HIV, or Human Immunodeficiency Virus, affects a person's immune system. If an HIV infection is left untreated, the immune system deteriorates and becomes increasingly susceptible to common viral and bacterial infections. AIDS, or Acquired Immune Deficiency Syndrome, is the final stage of HIV disease; it is characterized by a severely compromised immune system, as measured by the count of CD4 cells in the body. In recent years, HIV treatment has progressed to a point that a person infected with HIV — commonly known as being "HIV-positive" — can stay healthy without the infection progressing to the AIDS stage. There is no certain cure for HIV or AIDS at this time, but there are proven ways to prevent the spread of the virus and to slow the progress of HIV in those infected.
Relationship Between HIV and AIDS
As its name suggests, HIV is a virus that attacks the immune system, most notably the T-cells and CD4 cells, which fight other viruses in a healthy body. However, unlike common cold or flu viruses, HIV remains active in the body for life, often whittling away at the immune system until it can no longer function. At this point, the body is very susceptible to other illnesses, be they viral, bacterial, or cancerous.
HIV has three stages: acute infection, clinical latency, and AIDS. Each stage is related to a patient's CD4 count, or how many infection-fighting cells remain in the body. With proper, modern medical treatment, many people who are HIV-positive can live for decades in the clinical latency stage of the virus and therefore never develop AIDS. Without treatment, an HIV infection will progress to AIDS in about 10 to 12 years, which will lead to death.
The video below further explains the relationship between HIV and AIDS.
How HIV is Transmitted
HIV is most commonly transmitted through sexual contact with someone who has HIV and through the sharing of needles with someone who has HIV, but the virus can be contracted in other ways. HIV specifically spreads through certain body fluids, including blood; pre-seminal fluid, semen, vaginal fluids, rectal fluids; and breast milk. For infection to occur, an infected person's body fluid must come into contact with an area of an uninfected person's body that can receive the virus, such as a mucous membrane (found in the vagina, rectum, opening of the penis, and the mouth), damaged tissue (e.g., a cut or similar wound), or — in the case of needle sharing — directly into the bloodstream.
- Anal sex is the most common way that HIV is contracted sexually, which is why men who have sex with men are more likely to come into contact with HIV. Those on the receiving end of anal sex, rather than the penetrating end, are more likely to contract the virus from an infected person because the rectum offers a larger area — a mucous membrane — that can receive the infection. In contrast, a penis has a relatively small opening from which it can come into contact with the virus.
- Vaginal sex is the second most common way that HIV is contracted sexually. HIV-negative women are more likely to contract the virus from HIV-positive men than vice versa — again, because the vagina offers a larger area for the virus to enter the body.
- Needle sharing is the other common way that HIV is contracted. Sharing needles for drug use or reusing needles, ink, or equipment for tattoo work can all lead to HIV-negative people coming into contact with the disease.
- In some cases, an HIV-positive mother can pass the virus on to her child during pregnancy, birth, or breastfeeding. Modern medical intervention can help prevent infected mothers from passing on the disease.
- Oral sex is another way HIV can be contracted sexually, though it is a less common way. Coming into direct contact with semen during oral sex is riskier than not coming into contact with it.
There are numerous other ways one might contract HIV, but they are usually very rare in developed countries (e.g., via blood transfusion). Other factors may also increase the likelihood of infection when coming into contact with the virus.
Preventing the Spread of HIV
- Abstaining from sex or practicing safe sex by correctly and consistently using male or female condoms can help prevent the spread of HIV to a great degree. Using lubricant on condoms can help keep them from breaking. Having fewer sexual partners and ensuring partners are HIV-negative reduces the odds of coming into contact with HIV.
- Getting tested once or twice a year for HIV and other sexually transmitted diseases is wise, especially for those who have multiple sexual partners over short periods of time.
- Those who share needles or have come into contact with unsterilized needles or equipment should get tested for HIV and, in the event of drug abuse, seek addiction counseling.
- Taking antiretrovirals as soon as one suspects he or she has come into contact with HIV can, in some cases, prevent HIV infection. Antiretrovirals have the best chance of working if used within 72 hours of contact.
- HIV-positive women who become pregnant can make plans with a doctor on how best to prevent their children from contracting the disease. With proper treatment, babies born to HIV-positive women have a <1% chance of contracting the disease.
- In February 2015, scientists announced a potent new drug candidate that may be able to function as a vaccine. Much more research is needed before its safety and effectiveness can be confirmed.
In the U.S., the FDA has approved Truvada as an HIV preventative for high-risk groups, namely men who have sex with other men. The drug is made up of a combination of antiretrovirals: Tenofovir and Emtricitabine. To learn more about Truvada, see this New York Times Q&A.
One out of every six people who has HIV does not know he or she is infected. HIV symptoms can be subtle, even to doctors, which is why regular HIV testing — once or twice a year — is so important. Some will experience severe flu-like symptoms at HIV's onset (2-4 weeks into the infection), but others will experience no symptoms at all. This is very dangerous, as the second stage of HIV — clinical latency — is generally asymptomatic, meaning it can be all too easy for patients go from feeling fine to suddenly discovering they are sick with AIDS, the final stage of HIV. AIDS goes on to make patients very susceptible to other illnesses, which is why it is so deadly.
Many are afraid of finding out whether they might have contracted HIV, but it is more dangerous not to find out. Early detection of the disease is paramount. The only way to know for sure, one way or the other, is to get tested.
Getting Tested for HIV
An HIV test can be done with an oral swab or with a blood sample; in rare cases, a test is performed on a urine sample.
- The cheapest, quickest, most common method of testing is antibody testing, which uses oral fluids, blood, or urine to look for HIV antibodies instead of the virus itself. A positive antibody test requires a second test known as the Western blot test for confirmation of infection. It may take up to two weeks to receive results for this test.
- Antigen testing, which looks for a particular protein produced by HIV, is done on the blood. It is less common than antibody testing and is more expensive. However, antigen testing is very good at early HIV detection (less so at later detection), making it ideal for those who are of a high-risk demographic and fear they have recently come into contact with the disease.
- Two types of genetic testing known as PCR testing and NAT testing look for genetic material of HIV in the blood. These tests are less commonly used on adult patients, but they are often used on babies born to an HIV-positive mother. These are also the tests used to ensure donated blood is safe to enter into the blood supply.
Those in the U.S. can use AIDS.gov's service locator to find nearby clinics and care centers that will provide HIV testing. Furthermore, the FDA has approved one type of at-home rapid HIV testing kit, which can be bought from many pharmacies or from Amazon.
Treatment for HIV varies slightly depending on the stage of the disease. When HIV is detected in its early stages, either the acute infection stage or the clinical latency stage, it is possible for a person who is HIV-positive to live for many decades.
Antiretrovirals are the primary form of HIV treatment. They do not cure patients of the disease, which remains in the body for life, but rather hold the virus at bay by slowing its progress. There are many different kinds of antiretroviral drugs that work in slightly different ways, but all with the same purpose: slowing the disease's progression. Sometimes multiple antiretrovirals are prescribed in what is known as combination therapy.
While alternative healing therapies, like acupuncture, abound, but there is no solid evidence to suggest they offer a cure or work as well as antiretrovirals. This does not mean they cannot provide other therapeutic relief, only that they should not be used as a substitute for conventional medicine.
HIV/AIDS Cures and Reversals
There is no known, consistent cure or reversal for HIV/AIDS. However, there are some notable cases of "functional cures." Functional cures are cases where the virus is not removed from the body but is essentially made dormant in such a way that it no longer affects quality of life in any way.
Some examples of functional cures do exist:
- Very early detection and subsequent combination antiretroviral treatment of HIV has been found to functionally cure a small percentage of patients. In a study that involved 70 newly diagnosed HIV-positive individuals, 14 were able to eventually stop taking medication without having the virus rebound significantly over the next several years.
- A baby born to an HIV-positive mother in Mississippi was put on an aggressive antiretroviral regimen and remained on the therapy for about 18 months. At three years of age, the child was no longer taking antiretrovirals (as per the mother's choice), and there was no evidence of HIV in the child's system. However, in July of 2014, HIV was detected in the four-year-old for the first time.
- At least two people who have received bone marrow transplants had a reversal of their HIV. Unfortunately, in 2013, it was discovered that this reversal was temporary, and the virus has returned in these individuals.
Outside of functional cure examples, there are also people who appear to be immune to HIV infection. It is possible that studying these individuals will lead to a cure or other functional cures.
Myths About HIV Infection
Many myths persist about HIV, how it is spread, and how it might be treated.
- "HIV spreads by…" HIV cannot be spread through air or water; through casual contact (e.g., handshakes, sharing glasses or utensils); through public facilities (e.g., toilets, drinking fountains); through saliva, sweat, or tears; or through insect bites.
- "Only gay people and drug users get HIV." There is no statistical evidence to support this. While men who have sex with men are the most at-risk demographic, straight men and straight women also contract HIV. Though it is rare, it is even possible to contract HIV in other ways that do not involve sex or drug use (e.g., through unsterilized tattoo equipment).
- "HIV is a death sentence." — or, in contrast — "HIV can be cured." Today, HIV-positive people who receive proper treatment have similar life expectancies to those who are HIV-negative. However, there is no cure for the disease, and it remains in the body for life; it is simply that its negative symptoms are held at bay.
- "I don't have to worry about HIV because modern medicine means it's not a big deal." Though antiretrovirals and combination drugs like Truvada can go a long way to preventing infection or improving long-term outcomes, they should not be relied upon. Abstinence, safe sex, and/or careful needle use are the only true methods of prevention. HIV is no longer a death sentence necessarily, but it should not be taken lightly.
- "Taking antiretrovirals means I can't spread HIV." Antiretrovirals reduce HIV's viral load in blood and sexual fluids, but they do not eradicate the virus, which can "hide" in the body and be spread by those who feel well, even if HIV-positive. Safe sex is paramount to keep the virus from spreading.
- "HIV was created by the government." There is no evidence of this. A much simpler explanation is that a similar virus found in apes and monkeys evolved to a point that it could be transferred to humans (see zoonosis).
- "Alternative medicine is just as good as conventional medicine at treating AIDS." There is no evidence for this. Though many alternative therapies exist, few are put through rigorous clinical trials (to become "conventional medicine"), and the alternative medicine industry is filled with anecdotal claims. Alternative medicine may be therapeutic, but it offers no cure or reliable treatment.
For the dispelling of more common myths, see this page on WomensHealth.gov.
How Common Is HIV?
HIV is a global disease that affects all demographics, both directly and indirectly. Over 35 million people, the majority (70%) of whom are in Sub-Saharan Africa, live with the virus today. HIV is deadliest in impoverished nations where access to care is difficult or impossible. In 2012, over 1.5 million died from AIDS; most were children in Africa. Since the pandemic began, AIDS-related illnesses have taken the lives of 36 million people.
Recent News on HIV/AIDS
The first reported case of HIV/AIDS was in 1981. To learn about the history of HIV/AIDS, see this timeline.
Prominent Figures With HIV/AIDS
Many celebrities, politicians, and artists have lived with HIV. See Wikipedia for an expansive list of notable HIV-positive people.