Table of ContentsView AllTable of ContentsWhat Is HIV?What Is AIDS?Symptoms of HIVSymptoms of AIDSTransmissionOrigin of HIVDiagnosisTreatmentHIV MedicationsPreventionLiving With HIVFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is HIV?
What Is AIDS?
Symptoms of HIV
Symptoms of AIDS
Transmission
Origin of HIV
Diagnosis
Treatment
HIV Medications
Prevention
Living With HIV
Frequently Asked Questions
This article takes a comprehensive look at HIV/AIDS, including the symptoms, causes, stages of infection, and modes of transmission. It also explains how HIV is diagnosed, treated, and prevented, and what to expect if you test positive for HIV.
BigFive Images / Getty Images
When HIV infects a CD4 T-cell, it inserts its genetic material into the cell and “hijacks” its genetic machinery, turning it into an HIV-producing factory. After numerous copies of the virus have been made, the infected cell dies.
As more and more CD4 T-cells are killed off, the immune system loses its ability to defend itself against infections it could otherwise fight. These are calledopportunistic infections (OIs).
AIDS stands for acquired immunodeficiency syndrome. It is the most advanced stage of HIV infection when the immune system has been compromised, leaving the body vulnerable to a wide range of potentially life-threatening opportunistic infections.
You are said to have AIDS when one of two things occurs:
If left untreated, HIV can progress to AIDS in about eight to 10 years. Some people progress far more quickly.
RecapHIV is a virus that can lead to AIDS if left untreated. AIDS is the most advanced stage of HIV infection where the body’s immune defenses have been compromised.
Recap
HIV is a virus that can lead to AIDS if left untreated. AIDS is the most advanced stage of HIV infection where the body’s immune defenses have been compromised.
How Long Does It Take to Show Symptoms of HIV?
HIV Symptoms
HIV progresses in stages as CD4 T-cells are progressively destroyed. While the progression can vary from one person to the next, there are certain symptoms that are more likely to occur during three phases, broadly referred to as:
Early Symptoms of HIV
Acute HIV infection is the period immediately following exposure to the virus in which the immune system mounts an aggressive defense to control the virus. During this phase, anywhere from 50% to 90% of people will experience flu-like symptoms referred to asacute retroviral syndrome (ARS).
Symptoms of ARS tend to develop with two to four weeks of exposure and may include:
Acute symptoms tend to clear within 14 days but may last for several months in some people. Other people may have no symptoms at all.
Uncommon Symptoms of Early HIV
Chronic HIV Infection Symptoms
Even after the acute infection has been controlled, the virus does not disappear. Instead, it goes into a period of chronic HIV infection (also called clinical latency) in which the virus persists at lower levels in the bloodstream and continues to “silently” kill CD4 T-cells.
Clinical latency is a relatively long period in which there may be few, in any, notable signs or symptoms. If symptoms do occur, they tend to be non-specific and easily mistaken for other illnesses.
Some of the more common OIs experienced during chronic HIV infection include:
7 Signs of HIV You May Not Know
Is Rash a Symptom of HIV?
A rash may also be a sign of acute HIV infection. Research suggests that around 50% of people who seek a diagnosis for acute HIV symptoms will have a rash, sometimes referred to as an “HIV rash.”
An HIV rash is described as beingmaculopapular. This means that there will be flat, reddened patches of skin covered with small bumps.
An HIV rash most often affects the upper body, including the face and chest, but may also develop on the arms, legs, hands, and feet. The rash can be itchy and even painful. In most cases, the rash will clear within a week or two.
Rashes Commonly Seen With HIV
HIV Symptoms in Men
The symptoms of HIV are generally the same for all sexes. With that said, males may experience certain symptoms differently or exclusively.
These includesexually transmitted infections (STIs)that commonly occur alongside HIV. In males, symptoms of anSTI coinfectionmay include genital or anal sores, pain with urination, pain with ejaculation, or testicle swelling.
During clinical latency, males with HIV may experience an outbreak of painful ulcers on the penis or anus due to genital herpes.Erectile dysfunctionis also common, occurring at a rate three times greater than males without HIV.
Cancer is also a concern among males living with HIV. Research shows that males with HIV have roughly an eight-fold greater risk ofpenile cancerand 144-fold greater risk ofanal cancerthan males without HIV.
Signs and Symptoms of HIV in Males
HIV Symptoms in Women
STI coinfection in females with HIV can cause pain with urination, vaginal discharge, vaginal itchiness, a fishy vaginal odor, pain with sex, bleeding between menstrual periods, and vaginal sores.
During clinical latency, females with HIV are at higher risk ofrecurrent yeast infections,abnormal periods,premature menopause, chronic pelvic pain, and infertility compared to females without HIV.
Painful vaginal ulcers may also occur due to an outbreak of genital herpes.Women with HIV are also at a four-fold greater risk ofosteoporosisthan women in the general population.
During advanced-stage infection, females with HIV are at a six-fold greater risk of invasive cervical cancer at CD4 counts under 200 than those whose CD4 counts are over 500.
Signs and Symptoms of HIV in Women
AIDS Symptoms
Examples include:
Facts About HIV Transmission
HIV can be passed through bodily fluids such as semen, blood, vaginal fluids, anal fluids, and breast milk. With that said, somemodes of transmissionare more effective than others.
Ways That HIV Is Transmitted
Some of the ways that HIV can be effectively transmitted (passed) from one person to the next include:
There is little to no risk of transmitting HIV throughoral sexas enzymes in the saliva appear to be effective in neutralizing the virus.Similarly, the risk of transmission fromblood transfusionsis low due to the routine screening of the blood supply in the United States.
Tattooing, body piercing, and dental procedures are theoretical sources of HIV infection.
Ways That HIV Cannot Be Transmitted
According to the Centers for Disease Control and Prevention (CDC), HIVcannotbe transmitted in the following ways:
RecapHIV is commonly transmitted through anal sex, vaginal sex, and shared needles. It can also be passed from mother to child during pregnancy or breastfeeding. Healthcare workers are at risk of infection from needlestick injuries and other occupational injuries.
HIV is commonly transmitted through anal sex, vaginal sex, and shared needles. It can also be passed from mother to child during pregnancy or breastfeeding. Healthcare workers are at risk of infection from needlestick injuries and other occupational injuries.
High-Risk and Low-Risk Activities for HIV
HIV is a type of virus that is believed to have made thejump from animals to humans. There are two types of HIV that not only have different genetic origins but different rates of infectivity (the ability to be transmitted) and virulence (the ability to cause disease):
RecapHIV-1 is thought to have made the leap from chimpanzees and gorillas to humans, while HIV-2 is believed to have originated in the sooty mangabey monkey. HIV-1 is seen worldwide and accounts for the vast majority of infections, while HIV-2 is mainly confined to West Africa.
HIV-1 is thought to have made the leap from chimpanzees and gorillas to humans, while HIV-2 is believed to have originated in the sooty mangabey monkey. HIV-1 is seen worldwide and accounts for the vast majority of infections, while HIV-2 is mainly confined to West Africa.
How HIV-1 Differs From HIV-2
Diagnosing HIV
HIV is diagnosed with blood, oral fluid, or urine tests. These include point-of-care (POC) tests that are performed in a medical office and in-home tests that can be purchased online or at drugstores.
In addition to traditional lab-based tests, there are rapid tests (both POC and in-home versions) that can deliver results in as few as 20 minutes.
The tests deliver either apositive result(meaning that you have HIV) or anegative result(meaning that you don’t have HIV).
When confirmed with a second approved testing method, HIV tests are extremely accurate with a low rate offalse positives(a positive result when you don’t have HIV) andfalse negatives(a negative result when you do have HIV).
Antibody Tests
There are several HIV antibody tests approved in the United States:
A positive result needs to be confirmed with a second test, most commonly a blood test known as theWestern blot.
Combination Antibody/Antigen Tests
Combination antibody/antigen tests are the common method of HIV testing in the United States. The test not only detects HIV antibodies in the blood but also proteins on the surface of the virus itself calledantigens.
Combination antibody/antigen tests allow for the accurate detection of HIV in a shorter period of time after infection than an antibody test alone.
Combination antibody/antigen tests are commonly performed as a point-of-care test using blood from a vein. There is also a POC version that requires a finger prick.
Nucleic Acid Test (NAT)
Anucleic acid test (NAT)is not used for general screening purposes. Unlike the other tests, it looks for the actual virus in a sample of blood based on its genetic material. The NAT can not only tell if you have HIV but also how many viruses there are in the blood sample.
While a NAT can detect HIV sooner than the other types of tests, it is very expensive and is mainly used if there has been a recent high-risk exposure or there are early signs of HIV.
The NAT can also be used if initial HIV test results are indeterminate (neither positive nor negative). It is used to screen donated blood or test newborns suspected of having HIV.
What Is the Window for HIV?
TheHIV window periodis the time between exposure to HIV and when it becomes detectable in blood or saliva tests. An HIV test may show a negative result during the window period even if you have HIV. You can still pass the virus to others during this period even though a test didn’t detect the virus.
If you think you may have been exposed to HIV but tested negative, it could be because you tested too early. In such cases, you may be advised to return in several weeks or months to get retested.
RecapHIV can be diagnosed with antibody tests, antibody/antigen tests, and nucleic acid (NAT) tests. Antibody tests can be performed on blood or oral fluid, while NAT and antibody/antigen tests require a sample of blood. There are also rapid antibody tests that can detect HIV in a little as 20 minutes.
HIV can be diagnosed with antibody tests, antibody/antigen tests, and nucleic acid (NAT) tests. Antibody tests can be performed on blood or oral fluid, while NAT and antibody/antigen tests require a sample of blood. There are also rapid antibody tests that can detect HIV in a little as 20 minutes.
What Tests Can Diagnose HIV?
Treatment Options
HIV is treated withantiretroviral drugs. This is a group of drugs that are used in combination to control the virus and slow disease progression.
Antiretrovirals do not “cure” HIV. They simply suppress the virus if used as directed. If you stop treatment, the viral population will rebound and relaunch its assault on CD4 cells. At the same time, it can allow drug-resistant mutations to develop in the virus, making your drugs less effective and increasing the risk of treatment failure.
RecapHIV is treated with antiretroviral drugs that prevent the virus from making copies of itself. When used as directed, antiretrovirals can reduce HIV to undetectable levels where it can do the body little harm.
HIV is treated with antiretroviral drugs that prevent the virus from making copies of itself. When used as directed, antiretrovirals can reduce HIV to undetectable levels where it can do the body little harm.
How HIV Is Treated
Treatment Regimens
The classes of HIV drugs are named after the stage in the life cycle they inhibit (block):
As of 2022, the Food and Drug Administration (FDA) has approved more than two dozen different individual antiretroviral agents. Many of these are used to make fixed-dose combination (FDC) drugs containing two or more antiretrovirals. Some FDC drugs can treat HIV with a single pill taken once daily.
Traditionally, HIV therapy consisted of two or more antiretrovirals taken in one or more doses every day.In 2021, the FDA approved the first extended-relief treatment calledCabenuvawhich is just as effective in suppressing HIV with only two injections once monthly.
List of Approved HIV Antiretroviral Drugs
Side Effects
As with all drugs, antiretroviral can cause side effects. Some may occur when treatment is first started, while others develop over time as drug toxicities develop.
Most short-term side effects are relatively mild and tend to clear within several days or weeks. These include:
Antiretroviral therapy is associated withgynecomastia(abnormal breast enlargement) in some men taking antiretroviral drugs.
Delayed or longer-term side effects are often more severe. Many of these are due to drug toxicities that tend to affect people with certain pre-existing conditions (such as kidney or liver diseases). Others are due to hypersensitivity reactions in which the immune system suddenly overreacts to a drug.
Life Expectancy for People Living With HIV
Cost
Antiretroviral drugs are expensive. Some studies estimate that the lifetime cost of treatment (including medications, routine blood tests, and doctor’s visits) is well in excess of $400,000.Even with copayment and coinsurance, the costs can be prohibitive.
According to a 2020 study published inJAMA Internal Medicine,the average wholesale cost of a recommended first-line therapy in the United States ranged from roughly $37,000 per year to just over $50,000 per year.
Fortunately, there are ways to reduce the cost of antiretroviral therapy even if you don’t have insurance. Eligibility for most is based on your family’s annual income.
Options include:
4 Tips for Making HIV Drugs More Affordable
RecapThere are more than two dozen individual antiretroviral drugs and more than 20 fixed-dosed combination drugs used to treat HIV. Although the cost of treatment is expensive, there are governmental, private, and manufacturer assistance programs that can help cover some or all of the cost.
There are more than two dozen individual antiretroviral drugs and more than 20 fixed-dosed combination drugs used to treat HIV. Although the cost of treatment is expensive, there are governmental, private, and manufacturer assistance programs that can help cover some or all of the cost.
HIV Prevention
HIV prevention has changed dramatically since time when “ABC” (abstinence, be faithful, condomize) was the catchphrase among many public health officials. Today, there are medical interventions that have proven equally effective in reducing the risk of getting or passing the virus.
Practice Safer Sex
Equally important is a reduction in your number of sex partners. Studies have consistently shown that people with multiple sexual partners are more likely to be HIV-positive and/or have an STI co-infection than those with only one sex partner.
Avoid Sharing Needles
Today, 43 states offer clean needle exchange programs that allow you to access sterile needles and syringes, no questions asked. (Alabama, Delaware, Kansas, Mississippi, Nebraska, South Dakota, and Wyoming currently don’t.)
PrEP, PEP, and TasP
HIV post-exposure prophylaxis (PEP)is used to avert infection in someone who is accidentally exposed to HIV. It involves a 28-day course of three antiretrovirals drugs which must be started no later than 72 hours from the time of exposure (and ideally sooner).
Treatment as prevention (TasP) is a preventive strategy in which an undetectable viral load in someone with HIV dramatically reduces their risk of infecting others. Studies have shown that a sustained undetectable viral load can cut the odds of infecting a sexual partner to literally zero—a strategy referred to as"U=U" (“Undetectable Equals Untransmissible”).
8 Simple Steps to Prevent HIV
HIV is a far different disease than it was 20 years ago, with people enjoying long, healthy lives when diagnosed and treated early. Even so, it doesn’t minimize the challenges that people with HIV still face when coming to terms with their diagnosis.
Coping Strategies
Living with HIV can be stressful, not only due to concerns about treatment and the cost of care but also due to emotional issues like HIV stigma, thefear of disclosure, and the impact of HIV on relationships,dating, andfamily planning.
Education is your first step to coping with HIV. By better understanding what HIV is, how your drugs work, and how infection is avoided, you will not only feel less stress but be able to educate others around you, including family and friends.
Among some of the other key coping strategies:
HIV Life Expectancy
Today, a 20-year-old newly diagnosed with HIV can expect to live a near-normal life expectancy—roughly into their early 70s—if diagnosed and treated early.That’s an enormous change from 1996 when the average life expectancy was a mere 10 years.
Even so, there are many things that take back those gains and dramatically reduce the lifespan of someone with HIV. These includes:
HIV Statistics
HIV does not affect all communities equally. This is especially true of men who have sex with men (MSM), who accounted for 69% of all new infections (despite making up only 2% of the general population).
When risk factors intersect, the likelihood of infection increases. There is arguably no better example of this thanBlack MSMin the United States. Faced with high levels of poverty, homophobia, racism, incarceration, and unemployment, Black MSM have no less than a 50/50 chance of getting HIV in a lifetime, according to the CDC.
The High Risk of Gay Black Men Getting HIV
Epidemiology of HIV/AIDS
Globally, around 38 million people are living with HIV. Despite vast improvements in treatment access, an estimated 1.5 million new infections and 680,000 HIV-related deaths occurred in 2020. Even so, that is over 50% fewer deaths and new infections than were reported at the height of the pandemic in 1997.
More than half of all people living with HIV today are in Africa. In some African countries, as many as one in four adults are living with HIV, according to data from the United Nations Programme on HIV/AIDS (UNAIDS).
In the United States, around 1.2 million people are currently living with HIV. Of those infections, an estimated 13% remain undiagnosed. Among those who have been diagnosed, only 65% have been able to achieve an undetectable viral load.
In 2020, just over 37,000 new HIV infections were reported in the United States and dependent areas, a drop of roughly 8% from 2015. Deaths have also been on the decline with a total of 5,115 deaths attributed to HIV-related complications.
Is There an HIV Vaccine?
Despite over 35 years of aggressive global research, scientists have yet to develop a vaccine able to effectively prevent or eradicate HIV. This is due in part to the fact that HIV mutates rapidly. Because of this, it is extremely challenging to develop a single vaccine able to target the multitude of strains and mutations.
Even if a vaccine were able to eradicate HIV in the bloodstream, these “hidden” viruses can spontaneously reactivate and start infection anew.
Faced with these setbacks, many scientists have shifted their focus to developing therapeutic vaccines designed to improve the body’s immune response to HIV in someone who already has HIV.
Why Is It So Hard to Make an HIV Vaccine?
Is There a Cure?
In 2008, scientists reported that Timothy Ray Brown, an American living in Berlin, was effectively “cured” of HIV following an experimental stem cell transplant. Despite the promise of a cure, the procedure proved highly risky, and subsequent attempts to repeat the results were either mixed or failed.
To date, only three other people have been declared “cured” of HIV.Even so, the insights gained from Brown and the others provided a general template for HIV cure research.
Other scientists are focused on developing a “functional cure” for HIV. This is a vaccine that doesn’t eradicate HIV but instead prevents it from progressing without the need for antiretroviral drugs.
Is HIV Curable?
Summary
AIDS is the most advanced stage of the disease in which the immune system is compromised and unable to fight an ever-widening range of potentially life-threatening opportunistic infections.
HIV is diagnosed with highly accurate blood- and saliva-based tests, some of which can return results in a little as 20 minutes. If a positive result is received, medications called antiretrovirals are prescribed to can stop the virus from replicating.
The aim of HIV therapy is to achieve and sustain an undetectable viral load; this slows the progression of the disease and reduces the odds of infecting others to zero. There are currently more than two dozen different antiretroviral agents used in combination to treat HIV.
The same drugs can be used to reduce the risk of infection in someone without HIV (pre-exposure prophylaxis, or PrEP) or to avert infection in someone accidentally exposed to the virus (post-exposure prophylaxis, or PEP.)
Antiretrovirals do not cure HIV but keep it in check so that you can live a long, healthy life. If treatment is started early, a person can expect to live a near-normal life expectancy. Even so, of the 1.2 million people living with HIV in the United States, only 65% are able to achieve and sustain an undetectable viral load.
A Word From Verywell
HIV is not the same disease that it was 40 or even 20 years ago. Today, it is considered a chronic manageable condition in which people can enjoy a long and healthy life, plan for the future, and even have kids.
But, to do so, you need to be treated. This involves taking your medications every day as prescribed, seeing your healthcare provider, and getting routine blood tests performed as scheduled. For some, this can be difficult, particularly if you lack insurance, have an alcohol or substance abuse problem. or live with the fear of disclosure, stigma, or discrimination.
If faced with these concerns, it is important to share them with your healthcare provider who can refer to you people who can help (including counselors, social workers, and financial assistance advisors).
HIV is a virus that kills immune cells and leaves the body vulnerable to opportunistic infections. AIDS is the most advanced stage of HIV in which the immune system is compromised and unable to fight an ever-widening range of potentially life-threatening opportunistic infections.
If left untreated, HIV can progress to AIDS in about eight to 10 years. Some people progress more quickly. On the other hand, a rare group of individuals, called elite controllers, appear resistant to disease progression and may never progress to AIDS.
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