AIDS (acquired immunodeficiency syndrome) is the last stage of HIV infection.
Someone with HIV is more likely to get sick from things that don’t affect other people. And people with AIDS tend to get serious infections or cancers.
Although there’s no cure, treatment can slow or stop the progress of HIV. Many people who treat HIV live long, healthy lives and never develop AIDS.
Symptoms of HIV/AIDS and Stages
Many people don’t have symptoms at first, and sometimes even for years or decades. But there are signs that can happen, such as flu-like symptoms soon after you become infected with HIV. Even if you don’t feel sick, HIV damages the immune system. It hijacks infection-fighting white blood cells called CD4 cells and uses them to churn out thousands of copies of itself. Without treatment, HIV destroys so many of these cells that your body can’t protect you from life-threatening infections. If your CD4 count drops below 200, you have AIDS.
There are three stages of HIV infection:
Stage 1: This the earliest stage. You may also hear it called the “acute” stage. You might have a fever, rash, fatigue, chills, and other flu-like symptoms. But you might not have any symptoms. If you do, they may start 2-4 weeks after you’re infected. During this time, the virus quickly makes many copies of itself.
Stage 2: During this stage, HIV continues to reproduce, and it slowly damages your immune system over time. You might not feel sick or have symptoms. But HIV isn’t gone, and you can still spread it to other people. This stage can last for years or even decades.
Stage 3: This is when you have AIDS. Your immune system has been severely damaged, leaving you vulnerable to other illnesses. With AIDS, many people have symptoms such as chills, fever, sweats, swollen lymph glands, weakness, and weight loss.
HIV Risk Factors
Anyone can get HIV. You’re at greater risk for it if you:
HIV spreads when an infected person’s blood, semen, or rectal or vaginal fluids get into your bloodstream. The most common ways for this to happen are through unprotected anal or vaginal sex or sharing needles or syringes with an HIV-positive person.
Pregnant women who are HIV-positive can pass the virus to their baby before or during birth. HIV can also pass to a baby through breastfeeding. But the risk is very low for women who take HIV medicine.
It’s possible, but not common, for health care workers to become infected if they have an accidental needle stick while treating someone who has HIV.
There is little to no risk of catching HIV through oral sex. And it’s extremely rare to get it by being bitten by someone infected with HIV. There have been very few cases of that, and those were severe bites that broke the skin.
The only way to know if you have HIV is to get tested. If your test is positive, you can start treatment right away. You can also take steps so you don’t spread the virus to others. If you’re pregnant, it’s important to get tested and on treatment as soon as possible.
You can get an HIV test in a doctor’s office, clinic, community health center, hospital, or substance use program.
There are three types of HIV tests:
Antibody test. This looks for antibodies -- proteins your body makes to fight the virus. The test uses a small blood sample from a vein in your arm or finger stick. It can also use fluid from inside your mouth (oral fluid test). Finger stick and oral fluid tests are called rapid tests because you get the results in about 30 minutes or less.
Nucleic acid test (NAT). This looks for traces of HIV in your blood. Your blood is sent to a lab for testing, so it may take a few days to get the results.
There is a self-test, also known as a home test. OraQuick is a rapid antibody test you can take at home. You swab your gums to get a fluid sample and use the kit to test it. Results are ready in about 20 minutes. It’s important to use the test correctly or it won’t work well. If this happens, you can try another home test or go to a testing center. As for the self-test’s effectiveness, clinical studies show that the test may mistakenly tell 1 out of 12 HIV-positive people that they don’t have the virus. And for every 5,000 people who don’t have HIV, the results may falsely tell 1 person that they do have it. An at-home test that shows HIV should always be confirmed by another test taken at a doctor’s office, clinic, or testing center.
HIV Diagnosis and 'Window Period'
You won’t know if you have HIV right after you’re infected. It takes time for your body to make antibodies and for antigens to show up.
The “window period” is the time between when you might have been exposed to HIV and a test can tell for sure you have it. This varies from person to person and test to test. Your testing counselor can tell you more about the window period for the test you’re taking. Here are some general guidelines:
An antibody test can detect HIV 23 to 90 days after you’re exposed to the virus. The window for a test that uses blood from a vein is faster than one that uses oral fluid or blood from a finger stick.
An antigen/antibody test done in a lab on blood from a vein can detect HIV infection within 18 to 45 days. It takes longer (18 to 90 days) if the test’s done with blood from a finger stick.
A nucleic acid test (NAT) usually has the shortest window: 10 to 33 days. This test is not generally used to diagnose HIV infection unless you have symptoms and a history that suggest you were infected only a few days ago.
If you have a negative test (meaning that it shows that you don’t have HIV) and weren’t exposed to the virus during the window period for that test, you can be certain you didn’t have HIV when you were tested.
If your first test is positive (meaning that it shows that you have HIV), you’ll have a second test to make sure. Doctors diagnose HIV after two positive tests. If your test was done in a laboratory, this second test will be done automatically. If your first test was done at home or in a community testing site, it’s important to have another blood sample taken and tested in a laboratory.
The CDC recommends that all adults have an HIV test at least once, even if they’re not at risk. If your risk is higher -- for example, you have multiple sex partners or use needles for drugs -- you should be tested every year.
It’s not uncommon to have other health issues when you have HIV. They might result from your HIV status or its treatment. Other health problems may be unrelated. Those conditions may include:
Co-infections. This is when you have one or more infections in addition to HIV. Common co-infections include:
- Hepatitis B or hepatitis C, which damage your liver. Like HIV, both types of the hepatitis virus are transmitted through sex or needle sharing
- Tuberculosis. TB can seriously affect your lungs and other parts of your body. It’s spread through the air.
- Opportunistic infections. People with weakened immune systems are more susceptible to infections, such as herpes, salmonella, and thrush. Your risk for opportunistic infections is highest when your CD4 count is below 200. But they also can happen when your CD4 count is below 500.
Long-term inflammation. This can happen even if your HIV is well controlled. Over time, chronic inflammation may raise your chances for diabetes, heart, bone, or liver problems, and some types of cancer.
Things have come a long way from the days when there were no treatments for HIV. Today, antiretroviral therapy (ART) can slow down and sometimes stop the progress of the virus, no matter how long you’ve had it.
ART works by lowering your viral load, which is the amount of HIV in your body. The goal is to get it so low that a lab test can’t detect it. With an undetectable viral load, your overall health improves, and you can’t spread the virus to others.
You usually take a combination of at least three HIV meds (called antiretrovirals, or ARVs). Some come in a single pill. It’s important to take them at the right time every day, just as your doctor prescribes.
If you skip doses or go off treatment, your viral load goes up, and so does your ability to infect others.
There are seven types or classes of ARVs, which block HIV in different ways:
Nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside transcriptase inhibitors (NNRTIs) block an enzyme called reverse transcriptase. HIV uses this enzyme to make copies of itself.
Protease inhibitors and integrase inhibitors block other copy-making enzymes.
Entry inhibitors (fusion inhibitors, CCR5 antagonists, and post-attachment inhibitors) stop HIV from getting into CD4 cells.
You usually have blood tests 1 month and 3-6 months after you start treatment. These check your viral load and CD4 levels. In time, your viral load should go down and your CD4 count should go up. This means that though you still have the virus, your treatment’s working, and you should stick with it.
HIV Treatment Side Effects
Like all drugs, ART can cause side effects. These vary, depending on the person and type of treatment. Even people taking the same HIV drugs can have different side effects. The most common are:
You’re more likely to have these symptoms when you first start treatment, and some may go away in a few weeks. Other side effects can happen over time, including:
A hypersensitivity reaction to an HIV drug called abacavir (included in Triumeq, Trizivir, and Ziagen) which consists of liver damage (hepatoxicity) or severe skin rashes, can be life-threatening. Call your doctor or get emergency care right away if you think you have a severe reaction to this or any medication you take. Before you start any drug, make sure your doctor explains what side effects to watch out for.
Treatment as prevention: The best way to stay healthy and protect others is to start and stick with treatment. When your viral load is undetectable, you will keep yourself healthy, and there’s no chance you can pass the virus to your sexual partner(s).
HIV Prevention/Risk Reduction
There are many ways to prevent or lower your chance of HIV if you don’t already have it:
Safer sex: Use a new condom the right way every time you have anal or vaginal sex. Condoms aren’t 100% effective, so it’s a good idea to use other preventive measures, too. There’s almost no chance of HIV infection with oral sex, but you can get other STDs, like gonorrhea and chlamydia.
Pre-exposure prophylaxis (PrEP): Emtricitabine/tenofovir is a daily pill that helps prevent infection in people who don’t have HIV but are at high risk of getting it. This includes men who have sex with men, women and men who have sex with someone who has HIV, and people who inject drugs. For it to work, you must take it every day. And you should still use condoms to prevent STDs.
Post-exposure prophylaxis (PEP): ART helps prevent infection if you take it right after you’ve been exposed to HIV. For it to work, you must start within 3 days. You continue to take one or two pills a day for 28 days.
Safer drug use. If you inject drugs, use a clean needle every time. Never share needles or works. If you would like help getting off drugs, talk to your doctor or HIV counselor.