it between uses
• during pregnancy, labor, or delivery from a pregnant person to their baby
• during breastfeeding
• through “premastication,” or chewing a baby’s food before feeding it to them
• through exposure to the blood, semen, vaginal and rectal fluids, and breast milk of someone living with HIV, such as through a needle stick

The virus can also be transmitted through a blood transfusion or organ and tissue transplant. However, rigorous testing for HIV among blood, organ, and tissue donors ensures that this is very rare in the United States.

It’s theoretically possible, but considered extremely rare, for HIV to be transmitted through:

• oral sex (only if there are bleeding gums or open sores in the person’s mouth)
• being bitten by a person with HIV (only if the saliva is bloody or there are open sores in the person’s mouth)
• contact between broken skin, wounds, or mucous membranes and the blood of someone living with HIV

HIV does NOT transfer through:

• skin-to-skin contact
• hugging, shaking hands, or kissing
• air or water
• sharing food or drinks, including drinking fountains
• saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
• sharing a toilet, towels, or bedding
• mosquitoes or other insects

It’s important to note that if a person living with HIV is being treated and has a persistently undetectable viral load, it’s virtually impossible to transmit the virus to another person.

HIV is a variation of a virus that can be transmitted to African chimpanzees. Scientists suspect the simian immunodeficiency virus (SIV) jumped from chimps to humans when people consumed chimpanzee meat containing the virus.

Once inside the human population, the virus mutated into what we now know as HIV. This likely occurred as long ago as the 1920s.

HIV spread from person to person throughout Africa over the course of several decades. Eventually, the virus migrated to other parts of the world. Scientists first discovered HIV in a human blood sample in 1959.

It’s thought that HIV has existed in the United States since the 1970s, but it didn’t start to hit public consciousness until the 1980s.

Treatment should begin as soon as possible after a diagnosis of HIV, regardless of viral load.

The main treatment for HIV is antiretroviral therapy, a combination of daily medications that stop the virus from reproducing. This helps protect CD4 cells, keeping the immune system strong enough to take measures against disease.

Antiretroviral therapy helps keep HIV from progressing to AIDS. It also helps reduce the risk of transmitting HIV to others.

When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is not visible in test results.

However, the virus is still in the body. And if that person stops taking antiretroviral therapy, the viral load will increase again, and the HIV can again start attacking CD4 cells.

Many antiretroviral therapy medications are approved to treat HIV. They work to prevent HIV from reproducing and destroying CD4 cells, which help the immune system generate a response to infection.

This helps reduce the risk of developing complications related to HIV, as well as transmitting the virus to others.

These antiretroviral medications are grouped into seven classes:

• nucleoside reverse transcriptase inhibitors (NRTIs)
• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• protease inhibitors
• fusion inhibitors
• CCR5 antagonists, also known as entry inhibitors
• integrase strand transfer inhibitors
• attachment inhibitors

Treatment regimens

The U.S. Department of Health and Human Services (HHS) generally recommends a starting regimen of three HIV medications from at least two of these drug classes.

This combination helps prevent HIV from forming resistance to medications. (Resistance means the drug no longer works to treat the virus.)

Many of the antiretroviral medications are combined with others so that a person with HIV typically takes only one or two pills a day.

A healthcare provider will help a person with HIV choose a regimen based on their overall health and personal circumstances.

These medications must be taken every day, exactly as prescribed. If they’re not taken appropriately, viral resistance can develop, and a new regimen may be needed.

Blood testing will help determine if the regimen is working to keep the viral load down and the CD4 count up. If an antiretroviral therapy regimen isn’t working, the person’s healthcare provider will switch them to a different regimen that’s more effective.

Side effects and costs

Side effects of antiretroviral therapy vary and may include nausea, headache, and dizziness. These symptoms are often temporary and disappear with time.

Serious side effects can include swelling of the mouth and tongue and liver or kidney damage. If side effects are severe, the medications can be adjusted.

Costs for antiretroviral therapy vary according to geographic location and type of insurance coverage. Some pharmaceutical companies have assistance programs to help lower the cost.

To develop AIDS, a person has to have contracted HIV. But having HIV doesn’t necessarily mean that someone will develop AIDS.

Cases of HIV progress through three stages:

• stage 1: acute stage, the first few weeks after transmission
• stage 2: clinical latency, or chronic stage
• stage 3: AIDS

As HIV lowers the CD4 cell count, the immune system weakens. A typical adult’s CD4 count is 500 to 1,500 per cubic millimeter. A person with a count below 200 is considered to have AIDS.

How quickly a case of HIV progresses through the chronic stage varies significantly from person to person. Without treatment, it can last up to a decade before advancing to AIDS. With treatment, it can last indefinitely.

There’s currently no cure for HIV, but it can be managed. People with HIV often have a near-normal lifespan with early treatment with antiretroviral therapy.

Along those same lines, there’s technically no cure for AIDS currently. However, treatment can increase a person’s CD4 count to the point where they’re considered to no longer have AIDS. (This point is a count of 200 or higher.)

Also, treatment can typically help manage opportunistic infections.

HIV and AIDS are related, but they’re not the same thing.