HIV/AIDS

How HIV Is and Is Not Transmitted

HIV is a fragile virus. It cannot live for very long outside the body. As a result, the virus is not transmitted through day-to-day activities such as shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, drinking fountain, doorknob, dishes, drinking glasses, food, or pets. You also cannot get HIV from mosquitoes.

HIV is primarily found in the blood, semen, or vaginal fluid of an infected person. HIV is transmitted in 3 main ways:

• Having sex (anal, vaginal, or oral) with someone infected with HIV
• Sharing needles and syringes with someone infected with HIV
• Being exposed (fetus or infant) to HIV before or during birth or through breast feeding

HIV also can be transmitted through blood infected with HIV. However, since 1985, all donated blood in the United States has been tested for HIV. Therefore, the risk for HIV infection through the transfusion of blood or blood products is extremely low. The U.S. blood supply is considered among the safest in the world.

Risk Factors for HIV Transmission

You may be at increased risk for infection if you have

• injected drugs or steroids, during which equipment (such as needles, syringes, cotton, water) and blood were shared with others
• had unprotected vaginal, anal, or oral sex (that is, sex without using condoms) with men who have sex with men, multiple partners, or anonymous partners
• exchanged sex for drugs or money
• been given a diagnosis of, or been treated for, hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD) such as syphilis
• received a blood transfusion or clotting factor during 1978-1985
• had unprotected sex with someone who has any of the risk factors listed above

Preventing Transmission

Your risk of getting HIV or passing it to someone else depends on several things.  Do you know what they are? You might want to talk to someone who knows about HIV. You can also do the following:

• Abstain from sex (do not have oral, anal, or vaginal sex) until you are in a relationship with only one person, are having sex with only each other, and each of you knows the other's HIV status. 
• If both you and your partner have HIV, use condoms to prevent other sexually transmitted diseases (STDs) and possible infection with a different strain of HIV.
• If only one of you has HIV, use a latex condom and lubricant every time you have sex.
• If you have, or plan to have, more than one sex partner, consider the following:
• Get tested for HIV
• If you are a man who has had sex with other men, get tested at least once a year.
• If you are a woman who is planning to get pregnant or who is pregnant, get tested as soon as possible, before you have your baby.
• Talk about HIV and other STDs with each partner before you have sex.
• Learn as much as you can about each partner's past behavior (sex and drug use), and consider the risks to your health before you have sex.
• Ask your partners if they have recently been tested for HIV; encourage those who have not been tested to do so.
• Use a latex condom and lubricant every time you have sex.
• If you think you may have been exposed to another STD such as gonorrhea, syphilis, or Chlamydia trachomatis infection, get treatment. These diseases can increase your risk of getting HIV.
• Get vaccinated against hepatitis B virus.
• Even if you think you have low risk for HIV infection, get tested whenever you have a regular medical check-up.
• Do not inject illicit drugs (drugs not prescribed by your doctor). You can get HIV through needles, syringes, and other works if they are contaminated with the blood of someone who has HIV. Drugs also cloud your mind, which may result in riskier sex.
• If you do inject drugs, do the following:
• Use only clean needles, syringes, and other works.
• Never share needles, syringes, or other works.
• Be careful not to expose yourself to another person's blood.
• Get tested for HIV test at least once a year.
• Consider getting counseling and treatment for your drug use.
• Get vaccinated against hepatitis A and B viruses.
• Do not have sex when you are taking drugs or drinking alcohol because being high can make you more likely to take risks.

To protect yourself, remember these ABCs:

A=Abstinence

B=Be Faithful

C=Condoms

Symptoms of HIV Infection

The only way to know whether you are infected is to be tested for HIV. You cannot rely on symptoms alone because many people who are infected with HIV do not have symptoms for many years. Someone can look and feel healthy but can still be infected. In fact, one quarter of the HIV-infected persons in the United States do not know that they are infected. For more information view our question

HIV Testing

Once HIV enters the body, the body starts to produce antibodies-substances the immune system creates after infection. Most HIV tests look for these antibodies rather than the virus itself. There are many different kinds of HIV tests, including rapid tests and home test kits. All HIV tests approved by the US government are very good at finding HIV.

Finding a Testing Site

Many places offer HIV testing: health departments, doctors' offices, hospitals, and sites specifically set up to provide HIV testing.

What factors make women more vulnerable to HIV infection?

A combination of biological, social, cultural and economic factors contribute to women's increased vulnerability.  In particular, gender inequalities prevent women from asserting power over their own lives and controlling the circumstances that increase their vulnerability to infection.  Women are also physiologically more susceptible to becoming infected with HIV than men.

Is there a connection between HIV and STDs?

Question: Is there a connection between HIV and STDs?

People often ask if there is a connection between other sexually transmitted diseases and HIV. There is a connection between the two. Take a look at the answer to this very good question.

Answer: Yes there is. Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid) or does not cause breaks in the skin (e.g., Chlamydia, gonorrhea).

If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely.

In addition, if an HIV-infected person also is infected with another STD, that person is three to five times more likely than other HIV-infected persons to transmit HIV through sexual contact.

Not having (abstaining from) sexual intercourse is the most effective way to avoid STDs, including HIV. For those who choose to be sexually active, the following HIV prevention activities are highly effective:

• Engaging in sex that does not involve vaginal, anal, or oral sex
• Having intercourse with only one uninfected partner
• Using latex condoms every time you have sex.

What is the link between HIV and tuberculosis?
The HIV epidemic is largely responsible for the growing number of TB cases in many parts of the world. HIV weakens the cells in the immune system that are needed to fight TB; up to half of all people living with HIV/AIDS eventually develop TB. Worldwide, TB is the leading cause of death among HIV-positive people.

1.1 Introduction to HIV and AIDS drug treatment

This is the first of a set of treatment pages that give an overview of the issues surrounding HIV and AIDS drug treatment. It is followed by starting HIV & AIDS drug treatment and continuing HIV & AIDS drug treatment.

1.2 What is HIV antiretroviral drug treatment?

This is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a person's life.

The aim of antiretroviral treatment is to keep the amount of HIV in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV might have caused already.

The drugs are often referred to as:

antiretrovirals

anti-HIV or anti-AIDS drugs

HIV antiviral drugs

ARVs

1.1  

What is combination therapy?

Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART).

Why do people need to take more than one drug at a time?

If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antiretrovirals at the same time vastly reduces the rate at which resistance would develop, making treatment more effective in the long term.

Our continuing antiretroviral treatment page has more about drug resistance.

How many HIV and AIDS drugs are there?

There are more than 20 approved antiretroviral drugs but not all are licensed or available in every country. See our drugs table for a comprehensive list of antiretroviral drugs approved by the American Food and Drug Administration.

The groups of antiretroviral drugs

There are five groups of antiretroviral drugs. Each of these groups attacks HIV in a different way.

NRTIs and NNRTIs are available in most countries. Fusion/entry inhibitors and integrase inhibitors are usually only available in resource-rich countries.

Protease inhibitors are generally less suitable for starting treatment in resource-limited settings due to the cost, number of pills which need to be taken, and the particular side effects caused by protease drugs.

1.1 What does combination therapy usually consist of?

The most common drug combination given to those beginning treatment consists of two NRTIs combined with either an NNRTI or a "boosted" protease inhibitor. Ritonavir (in small doses) is most commonly used as the booster; it enhances the effects of other protease inhibitors so they can be given in lower doses. An example of a common antiretroviral combination is the two NRTIs zidovudine and lamivudine, combined with the NNRTI efavirenz.

Some antiretroviral drugs have been combined into one pill, which is known as a ‘fixed dose combination'. This reduces the number of pills to be taken each day.

The choice of drugs to take can depend on a number of factors, including the availability and price of drugs, the number of pills, the side effects of the drugs, the laboratory monitoring requirements and whether there are co-blister packs or fixed dose combinations available. Most people living with HIV in the developing world still have very limited access to antiretroviral treatment and often only receive treatment for the diseases that occur as a result of a weakened immune system. Such treatment has only short-term benefits because it does not address the underlying immune deficiency itself.

1.2 First and second line therapy

At the beginning of treatment, the combination of drugs that a person is given is called first line therapy. If after a while HIV becomes resistant to this combination, or if side effects are particularly bad, then a change to second line therapy is usually recommended.

Second line therapy will ideally include a minimum of three new drugs, with at least one from a new class, in order to increase the likelihood of treatment success.

Our continuing antiretroviral treatment page has more information about changing HIV treatment.

1.3 More information

Choosing when to start antiretroviral treatment is a very important decision. Once treatment has begun it must be adhered to, in spite of side effects and other challenges. Many factors must be weighed up when deciding whether to begin treatment, including the results of various clinical tests. These issues are addressed in our starting HIV treatment