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HIV stands for human immunodeficiency virus. HIV is a retrovirus that infects cells of the human immune system (mainly CD4-positive T-cells and macrophages key components of the cellular immune system) and destroys or impairs their function. Infection with this virus results in the progressive depletion of the immune system, leading to immunodeficiency.
The immune system is considered deficient when it can no longer fulfil its role of fighting off infection and diseases. People with immunodeficiency are much more vulnerable to a wide range of infections and cancers, most of which are rare among people without immunodeficiency. Diseases associated with severe immunodeficiency are known as opportunistic infections because they take advantage of a weakened immune system
AIDS stands for acquired immunodeficiency syndrome and describes the collection of symptoms and infections associated with acquired deficiency of the immune system. Infection with HIV has been established as the underlying cause of AIDS. The level of immunodeficiency or the appearance of certain infections are used as indicators that HIV infection has progressed to AIDS (see question 4).
Most people infected with HIV do not know that they have become infected. Immediately after the infection, some people have a glandular fever-like illness (with fever, rash, joint pains and enlarged lymph nodes), which can occur at the time of seroconversion. Seroconversion refers to the development of antibodies to HIV and usually takes place between one and two months after an infection has occurred (see question 32).
Despite the fact that HIV infection often does not cause any symptoms, a person newly infected with HIV is infectious and can transmit the virus to another person (see question 7). The way to determine whether HIV infection has occurred is by taking an HIV test (see question 31).
HIV infection causes a gradual depletion and weakening of the immune system. This results in an increased susceptibility of the body to infections and cancers and can lead to the development of AIDS (see questions 2 and 4).
Most people infected with HIV do not know that they have become infected. Immediately after the infection, some people have a glandular fever-like illness (with fever, rash, joint pains and enlarged lymph nodes), which can occur at the time of seroconversion. Seroconversion refers to the development of antibodies to HIV and usually takes place between one and two months after an infection has occurred (see question 32).
Despite the fact that HIV infection often does not cause any symptoms, a person newly infected with HIV is infectious and can transmit the virus to another person (see question 7). The way to determine whether HIV infection has occurred is by taking an HIV test (see question 31).
HIV infection causes a gradual depletion and weakening of the immune system. This results in an increased susceptibility of the body to infections and cancers and can lead to the development of AIDS (see questions 2 and 4).
The term AIDS applies to the most advanced stages of HIV infection.
The majority of people infected with HIV, if not treated, develop signs of AIDS within eight to 10 years.
AIDS is identified on the basis of certain infections. Stage 1 HIV disease is asymptomatic and not categorized as AIDS. Stage II (includes minor mucocutaneous manifestations and recurrent upper respiratory tract infections), III (includes unexplained chronic diarrhoea for longer than a month, severe bacterial infections and pulmonary tuberculosis) or IV (includes toxoplasmosis of the brain, candidiasis of the oesophagus, trachea, bronchi or lungs and Kaposi�s sarcoma) HIV disease are used as indicators of AIDS. Most of these conditions are opportunistic infections that can be treated easily in healthy people.
In addition, the United States Centers for Disease Control and Prevention defines AIDS on the basis of a CD4-positive T-cell count of less than 200 per mm3 of blood (see: http://www.cdc.gov/epo/dphsi/print/aids1993.htm) CD4-positive T-cells are critical in mounting an effective immune response to infections.
HIV can be transmitted through penetrative sex. HIV is not transmitted very efficiently so the risk of infection through a single act of vaginal sex is low. Transmission through anal sex has been reported to be 10 times higher than by vaginal sex. A person with an untreated sexually transmitted infection, particularly involving ulcers or discharge, is, on average, six to 10 times more likely to pass on or acquire HIV during sex.
Oral sex is regarded as a low-risk sexual activity in terms of HIV transmission.
When a person living with HIV is taking effective antiretroviral therapy and has a suppressed viral load they are no longer infectious.
Re-using or sharing needles or syringes represents a highly efficient way of transmitting HIV. The risk of transmission can be lowered substantially among people who inject drugs by always using new needles and syringes that are disposable or by properly sterilizing reusable needles/syringes before reuse (see question 19). Transmission in a health-care setting can be lowered by health-care workers adhering to universal precautions (see question 20).
HIV can be transmitted to an infant during pregnancy, labour, delivery and breastfeeding. Generally, there is a 15�30% risk of transmission from mother to child before and during delivery. A number of factors influence the risk of infection, particularly the viral load of the mother at birth (the higher the load, the higher the risk). Transmission from mother to child after birth can also occur through breastfeeding (see question 21). The chances of transmission of HIV to a child is very low if the mother is on antiretroviral therapy during pregnancy and when breastfeeding.
There is a high risk (greater than 90%) of acquiring HIV through transfusion of infected blood and blood products. However, the implementation of blood safety standards ensures the provision of safe, adequate and good-quality blood and blood products for all patients requiring transfusion. Blood safety includes screening of all donated blood for HIV and other blood-borne pathogens, as well as appropriate donor selection.
A risk of HIV transmission does exist if contaminated instruments are either not sterilized or are shared with others. Instruments that are intended to penetrate the skin should be used once, then disposed of or thoroughly cleaned and sterilized.
Having sex with someone living with HIV is safe if the person�s virus is fully suppressed by treatment. Sex is also safe if a condom is used properly or if you are taking pre-exposure prophylaxis in accordance with your health-care provider�s recommendations.
Safer sex involves taking precautions that decrease the potential of transmitting or acquiring sexually transmitted infections, including HIV, while having sex. Using condoms correctly and consistently during sex is considered safer sex, as is oral sex and non-penetrative sex or taking pre exposure prophylaxis if you are at risk of HIV infection or having undetectable viral load if you are living with HIV.
A female condom is a female-controlled contraceptive barrier method. The female condom is a strong, soft, transparent polyurethane sheath inserted into the vagina before sexual intercourse. It entirely lines the vagina and, therefore, with correct and consistent use, provides protection against both pregnancy and many sexually transmitted infections, including HIV. The female condom has no known side-effects or risks and does not require a prescription or the intervention of a health-care provider.
Post-exposure preventive (PEP) treatment consists of medication, laboratory tests and counselling. PEP treatment must be initiated within hours of possible HIV exposure and must continue for a period of approximately four weeks. Research studies suggest that, if the medication is initiated quickly after possible HIV exposure (ideally within two hours and not later than 72 hours following such exposure), it is beneficial in preventing HIV infection.
For more information, see http://www.who.int/hiv/topics/prophylaxis/en/.
For injecting drug users, certain steps can be taken to reduce personal and public health risks:
Health-care workers should follow universal precautions. Universal precautions are infection-control guidelines developed to protect health workers and their patients from exposure to diseases spread by blood and certain body fluids.
In addition, it is recommended that all health-care workers take precautions to prevent injuries caused by needles, scalpels and other sharp instruments or devices. In accordance with universal precautions, blood and other body fluids from all people are considered as infected with HIV and other possible viruses, regardless of the known or supposed status of the person.
For more information, see http://www.who.int/hiv/topics/precautions/universal/en/.
There is no cure for HIV. However, there is effective treatment, which, if started promptly and taken regularly, results in a quality and length of life for someone living with HIV that is similar to that expected in the absence of infection.
Antiretroviral medicines are used in the treatment of HIV infection. They work against HIV infection by blocking the reproduction of HIV in the body (see question 4). When a person living with HIV is on effective antiretroviral therapy, they are no longer infectious.
Inside an infected cell, HIV produces new copies of itself, which can then go on to infect other healthy cells within the body. The more cells HIV infects, the greater its impact on the immune system (immunodeficiency). Antiretroviral medicines slow down the replication and, therefore, the spread of the virus within the body by interfering with its replication process in different ways.
Nucleoside reverse transcriptase inhibitors: HIV needs an enzyme called reverse transcriptase to generate new copies of itself. This group of medicines inhibits reverse transcriptase by preventing the process that replicates the virus�s genetic material.
Non-nucleoside reverse transcriptase inhibitors: this group of medicines also interferes with the replication of HIV by binding to the reverse transcriptase enzyme itself. This prevents the enzyme from working and stops the production of new virus particles in the infected cells.
Protease inhibitors: protease is a digestive enzyme that is needed in the replication of HIV to generate new virus particles. It breaks down proteins and enzymes in the infected cells, which can then go on to infect other cells. The protease inhibitors prevent this breakdown of proteins and therefore slows down the production of new virus particles.
Other medicines that inhibit other stages in the virus�s cycle (such as entry of the virus and fusion with an uninfected cell) are currently being tested in clinical trials.
The use of antiretroviral medicines in a combination of three medicines has been shown to dramatically reduce AIDS-related illness and death. While not a cure for AIDS, combination antiretroviral therapy has enabled people living with HIV to live longer, healthier, more productive lives by reducing viraemia (the amount of HIV in the blood) and increasing the number of CD4-positive cells (white blood cells that are central to the effective functioning of the immune system).
For antiretroviral treatment to be effective for a long time, different antiretroviral medicines need to be combined. This is what is known as combination therapy. The term highly active antiretroviral therapy (HAART) is used to describe a combination of three or more anti-HIV medicines.
If one medicine is taken on its own, it has been found that, over a period of time, changes in the virus enable it to build up resistance to the medicine. The medicine is then no longer effective and the virus starts to reproduce to the same extent as before. If two or more antiretroviral medicines are taken together, the rate at which resistance develops can be reduced substantially.
Effective antiretroviral therapy also prevents the transmission of HIV. When a person living with HIV is taking effective antiretroviral therapy and has a suppressed viral load HIV can no longer be transmitted through sex.
Antiretroviral medicines should only be taken as prescribed by a health-care professional.
An HIV test is a test that reveals whether a person has been infected with HIV. Commonly used HIV tests detect the antibodies produced by the immune system in response to HIV, as they are much easier (and cheaper) to detect than the virus itself. Antibodies are produced by the immune system in response to an infection.
For most people, it takes a month for these antibodies to develop. Antibodies can be found in blood or oral fluid.
Generally, it is recommended that you wait three months after possible exposure before being tested for HIV. Although HIV antibody tests are very sensitive, there is a window period of up to two months, depending on the specific test being used, which is the period between infection with HIV and the appearance of detectable antibodies to the virus. In the case of the most sensitive anti-HIV tests currently recommended, the window period is about three weeks. This period may be longer if less-sensitive tests are used.
During the window period, people infected with HIV have no antibodies in their blood that can be detected by an HIV test. However, the person may already have high levels of HIV in their body fluids, such as blood, semen, vaginal fluids and breast milk. HIV can be passed on to another person during the window period even though an HIV test may not show that they are infected with HIV.
Knowing your HIV status has two vital benefits. Firstly, if you are HIV-infected, you can start treatment promptly, thereby potentially prolonging your life for many years (see question 36). Secondly, if you know you are infected, you can take all the necessary precautions to prevent the spread of HIV to others (see question 13). If you are not infected with HIV, you can learn how to protect yourself from HIV in the future
There are many places where you can be tested for HIV: in the offices of a private doctor, a local health department, hospitals, family planning clinics and sites specifically set up for HIV testing. Always try to find testing at a place where counselling is provided about HIV. You can also take an HIV test in privacy by using an HIV self-test kit. However you should go and see your health-care provider in the event of a positive test result for confirmation and seeking appropriate treatment.
All people taking an HIV test must give informed consent prior to being tested. The results of the test must be kept absolutely confidential. There are different types of testing available: Confidential HIV test: the medical professionals handling the HIV test keep the result of the test confidential within the medical records. Results cannot be shared with another individual unless written permission is provided by the person tested. Anonymous HIV test: the tested person�s name is not used in connection with the test. Instead, a code or number is assigned to the test, which allows the individual being tested to receive the results of the test. No records are kept that would link the person to the test. Shared confidentiality is encouraged and refers to confidentiality that is shared with others, who might include family members, loved ones, caregivers and trusted friends. However, care should be taken when revealing the results as it can lead to discrimination in health-care and professional and social settings. Shared confidentiality is therefore at the discretion of the person who will be tested. Although the result of the HIV test should be kept confidential, other professionals, such as counsellors and health and social service workers, might also need to be aware of the person�s HIV-positive status in order to provide appropriate care.
A negative test result means that no HIV antibodies were found in your blood at the time of testing. If you are negative, make sure you stay that way: learn the facts about HIV transmission and avoid engaging in unsafe behaviour. However, there is still a possibility of being infected, since it can take up to three months for your immune system to produce enough antibodies to show infection in a blood test. It is advisable to be retested at a later date and to take appropriate precautions in the meantime. During the window period, a person is highly infectious, and should therefore take measures to prevent any possible transmission.
HIV is not transmitted by day-to-day contact in social settings, schools or the workplace. You cannot be infected by shaking someone�s hand, by hugging someone, by using the same toilet or drinking from the same glass as someone living with HIV or by being exposed to coughing or sneezing by an infected person (see question 7).
You cannot tell if someone has HIV by just looking at them. A person infected with HIV may look healthy and feel good, but they can still pass the virus to you. An HIV test is the only way a person can find out if he or she is infected with HIV.
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