In October of 1983, I was in my fourth month as the first communications director of the Gay Men’s Health Crisis (GMHC) in New York. If we weren’t then, we would soon be the largest AIDS service organization in the United States. I had been in New York for less than a year, working on morning drive at a news and talk radio station. Fresh from years in Alabama and Georgia, my naÏvety knew no bounds.

For us, then, AIDS was an emergency. We thought we were fundraising and counselling and managing politicians to get past a crisis. It soon became clear that the numbers were vast and the crisis would become a fact of life and death for affected communities across the world. More chilling still, AIDS had been present in humans since the early part of the twentieth century but, because only Africans were dying, no-one had even noticed.  

By October of 2023, the twin miracles of pharmaceutical discovery and global political will had turned HIV into a manageable chronic condition, but I had become much more world weary about the crisis ever concluding.  I moderated a panel that month at the World Health Summit in Berlin and left it thinking that the world really could achieve the UNAIDS goal of ending AIDS as a public health threat by 2030. 

The triumph of hope

“Sixteen years ago, I landed in Lilongwe and, on the way from the airport, there were roads full of coffin makers… I’ve been back and I’ve seen what happens when there is a commitment of resources and the will to fight AIDS,” Dr Mamadi Yilla, the Deputy Global AIDS Coordinator for Multisector Relations at the U.S. Department of State, told the panel. My moment of hopelessness came standing on the Thai – Burmese border sometime around the turn of the century and wondering how people caught up in fighting, without reliable access to primary care could ever be treated with the new highly active antiretroviral therapies.

Despite the coffins and the insurrections, we are within grasp of the current 90-90-90 global targets: ninety percent of those infected knowing their status, 90 percent of them on treatment and 90 percent of them with undetectable viral load. “Being hopeful is what has carried us through the last 30 years,” said another panel member, Christine Stegling, the Deputy Executive Director for Policy at UNAIDS. It was naïve and almost foolish hope but it changed the world

To understand how vast the accomplishment is, appreciate that minimal success in HIV is defined as 90 percent being on treatment effective enough to remove any trace of the virus; in Europeans being treated for hypertension, at least 40% do not control their high blood pressure. Those Europeans have no stigma, no supply chain interruptions, no systemic lack of primary care and very few side effects, yet they are four times as likely as a typical African with HIV to be incapable of controlling their life-threatening illness

We will need more resources and more political will to reach the remaining ten percent. The technological innovations coming will be especially important in the areas where the challenges are toughest. “The places that we’re getting to late are the ones with the most need,” said panellist Janet Dorling, Senior Vice President, Intercontinental Region and Global Patient Solutions at Gilead.  “They’re often the ones with the most people at the most risk…But with partnerships we can do things differently,” she added. 

About 4,900 women a week are still contracting HIV and 4,000 of those are in Africa, Dorling said. Reaching them is complicated by the baked-in inequity around women’s access to healthcare in Africa, panellist Florence Riako Anam said. She is the co-Executive Director of the Global Network of People Living with HIV – GNP+. 

Five countries are on track to remove AIDS as a public health threat by 2030, while 16 more are almost there, Stegling reported. The disproportionate share of national and donor resources required to achieve 100-100-100 goals should, I think, be seen as justified. “Everything about the HIV response is a model. This HIV response has taught us about how we serve vulnerable people whatever the threat impacting them” Yilla said

The incredible world waiting for us

The key role in reaching the end of AIDS as a threat will come from people living with it. “The ultimate goal for us is to be undetectable [have an undetectable amount of the virus in the bloodstream] because we will live long healthy lives… but also because the science tells us that if we’re undetectable, there’s zero risk of transmission… We must now use the confidence of the science to shift how we talk about HIV,” Riako Anam said. 

Science and innovation will be vital too. One innovation, Stegling said, tends to become transiently fashionable – the focus of all attention – while others are neglected, often those for women. Then the pack moves on.  “They take one thing and bold it, while forgetting everything else,” Riako Anam agreed. 

Innovation can not only prevent infections and improve quality of life; “innovation can help combat barriers and inequity,” Dorling said, but cautioned that it had to be innovation centred on those living with or vulnerable to HIV. Without transformative, multi-sector partnerships, the panellists concluded, new technologies and approaches would still come to Africa a decade late.

Scientific progress means that there is “an incredible world waiting for us”, Yilla said. Digital practitioners in Lusaka are already using telemedicine to deliver expert care through remote clinics. Digital technologies and AI could transform many aspects of care, she thought. But, she added, that progress in discovery had to be accompanied by progress in policy. Several panellists discussed a wave of bad policies on issues such as criminalising same-sex partnerships and any sexual relationships at all for people living with HIV and AIDS. “Bad policy will undermine the gains we have made in HIV,” Stegling warned. 

There is “a growing global numbness to pain,”  Riako Anam said. It is made worse by those too young or too forgetful to remember how things were twenty years ago in the boom time for coffin makers. “There is a whole generation who don’t know what 2003 was like and some of these people are making decisions,” she added. “They don’t remember what people with HIV looked like then.”

I remember clearly the skeletal, lesion-covered bodies of the early years of the epidemic. I also remember the hopelessness that set in as the scale of the epidemic became clear. This panel reminded me that I have, throughout the forty years since, underestimated the power of hopeful people to change the world. The threat is now almost over. 

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What can I do before getting pregnant to lower my risk of passing HIV to my baby?

If you plan to become pregnant, talk to your doctor right away. Your doctor can talk with you about how HIV can affect your health during pregnancy and your unborn baby’s health. Your doctor can work with you to prepare for a healthy pregnancy before you start trying to become pregnant.

Everyone living with HIV should take HIV medicines to stay healthy. If you are thinking about becoming pregnant and are not taking HIV treatment, it is important that you begin, because this will lower your chances of passing the virus to your baby when you become pregnant.

There are ways for you to get pregnant that will limit your partner’s risk of HIV infection. You can ask your doctor about ways to get pregnant and still protect your partner.

I do not have HIV, but my partner does. Can I get pregnant without getting HIV?

Women have a higher risk of HIV infection during vaginal sex than men. If you do not have HIV but your male partner does, the risk of getting HIV while trying to get pregnant can be reduced but not totally eliminated.

Talk to your doctor about HIV medicine you can take (called pre-exposure prophylaxis or PrEP) to help protect you and your baby from HIV.

You may also want to consider donor sperm or assisted reproductive technology, such as semen washing or in vitro fertilization, to get pregnant. These options can be expensive and may not be covered by your health insurance.

I’m pregnant. Will my baby have HIV?

If you just found out you are pregnant, see your doctor right away. Find out what you can do to take care of yourself and to give your baby a healthy start to life.

With your doctor’s help, you can decide on the best treatment for you and your baby before, during, and after the pregnancy. You should also take these steps below before and during your pregnancy to help you and your baby stay healthy.

Just because you have HIV doesn’t mean your child will get HIV. In the United States, before effective treatment was available, about 25% of pregnant mothers with HIV passed the virus to their babies. Today, if you take HIV treatment and have an undetectable viral load, your risk of passing HIV to your baby is less than 1%.¹

What can I do to lower my risk of passing HIV to my baby?

Thanks to more HIV testing and new medicines, the number of children infected with HIV during pregnancy, labor and childbirth, and breastfeeding has decreased by 90% since the mid-1990s. The steps below can lower the risk of giving HIV to your baby:

Step 1

Tell your doctor you want to get pregnant. Your doctor can help you decide if you need to change your treatments to lower your viral load, to help you get pregnant without passing HIV to your partner, and to prevent you from passing the virus to your baby. He or she will also help you get as healthy as possible before you get pregnant to improve your chances of a healthy pregnancy and baby. Don’t stop using condoms for STI prevention and another method of birth control for pregnancy prevention until your doctor says you are healthy enough to start trying.

Step 2

Get prenatal care. Prenatal care is the care you receive from your doctor while you are pregnant. You need to work closely with your doctor throughout your pregnancy to monitor your treatment, your health, and your baby’s health.

Step 3

Start HIV treatment. You can start treatment before pregnancy to lower the risk of passing HIV to your baby. If you are already on treatment, do not stop, but do see your doctor right away. Some HIV drugs should not be used while you’re pregnant. For other drugs, you may need a different dosage.

Step 4

Manage side effects. Side effects from HIV medicines can be especially challenging during pregnancy, but it is still important that you take your medicine as directed by your doctor. Talk to your doctor about any side effects you have and about ways to manage them.

Step 5

Do not breastfeed. You can pass the virus to your baby through your breastmilk even if you are taking medicine. The best way to avoid passing HIV to your baby is to feed your infant formula instead of breastfeeding.

Step 6

Make sure your baby is tested for HIV right after birth. You should choose a doctor or clinic experienced in caring for babies exposed to HIV. They will tell you what follow-up tests your baby will need and when. Talk to your doctor about whether your baby may benefit from starting treatment right away.

Step 7

Ask your pediatric HIV specialist if your baby might benefit from anti-HIV medicines before you know if your baby is HIV-positive or HIV-negative. Research has shown that giving combination HIV drugs to newborns is better at preventing HIV than taking AZT (azidothymidine, an antiretroviral medicine) alone.

Can I take HIV medicine during pregnancy?

HIV-infected pregnant women should take HIV medicines. These medicines can lower the risk of passing HIV to a baby and improve the mother’s health.

If you haven’t used any HIV drugs before pregnancy and are in your first trimester, your doctor will help you decide if you should start treatment. Here are some things to consider:

• Nausea and vomiting may make it hard to take the HIV medicine early during pregnancy.
• It is possible the medicine may affect your baby. Your doctor will prescribe medicine that is safe to use during pregnancy.
• HIV is more commonly passed to a baby late in pregnancy or during delivery. HIV can be passed early in pregnancy if your viral load is detectable.
• Studies show treatment works best at preventing HIV in a baby if it is started before pregnancy or as early as possible during pregnancy.

If you are taking HIV drugs and find out you’re pregnant in the first trimester, talk to your doctor about sticking with your current treatment plan. Some things you can talk about with your doctor include:

• Whether to continue or stop HIV treatment in the first trimester. Stopping HIV medicine could cause your viral load to go up. If your viral load goes up, the risk of infection also goes up. Your disease also could get worse and cause problems for your baby. So this is a serious decision to make with your doctor.
• What effects your HIV medicines may have on the baby
• Whether you are at risk for drug resistance. This means the HIV medicine you take no longer works against HIV. Never stop taking your HIV medicine without first talking to your doctor.

Can I get help paying for care during pregnancy?

If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and living with HIV, Medicaid might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. Each state makes its own rules regarding Medicaid. Contact your local or county medical assistance, welfare, or social services office to learn more. If you are unable to find that number, search your state’s department of health.

If you don’t think you qualify for assistance, check again. Sometimes states change their Medicaid rules. Under the Affordable Care Act, Medicaid eligibility expanded to cover many more people. Also, you may be newly eligible for Medicaid because of increased income limits for prenatal care and HIV treatment for pregnant women.

You may also access care through the Ryan White HIV/AIDS Program. Find a Ryan White HIV/AIDS Program medical care provider near you. 

Offsite Resources

For more information about HIV and pregnancy, check out the following resources from other organizations:

• HIV Among Pregnant Women, Infants, and Children — Fact sheet from the Centers for Disease Control and Prevention (CDC).
• HIV and Pregnancy — Information from AIDSinfo.
• Infant feeding and HIV — Publication from UNICEF.
• Elimination of Mother-to-Child HIV Transmission (EMCT) in the United States — Fact sheet from CDC.
• One Test. Two Lives. — Campaign information from the CDC.

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Fact: HIV and AIDS are problems in the United States.

HIV and AIDS are not problems that exist only in Africa or in other parts of the world. The Centers for Disease Control and Prevention estimates that more than 1.2 million Americans 13 years and older are living with HIV.

One in four people living with AIDS in the United States in 2014 was a woman. An estimated 128,778 women have died of AIDS since the beginning of the epidemic in 1981.

Fact: HIV is not the same as AIDS.

HIV is the virus that leads to AIDS. You have AIDS if your CD4 count drops below 200 or when you have certain infections or cancers. You can have HIV for years without having AIDS. Being infected with HIV does not mean you have developed AIDS.

Also, people with HIV who start treatment early in their infection, stay on treatment, and have an undetectable viral load can stay healthy and prevent the disease from progressing to AIDS.

Fact: HIV tests are reliable.

Newer HIV tests identify the virus itself and a marker on the virus called p24 antigen. These tests can detect HIV infection much earlier than previous tests. A follow-up test to confirm the results also can determine the strain of HIV infection you may have. 

Fact: HIV cannot be cured.

There is no cure for HIV at this time. But with today’s medicine, women can reduce their viral load (amount of HIV in the blood) to the point that it is undetectable. This means that your viral load is fewer than 40 to 75 copies in a sample of your blood.

An undetectable viral load does not mean that you no longer have HIV. It is still possible to pass HIV to others, although the risk is much lower. Having an undetectable viral load also helps prevent the progression to AIDS or getting other infections.

Research is being done that may lead to new treatments and new ways of preventing HIV infection. In the meantime, women with HIV are living full lives, including working, having children, and participating fully in their communities.

Fact: There is no vaccine to prevent HIV.

Right now we do not have a vaccine to prevent HIV. Vaccines are the best way to prevent diseases you can get from other people, like the measles, mumps, or polio. Researchers have been working for more than 20 years to develop a safe and effective vaccine against HIV.

HIV is a complicated virus that changes over time. This makes vaccine research difficult, and it takes a long time to do the research. Researchers are closer to developing a vaccine to prevent HIV and a vaccine to treat HIV and AIDS.

Fact: People with HIV should start HIV medicine right away.

Even if you’re feeling great and have no symptoms, HIV is hurting your immune system. To protect your immune system, most experts recommend starting HIV medicines (called antiretroviral therapy or ART) as soon as you are diagnosed with HIV. Because these drugs reduce your “viral load,” or the amount of HIV in your blood, they also reduce your chances of passing HIV to others.

Fact: You cannot know if your partner has HIV unless he or she is tested.

It can take years for you to see symptoms of HIV. This is called the latency period. The only way to fully protect yourself from sexually transmitted HIV is to not have sex of any kind. Using a condom correctly every time you have vaginal, oral, or anal sex can reduce the risk of passing HIV by 80%. Male latex condoms offer the best protection against HIV, but female condoms are also approved by the Food and Drug Administration to help lower your risk for HIV infection.

Use a condom every time you have sex for two reasons. First, your partner might be infected but not know it. Second, you cannot control your partner’s risky behavior. You can know only your HIV status and control only your own risk-taking.

Fact: You (or your partner) need to wear a condom during sex, even if you are both HIV-positive.

If you and your partner have HIV, you still need to practice safer sex. Use a condom every time you have vaginal, oral, or anal sex. Condoms can protect you from other sexually transmitted infections (STIs).

Also, since there are different strains (types) of HIV, you can be infected a second time with a different type than what you already have. Some forms of HIV are also more virulent, meaning they progress to AIDS faster. You could become infected with a drug-resistant strain of HIV. This can make it very hard for treatment to work.

Fact: Women can give HIV to men.

It is much harder for men to get HIV from women, but it does happen. HIV can enter a man’s body at the opening of the tip of the penis and through cuts or sores on the shaft that may not be visible.

Plus, if a partner has an untreated sexually transmitted infection (STI) like genital herpes, syphilis, gonorrhea, or chlamydia, the risk is even higher. These infections can bring more CD4 cells to the area of infection or cause breaks in the skin. These STIs also raise your risk for passing HIV to others.

Fact: A pregnant woman with HIV can lower the chance of passing HIV to her unborn baby to less than 1%.

A woman who knows about her HIV infection early in pregnancy and gets antiretroviral (ARV) medicine can lower the risk of passing HIV to her baby to less than 1%. Without treatment, the risk of a mother with HIV passing it to her baby is about 25% (in the United States).

If you are pregnant, get tested for HIV. Also, do not breastfeed your baby until you and your doctor are certain you don’t have HIV.

Fact: Lesbians can get HIV.

It is rare for women who have only ever had sex with women to get or pass HIV. But HIV can be passed through vaginal fluids and menstrual blood.

Avoid sex if you (or your partner) have HIV and either a yeast infection or your period. Also, do not share sex toys, because microscopic particles in the fluids on sex toys can pass HIV. You can also get HIV from drugs and shared needles or syringes.

Fact: Women of all ages, races and ethnicities, and sexual orientations can get HIV.

Any woman who has unprotected sex or shares needles or syringes with someone who is HIV-positive or whose HIV status is unknown is at risk for HIV.

HIV is not just a disease of gay men. In fact, worldwide, most people living with HIV are straight (heterosexual), and more than half of people living with HIV are women. In the United States, women make up about one in four people living with HIV.

Most women who are HIV-positive got HIV from unprotected sex with an HIV-positive male. 

Fact: You can get HIV from sharing needles or getting tattoos or body piercings.

Sharing needles is the second most common way that HIV is spread to women in the United States (sex is the most common way). Any woman who shares needles with someone who is HIV-positive or whose HIV status is unknown is at risk for HIV. 

It is also possible to get HIV from tattoo and piercing tools that are not sterilized correctly between clients. Tools that cut the skin should be used once and then thrown away or sterilized between uses.

Before you get a tattoo or have your body pierced, ask the right questions. Find out what steps the staff takes to prevent HIV and other infections, like hepatitis B and hepatitis C. You also can call your local health department to ask how tattoo shops should sterilize their tools. A new, sterilized needle should be used for each person.

Many, but not all, states regulate and issue permits for tattoo parlors. Before getting a tattoo, learn what regulations your tattoo parlor must follow and whether it has passed a health inspection.

Fact: HIV is not spread by mosquitoes, sweat, tears, pools, or casual contact.

Even if mosquitoes could carry the HIV virus, they do not inject blood into your skin. No transmission of this type has ever been reported around the world. Also, you cannot get HIV from shaking hands, using the toilet, or coming into contact with someone’s sweat or tears from their eyes. The only bodily fluids that are known to transmit HIV are semen, vaginal fluids, anal fluids, breastmilk, and blood (including menstrual blood).

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Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS).

• HIV is transmitted through close contact with a body fluid that contains the virus or cells infected with the virus (such as blood, semen, or vaginal fluids).
• HIV destroys certain types of white blood cells, weakening the body’s defenses against infections and cancers.
• When people are first infected, symptoms of fever, rashes, swollen lymph nodes, and fatigue may last a few days to several weeks.
• Many infected people remain well for more than a decade.
• About half of untreated people become ill and develop AIDS, defined by the presence of serious infections and cancers, within about 10 years.
• Eventually, most untreated people develop AIDS.
• Blood tests to check for HIV antibody and to measure the amount of HIV virus can confirm the diagnosis.
• HIV drugs (antiretroviral drugs)—two, three, or more taken together—can stop HIV from reproducing, strengthen the immune system, and thus make people less susceptible to infection, but the drugs cannot eliminate HIV, which persists in an inactive form.

HIV infections may be caused by one of two retroviruses, HIV-1 or HIV-2. HIV-1 causes most HIV infections worldwide, but HIV-2 causes many HIV infections in West Africa.

HIV progressively destroys certain types of white blood cells called CD4+ lymphocytes. Lymphocytes help defend the body against foreign cells, infectious organisms, and cancer. Thus, when HIV destroys CD4+ lymphocytes, people become susceptible to attack by many other infectious organisms. Many of the complications of HIV infection, including death, usually result from these other infections and not from HIV infection directly.

HIV-1 originated in Central Africa during the first half of the 20th century when a closely related chimpanzee virus first infected people. The global spread of HIV-1 began in the late 1970s, and AIDS was first recognized in 1981.

In 2016, about 36.7 million people, including 2.1 million children under age 15, were living with HIV infection worldwide. There were 1 million AIDS-related deaths, and 1.8 million people were newly infected.

Most (95%) new infections occur in the developing world. Almost 70% of new HIV infections occur in sub-Saharan Africa, with more than half occurring in women and 1 in 10 occurring in children under 15 years old. However, in many sub-Saharan African countries, the number of new HIV infections has greatly decreased, partly because of international efforts to provide treatment and strategies for prevention.

In the United States, over 1.1 million people aged 13 years or older were estimated to have HIV infection in 2015. About 15% of them do not know they have HIV infection. In 2016, 39,782 cases of HIV infection were diagnosed in the United States. Over two thirds of these infections occurred in gay and bisexual men. Among these men, most infections occurred in black men (10,223), followed by Hispanic/Latino men (7,425) and white men (7,390).

Acquired immunodeficiency syndrome (AIDS)

AIDS is the most severe form of HIV infection. HIV infection is considered to be AIDS when at least one serious complicating illness develops or the number (count) of CD4+ lymphocytes decreases substantially.

When people who are infected with HIV develop certain illnesses, AIDS is diagnosed. These illnesses, called AIDS-defining illnesses, include

• Serious infections that occur mainly in people with a weakened immune system (called opportunistic infections), including fungal infections (such as cryptococcosis and Pneumocystis jirovecii pneumonia) and severe herpes simplex infections
• Certain cancers, such as invasive cervical cancer, Kaposi sarcoma, and certain lymphomas
• Dysfunction of the nervous system
• A substantial loss of weight due to HIV infection (AIDS wasting)

Transmission of HIV Infection

The transmission of HIV requires contact with a body fluid that contains the virus or cells infected with the virus. HIV can appear in nearly any body fluid, but transmission occurs mainly through blood, semen, vaginal fluids, and breast milk. Although tears, urine, and saliva may contain low concentrations of HIV, transmission through these fluids is extremely rare, if it occurs at all.

HIV is not transmitted by casual contact (such as touching, holding, or dry kissing) or by close, nonsexual contact at work, school, or home. No case of HIV transmission has been traced to the coughing or sneezing of an infected person or to a mosquito bite. Transmission from an infected doctor or dentist to a patient is extremely rare.

HIV is usually transmitted in the following ways:

• Sexual contact with an infected person, when the mucous membrane lining the mouth, vagina, penis, or rectum is exposed to body fluids such as semen or vaginal fluids that contain HIV, as occurs during unprotected sexual intercourse
• Injection of contaminated blood, as can occur when needles are shared or a health care worker is accidentally pricked with an HIV-contaminated needle
• Transfer from an infected mother to a child before birth, during birth, or after birth through the mother’s milk
• Medical procedures, such as transfusion of blood that contains HIV, procedures done with inadequately sterilized instruments, or transplantation of an infected organ or tissues

HIV is more likely to be transmitted if skin or a mucous membrane is torn or damaged—even if minimally.

In the United States, Europe, and Australia, HIV has been transmitted mainly through male homosexual contact and the sharing of needles among people who inject drugs, but transmission through heterosexual contact accounts for about one fourth of cases. HIV transmission in Africa, the Caribbean, and Asia occurs primarily between heterosexuals, and HIV infection occurs equally among men and women. In the United States, fewer than 25% of adults who have HIV infection are women. Before 1992, most American women with HIV were infected by injecting drugs with contaminated needles, but now most are infected through heterosexual contact.

Transmission of HIV through its most common routes—sexual contact or sharing of needles—is almost completely preventable.

Through sexual activity

Risk of transmitting HIV is highest during vaginal or anal sex when a condom is not used or is used incorrectly. HIV transmission can also occur during oral sex, although transmission is less likely than during vaginal or anal sex.

Risk of HIV infection is increased when semen or vaginal fluids contain a large amount of HIV and/or when there are tears or sores, even small ones, in the skin or membranes lining the genitals, mouth, or rectum. Thus, transmission is much more likely during the following:

• The first weeks after people are infected because at that time, the blood and body fluids contain very large amounts of HIV
• Vigorous sexual activities that damage the skin or membranes lining the genitals, mouth, or rectum
• Sexual intercourse when either partner has a genital herpes infection, syphilis, or another sexually transmitted disease (STD) that can cause sores or tears in the skin or inflammation of the genitals

HIV (antiretroviral) drugs can reduce the amount of HIV in semen and vaginal fluids. Thus, treatment of HIV infection with these drugs can dramatically reduce the likelihood of transmission.

Sexual activities that can damage the membranes lining the genitals, mouth, or rectum include fisting (inserting most or all of the hand into the rectum or vagina) and using sex toys.

The risk of being infected with HIV during heterosexual intercourse is higher for young people partly because they have less control over their impulses and thus are more likely to engage in risky sexual behavior, such as having several sex partners and not using condoms.

Recent evidence shows that HIV infected people in whom antiretroviral therapy has reduced their viral load below the current detectable level (virally suppressed) do not sexually transmit the virus to their partners.

Through needles or other instruments

Health care workers who are accidentally pricked with an HIV-contaminated needle have about a 1 in 300 chance of contracting HIV unless they are treated as soon as possible after exposure. Such treatment reduces the chance of infection to less than 1 in 1,500. The risk increases if the needle penetrates deeply or if the needle is hollow and contains HIV-contaminated blood (as with a needle used to draw blood or to inject street drugs) rather than simply being coated with blood (as with a needle used to stitch a cut).

Infected fluid splashing into the mouth or eyes has less than a 1 in 1,000 chance of causing infection.

From mother to child

HIV infection in a large number of women of childbearing age has led to an increase in HIV infection among children.

HIV infection can be transmitted from an infected mother to her child in the following ways:

• To the fetus through the placenta
• To the baby during passage through the birth canal
• To the baby after birth through breast milk

If infected mothers are not treated, about 25 to 35% of their babies are likely to be infected at birth, and if they breastfeed, about another 10 to 15% of the babies are likely to be infected.

Treating infected women with HIV drugs can dramatically reduce the risk of transmission. Infected pregnant women should be treated during the 2nd and 3rd trimesters of pregnancy, during delivery, and during breastfeeding. Doing a cesarean delivery and treating the baby for several weeks after birth also reduce the risk.

Infected mothers should not breastfeed if they live in countries where formula feeding is safe and affordable. However, in countries where infectious diseases and undernutrition are common causes of infant death and where safe, affordable infant formula is not available, the World Health Organization recommends that mothers breastfeed. In such cases, the protection provided by breastfeeding from potentially fatal infections may counterbalance the risk of HIV transmission.

Because many pregnant women with HIV infection are treated or take drugs to prevent HIV infection, the number of children getting AIDS is decreasing in many countries.

Through blood transfusions or organ transplants

Currently, HIV infection is rarely transmitted through blood transfusions or organ transplants.

Since 1985 in most developed countries, all blood collected for transfusion is tested for HIV, and when possible, some blood products are treated with heat to eliminate the risk of HIV infection. The current risk of HIV infection from a single blood transfusion (which is carefully screened for HIV and other bloodborne viruses) is estimated to be less than 1 in about 2 million in the United States. However, in many developing countries, blood and blood products are not screened for HIV or are not screened as stringently. There, the risk remains substantial.

HIV has been transmitted when organs (kidneys, livers, hearts, pancreases, bone, and skin) from infected donors were unknowingly used as transplants. HIV transmission is unlikely to occur when corneas or certain specially treated tissues (such as bone) are transplanted.

Artificial insemination

HIV transmission is also possible when sperm from an infected donor is used to inseminate a woman. In the United States, measures have been taken to reduce this risk. Fresh semen samples are no longer used. Sperm from donors is frozen for 6 months or more. Then the donors are retested for HIV infection before the sperm is used.

If a sperm donor is known to have HIV infection, washing sperm is an effective way to remove HIV from sperm.

Mechanism of HIV Infection

Once in the body, HIV attaches to several types of white blood cells. The most important are certain helper T lymphocytes (T cells). Helper T lymphocytes activate and coordinate other cells of the immune system. On their surface, these lymphocytes have a receptor called CD4, which enables HIV to attach to them. Thus, these helper lymphocytes are designated as CD4+.

HIV is a retrovirus. That is, it stores its genetic information as ribonucleic acid (RNA). Once inside a CD4+ lymphocyte, the virus uses an enzyme called reverse transcriptase to make a copy of its RNA, but the copy is made as deoxyribonucleic acid (DNA). HIV mutates easily at this point because reverse transcriptase is prone to making errors during the conversion of HIV RNA to DNA. These mutations make HIV more difficult to control because the many mutations increase the chance of producing HIV that can resist attacks by the person’s immune system and/or antiretroviral drugs.

The HIV DNA copy is incorporated into the DNA of the infected lymphocyte. The lymphocyte’s own genetic machinery then reproduces (replicates) the HIV. Eventually, the lymphocyte is destroyed. Each infected lymphocyte produces thousands of new viruses, which infect other lymphocytes and destroy them as well. Within a few days or weeks, the blood and genital fluids contain a very large amount of HIV, and the number of CD4+ lymphocytes may be reduced substantially. Because the amount of HIV in blood and genital fluids is so large so soon after HIV infection, newly infected people transmit HIV to other people very easily.

When HIV infection destroys CD4+ lymphocytes, it weakens the body’s immune system, which protects against many infections and cancers. This weakening is part of the reason that the body is unable to eliminate HIV infection once it has started. However, the immune system is able to mount some response. Within a month or two after infection, the body produces lymphocytes and antibodies that help lower the amount of HIV in the blood and keep the infection under control. For this reason, untreated HIV infection may cause no symptoms or only a few mild symptoms for an average of about 10 years (ranging from 2 to more than 15 years).

HIV also infects other cells, such as cells in the skin, brain, genital tract, heart, and kidneys, causing disease in those organs.

CD4 count

The number of CD4+ lymphocytes in blood (the CD4 count) helps determine the following:

• How well the immune system can protect the body from infections
• How severe the damage done by the HIV is

Most healthy people have a CD4 count of 500 to 1,000 cells per microliter of blood. Typically, the number of CD4+ lymphocytes is reduced during the first few months of infection. After about 3 to 6 months, the CD4 count stabilizes, but without treatment, it usually continues to decline at rates that vary from slow to rapid.

If the CD4 count falls below about 200 cells per microliter of blood, the immune system becomes less able to fight certain infections (such as Pneumocystis jirovecii pneumonia). Most of these infections are rare in healthy people. However, they are common among people with a weakened immune system. Such infections are called opportunistic infections because they take advantage of a weakened immune system.

A count below about 50 cells per microliter of blood is particularly dangerous because additional opportunistic infections that can rapidly cause severe weight loss, blindness, or death commonly occur. These infections include

• Cytomegalovirus infections
• Mycobacterium avium complex infections

Viral load

The amount of HIV in the blood (specifically the number of copies of HIV RNA) is called the viral load.

Viral load represents how quickly HIV is replicating. When people are first infected, the viral load increases rapidly. Then, after about 3 to 6 months, even without treatment, it drops to a lower level, which remains constant, called the set point. This level varies widely from person to person—from as little as a few hundred to over a million copies per microliter of blood.

Viral load also indicates

• How contagious the infection is
• How fast the CD4 count is likely to decrease
• How fast symptoms are likely to appear

The higher the set point of the viral load, the more quickly the CD4 count decreases to the low levels (less than 200) that increase risk of opportunistic infections, even in people without symptoms.

During successful treatment, the viral load decreases to very low or undetectable levels (less than about 20 to 40 copies per microliter of blood). However, inactive (latent) HIV is still present within cells, and if treatment is stopped, HIV starts replicating and the viral load increases.

An increase in the viral load during treatment may indicate the following:

• The HIV has developed resistance to drug treatment.
• The person is not taking the prescribed drugs.
• Both

Symptoms

Initial infection

When initially infected, many people have no noticeable symptoms, but within 1 to 4 weeks, fever, rashes, sore throat, swollen lymph nodes, fatigue, and a variety of less common symptoms develop in some people. Symptoms of initial (primary) HIV infection usually last from 3 to 14 days.

Interval of mild or no symptoms

After the first symptoms disappear, most people, even without treatment, have no symptoms or only occasionally have a few mild symptoms. This interval of few or no symptoms may last from 2 to 15 years. The symptoms that most commonly occur during this interval include the following:

• Swollen lymph nodes, felt as small, painless lumps in the neck, under the arms, or in the groin
• White patches in the mouth (thrush) due to candidiasis (a yeast infection)
• Shingles
• Diarrhea
• Fatigue
• Fever sometimes with sweating
• Progressive loss of weight
• Anemia

Some people progressively lose weight and have a mild fever or diarrhea.

These symptoms may result from HIV infection or from opportunistic infections that develop because HIV has weakened the immune system.

More severe symptoms

For some people, the first symptoms are those of AIDS.

AIDS is defined as the development of very serious opportunistic infections or cancer—the ones that usually develop only in people with a CD4 count of less than 200 cells per microliter of blood.

The specific opportunistic infections and cancers that develop cause many of the symptoms. These infections occur more frequently or are more severe in people with HIV infection than in those without the infection. For example, an infection with the fungus Candida may cause white patches in the mouth and sometimes pain when swallowing (called thrush) or a thick, white discharge from the vagina that resembles cottage cheese (a vaginal yeast infection). Shingles (herpes zoster) may cause pain and a rash.

More serious opportunistic infections may cause various symptoms depending on the organ affected:

• Lungs: Fever, cough, or shortness of breath
• Brain: Headache, weakness, loss of coordination, or deterioration of mental function
• Digestive tract: Pain, diarrhea, or bleeding

HIV can also cause symptoms when it directly infects and damages organs such as the following:

• Brain: Brain damage with memory loss, difficulty thinking and concentrating, or both, eventually resulting in dementia if HIV infection is not treated, as well as weakness, tremor, or difficulty walking
• Kidneys: Kidney failure with swelling in the legs and face, fatigue, and changes in urination (more common in blacks than in whites), but often not until the infection is severe
• Heart: Heart failure with shortness of breath, cough, wheezing, and fatigue (uncommon)
• Genital organs: Decreased levels of sex hormones, which may cause fatigue and sexual dysfunction in men

HIV is probably directly responsible for a substantial loss of weight (AIDS wasting) in some people. Wasting in people with AIDS may also be caused by a series of infections or by an untreated, persistent digestive tract infection.

Cause of death

Usually, death is caused by the cumulative effects of opportunistic infections or cancers, wasting, and/or dementia.

Diagnosis

• Tests to detect antibodies to the HIV virus in a sample of blood or saliva
• Tests to detect HIV RNA in a sample of blood

Early diagnosis of HIV infection is important because it makes early treatment possible. Early treatment enables infected people to live longer, be healthier, and be less likely to transmit HIV to other people.

Doctors usually ask about risk factors for HIV infection (such as possible exposure in the workplace, high-risk sexual activities, and use of injected street drugs) and about symptoms (such as fatigue, rashes, and weight loss).

Doctors also do a complete physical examination to check for signs of opportunistic infections, such as swollen lymph nodes and white patches inside the mouth (indicating thrush), and for signs of Kaposi sarcoma of the skin or mouth.

Screening and diagnostic tests

If doctors suspect exposure to HIV infection, they do a screening test for HIV. Doctors also recommend that all adults and adolescents, particularly pregnant women, have a screening test regardless of what their risk appears to be. Anyone who is concerned about being infected with HIV can request to be tested. Such testing is confidential and often free of charge.

The current (4th-generation) combination screening test tests for two things that suggest HIV infection:

• Antibodies to HIV
• HIV antigens (p24 antigen)

Antibodies are proteins produced by the immune system to help defend the body against a particular attack, such as that by HIV. Antigens are foreign substances that can trigger an immune response.

The body takes several weeks to produce enough antibodies to be detected by the test, so results of the antibody test are negative during the first few weeks after the virus enters the body. However, results of the p24 antigen test can be positive as early as 2 weeks after the initial infection. The combination tests can be done quickly by a laboratory. Also, a version of these tests can be done in a doctor’s office or clinic (called bedside testing). If results are positive, doctors do a test to distinguish HIV-1 from HIV-2 and a test to detect the amount of HIV RNA in the blood (the viral load).

The newer combination screening test is quicker and less complex than older screening tests, which use enzyme-linked immunosorbent assay (ELISA) to detect HIV antibodies and then confirm positive results using a separate, more accurate, specific test such as the Western blot test.

Other, older rapid bedside tests are also available. These tests can be done using a sample of blood or saliva. If results of these rapid screening tests are positive, they are confirmed by ELISA (with or without Western blot) or by repetition of one or more other rapid tests.

If people at low risk have a negative test result, the screening test is not repeated unless their risk status changes. If people at the highest risk have a negative test result (especially if they are sexually active, have several sex partners, or do not practice safe sex), testing should be repeated every 6 to 12 months.

HIV RNA tests can confirm positive results of an antibody test or detect evidence of HIV infection when antibody test results are negative. HIV RNA tests often use techniques to produce many copies of an organism’s genetic material (called nucleic acid amplification). These tests can detect very small amounts of HIV RNA in blood and are very accurate.

Monitoring

If HIV infection is diagnosed, blood tests should be done regularly to measure the following:

• CD4 count
• Viral load

If the CD4 count is low, people are more likely to develop serious infections and other complications of HIV such as certain cancers. Viral load helps predict how fast the CD4 count is likely to decrease over the next few years.

These two measurements help doctors determine

• How soon to start antiretroviral drugs
• What effects treatment is likely to have
• Whether other drugs may be needed to prevent complicating infections

With successful treatment, the viral load falls to very low levels within weeks, and the CD4 count begins a slow recovery toward normal levels.

Diagnosis of AIDS

AIDS is diagnosed when the CD4 count falls below 200 cells per microliter of blood or when extreme wasting or certain serious opportunistic infections or cancers develop.

Diagnosis of HIV-related conditions

Various tests may be done to check for conditions that can accompany HIV infection. These tests include the following:

• Bone marrow aspiration and biopsy: To check for low blood cell counts (including anemia), which may be due to lymphomas, cancers, and opportunistic infections
• Computed tomography (CT) with a contrast agent or magnetic resonance imaging (MRI): To check for damage to the brain or spinal cord

Prevention

At present, there is no effective HIV vaccine to prevent HIV infection or slow the progression of AIDS in people who are already infected. However, treating people who have HIV infection reduces the risk of their transmitting the infection to other people.

Transmission of HIV through its most common routes—sexual contact or sharing of needles—is almost completely preventable. However, the measures required for prevention—sexual abstinence or consistent condom use and access to clean needles—are sometimes personally or socially unpopular. Many people have difficulty changing their addictive or sexual behaviors, so they continue to put themselves at risk of HIV infection. Also, safe sex practices are not foolproof. For example, condoms can leak or break.

Condoms made of latex provide good protection against HIV (as well as other common sexually transmitted diseases), but they are not foolproof. Oil-based lubricants (such as petroleum jelly) should not be used because they may dissolve latex, reducing the condom’s effectiveness.

Other measures can help. For men, circumcision, an inexpensive, safe procedure, reduces the risk of becoming infected during vaginal intercourse with an infected woman by about half. Whether circumcision reduces the risk of HIV infection in other circumstances is unclear. Because circumcision provides only partial protection against HIV infection, people should also use other measures to prevent HIV infection. For example, if either partner has a sexually transmitted disease or HIV infection, it should be treated, and condoms should be used correctly and consistently.

Universal precautions

People who are likely to come into contact with blood or other body fluids at their job should wear protective latex gloves, masks, and eye shields. These precautions apply to body fluids from all people, not just those from people with HIV, and are thus called universal precautions. Universal precautions are taken for two reasons:

• People with HIV may not know that they are infected.
• Viruses that cause other serious disorders (such as hepatitis B and C) can be transmitted by body fluids.

Surfaces contaminated with HIV can easily be cleaned and disinfected because HIV is inactivated by heat and by common disinfectants such as hydrogen peroxide and alcohol.

Because HIV is not transmitted through the air or by casual contact (such as touching, holding, or dry kissing), hospitals and clinics do not isolate HIV-infected people unless they have another contagious infection.

Preventing transmission by blood transfusions and organ transplants

In the United States, the following have almost eliminated transmission of HIV infection by organ transplantation or blood transfusion:

• Screening donors of organs or blood for risk factors for HIV infection
• Screening donated blood for HIV

Risk is reduced further by asking people with risk factors for HIV infection, regardless of their test results for HIV, not to donate blood or organs for transplantation.

However, developing countries have not consistently used sensitive HIV screening tests and have not restricted donors. Consequently, transmission by these routes is still a problem in these countries.

Preventing transmission from mother to newborn

Pregnant women infected with HIV can transmit the virus to the newborn.

The following can help prevent HIV transmission from mother to newborn:

• Testing pregnant women to determine whether they are infected with HIV
• If they are infected, treating them with antiretroviral drugs during pregnancy and labor (treatment during labor is especially important)
• Delivering the baby by cesarean rather than by vaginal delivery
• After birth, treating the newborn with zidovudine, given intravenously, for 6 weeks
• If possible, using formula instead of breastfeeding (HIV can be transmitted in breast milk)

Preventive treatment before exposure

Taking an antiretroviral drug before being exposed to HIV can reduce the risk of HIV infection. Such preventive treatment is called preexposure prophylaxis (PrEP). However, PrEP is expensive and is effective only if people take the drug every day. Thus, PrEP is recommended only for people who have a very high risk of becoming infected, such as people who have a partner who is infected with HIV.

PrEP may also be recommended for people who engage in high-risk sexual activities, such as the following:

• Men who have anal sex with men without using a condom
• Heterosexual men and women who do not regularly use condoms during sex with partners whose HIV status is unknown and who are at increased risk of HIV infection

People who use PrEP still need to use other methods to prevent HIV infection, including consistent use of condoms and not sharing needles to inject drugs.

Preventive treatment after exposure

People who have been exposed to HIV from a blood splash, needlestick, or sexual contact may reduce the chance of infection by taking antiretroviral drugs for 4 weeks. These drugs are more effective when they are started as soon as possible after the exposure. Taking two or more drugs is currently recommended.

Doctors and the person who was exposed typically decide together whether to use these preventive drugs. They base the decision on the estimated risk of infection and the possible side effects of the drugs. If they do not know whether the source is infected with HIV, they consider how likely the source is to be infected. However, even when the source of the exposure is known to be infected with HIV, the risk of infection after exposure varies, depending on the type of exposure. For example, risk from a blood splash is less than that from a needlestick.

Immediately after exposure to HIV infection, what is done depends on the type of exposure:

• If skin is exposed, it is cleaned with soap and water.
• Puncture wounds are cleaned with antiseptic.
• If mucous membranes are exposed, they are flushed with large amounts of water.

Immunization

People with HIV infection should have the following vaccinations (for more information, see CDC immunization recommendations):

• Conjugate pneumococcal vaccine (PCV13) and polysaccharide pneumococcal vaccine (PPSV23) if they have not had them before (PCV13 is given first, followed by PPSV23 at least 8 weeks later)
• Influenza vaccine every year
• Hepatitis B vaccine if they have not had the vaccine before or have not completed the series of 3 vaccinations
• Hepatitis A vaccine if they are at increased risk of or desire protection from hepatitis A
• Human papillomavirus (HPV) vaccine to prevent HPV-related cervical and anal cancers (given to females and males at the recommended ages)
• Meningococcal vaccine if adults have not had the vaccine before (doses are given at least 2 months apart)
• Tetanus-diphtheria vaccine (Td) with a booster every 10 years (if people have not previously received the tetanus-diphtheria-pertussis vaccine [Tdap], Tdap is substituted for one Td booster)

The herpes zoster vaccine may be useful. However, the original live-attenuated zoster vaccine is not given in people with a weakened immune system and if the CD4 count is below 200 cells per microliter of blood. However, recommendations regarding use of the newer recombinant zoster vaccine in people with HIV have not yet been made.

Treatment

• Antiretroviral drugs 
• Drugs to prevent opportunistic infections
• Drugs to relieve symptoms 

Treatment with antiretroviral drugs is recommended for almost all people with HIV infection because without treatment, HIV infection can lead to serious complications and because newer, less toxic drugs have been developed. For most people, early treatment has the best results. Research has shown that people who are promptly treated with antiretroviral drugs are less likely to develop AIDS-related complications and to die of them.

Treatment cannot eliminate the virus from the body, although the HIV level often decreases so much that it cannot be detected in blood or other fluids or tissues. The goals of treatment are

• Reducing HIV level to undetectable
• Restoring CD4 count to normal

If treatment is stopped, the HIV level increases, and the CD4 count begins to fall. Thus, people need to take antiretroviral drugs for their lifetime.

Before starting a treatment regimen, people are taught about the necessity of the following:

• Taking drugs as directed
• Not skipping any doses
• Taking the drugs for the rest of their life

Taking the drugs as directed for a life time is demanding. Some people skip doses or stop taking the drugs for a time (called a drug holiday). These practices are dangerous because they enable HIV to develop resistance to the drugs.

Because taking HIV drugs irregularly often leads to drug resistance, health care practitioners try to make sure that people are both willing and able to adhere to the treatment regimen. To simplify the drug schedule and to help people take the drugs as directed, doctors often prescribe treatment that combines two or more drugs in one tablet that can be taken only once a day.

Prognosis

Exposure to HIV does not always lead to infection, and some people who have had repeated exposures over many years remain uninfected. Moreover, many HIV-infected people remain well for more than a decade. A very few HIV-infected, untreated people have remained well for over 20 years. Why some people become ill so much sooner than others is not fully understood, but a number of genetic factors appear to influence both susceptibility to infection and progression to AIDS after infection.

If infected people are not treated, AIDS develops in most of them. How quickly the number of CD4 cells decreases and HIV infection progresses toward AIDS varies greatly from person to person. Generally, experts estimate that if untreated, people develop AIDS at the following rates:

• For the first several years after infection: 1 to 2% each year
• Each year thereafter: 5 to 6%
• Within 10 to 11 years: 50%
• Eventually: More than 95%, possibly all if they live long enough

However, with effective treatment, the HIV RNA level decreases to undetectable levels, CD4 counts increase dramatically, and people can continue to lead productive, active lives. The risk of illness and death decreases but remains higher than that of people who are of similar age and who are not infected with HIV. However, if people cannot tolerate or take drugs consistently, HIV infection and immune deficiency progresses, causing serious symptoms and complications.

Usually, HIV infection does not directly cause death. Instead, HIV infection leads to a substantial loss of weight (wasting), opportunistic infections, cancers, and other disorders, which then lead to death.

Cure has been thought to be impossible, although intensive research on how to eliminate all of the latent HIV from infected people continues.

The post HIV, The Human Immunodeficiency Virus and AIDS appeared first on Medika Life.

Human immunodeficiency virus (HIV) infection results from 1 of 2 similar retroviruses (HIV-1 and HIV-2) that destroy CD4+ T lymphocytes and impair cell-mediated immunity, increasing risk of certain infections and cancers.

This article will examine both strains and explain CD4+ T lymphocytes and AIDS in more detail.

Initial HIV infection may cause nonspecific febrile illness. Risk of subsequent manifestations—related to immunodeficiency—is proportional to the level of CD4+ lymphocyte depletion. HIV can directly damage the brain, gonads, kidneys, and heart, causing cognitive impairment, hypogonadism, renal insufficiency, and cardiomyopathy.

Manifestations range from asymptomatic carriage to acquired immune deficiency syndrome (AIDS), which is defined by serious opportunistic infections or cancers or a CD4 count of < 200/mcL. HIV infection can be diagnosed by antibody, nucleic acid (HIV RNA), or antigen (p24) testing. Treatment aims to suppress HIV replication by using combinations of 3 or more drugs that inhibit HIV enzymes; treatment can restore immune function in most patients if suppression of replication is sustained.

HIV-1 and HIV-2

HIV-1 causes most HIV infections worldwide, but HIV-2 causes a substantial proportion of infections in parts of West Africa. In some areas of West Africa, both viruses are prevalent and may co-infect patients. HIV-2 appears to be less virulent than HIV-1.

HIV-1 originated in Central Africa in the first half of the 20th century, when a closely related chimpanzee virus first infected humans. Epidemic global spread began in the late 1970s, and AIDS was recognized in 1981.

The World Health Organization (WHO) estimates that in 2017, about 36.9 million people, including 1.8 million children (younger than 15 years), were living with HIV worldwide; of the total, about 25.7 million live in sub-Saharan Africa. About 25% of people living with HIV were undiagnosed. Among people who knew they were infected, 79% were accessing treatment. 

In 2017, about 940,000 people died from AIDS-related illnesses worldwide (70% in sub-Saharan Africa), compared to 1.9 million in 2004 and 1.4 million in 2010. In 2017, about 1.8 million people, including 180,000 children, were newly infected with HIV, compared to 3.4 million new infections in 1996. Most new infections (95%) now occur in the developing world; over half are in women in sub-Saharan Africa.

In many sub-Saharan African countries, incidence of HIV infection is declining markedly from the very high rates of a decade before; nevertheless, important gaps remain to meet the World Health Organization’s Fast-Track strategy to end the AIDS epidemic by 2030.

In the United States in 2015, more than 1.1 million people aged over 13 years were estimated to be living with HIV infection; HIV was undiagnosed in about 15% of them. Overall, the number of new cases decreased by 19% from 2005 to 2014. In 2016, 39,782 cases were diagnosed. Over two thirds (67% or 26,570) of new infections occurred in gay and bisexual men. Among gay and bisexual men, the number of new infections was 10,223 in black/African American men, 7,425 in Hispanic/Latino men, and 7,390 in white men.

CD4+ T Lymphocytes

The 2 main types of lymphocytes are

• B cells (which mature in bone marrow)
• T cells (which mature in the thymus)

The main types of lymphocytes are morphologically indistinguishable but have different immune functions. They can be distinguished by antigen-specific surface receptors and molecules called clusters of differentiation (CDs), whose presence or absence define some subsets. More than 300 CDs have been identified. Each lymphocyte recognizes a specific antigen via surface receptors.

T cells

T cells develop from bone marrow stem cells that travel to the thymus, where they go through rigorous selection. There are 3 main types of T cell:

• Helper
• Regulatory (suppressor)
• Cytotoxic

In selection, T cells that react to self antigen presented by self MHC molecules or to self MHC molecules (regardless of the antigen presented) are eliminated by apoptosis, limiting the likelihood of autoimmunity. Only T cells that can recognize nonself antigen complexed to self MHC molecules survive; they leave the thymus for peripheral blood and lymphoid tissues.

Most mature T cells express either CD4 or CD8 and have an antigen-binding, Ig-like surface receptor called the T-cell receptor (TCR). There are 2 types of TCR:

• Alpha-beta TCR: Composed of TCR alpha and beta chains; present on most T cells
• Gamma-delta TCR: Composed of TCR gamma and delta chains; present on a small population of T cells

Genes that encode the TCR, like Ig genes, are rearranged, resulting in defined specificity and affinity for antigen. Most T cells (those with an alpha-beta TCR) recognize antigen-derived peptide displayed in the MHC molecule of an antigen-presenting cell. Gamma-delta T cells recognize protein antigen directly or recognize lipid antigen displayed by an MHC-like molecule called CD1. As for B cells, the number of T-cell specificities is almost limitless.

For alpha-beta T cells to be activated, the TCR must engage with antigen-MHC. Costimulatory accessory molecules must also interact (eg, CD28 on the T cell interacts with CD80 and CD86 on the antigen-presenting cell); otherwise, the T cell becomes anergic or dies by apoptosis. Some accessory molecules (eg, CTLA-4 [cytotoxic T-lymphocyte antigen 4] on the T cell, which also interacts with CD80 and CD86 on the antigen-presenting cell, PD-1 [programmed cell death protein 1] on the T cell, which interacts with PD-L1 [programmed cell death protein ligand 1] on the antigen-presenting cell) inhibit previously activated T cells and thus dampen the immune response. Molecules such as CTLA-4 and PD-1, and their ligands, are termed checkpoint molecules because they signal that the T cell needs to be restrained from continuing its activity. Cancer cells that express checkpoint molecules may thus be protected from the immune system by restraining the activity of tumor-specific T cells.

Monoclonal antibodies that target checkpoint molecules on either T cells or on tumor cells (termed checkpoint inhibitors) are used to prevent downregulation of antitumor responses and effectively treat some heretofore resistant cancers. However, because checkpoint molecules are also involved in other types of immune response, checkpoint inhibitors can cause severe immune-related inflammatory and autoimmune reactions (both systemic and organ specific).

Polymorphisms in the CTLA-4 gene are associated with certain autoimmune disorders, including Graves disease and type I diabetes.

AIDS

AIDS is defined as one or more of the following:

• HIV infection that leads to any of certain illnesses highlighted below
• A CD4+ T lymphocyte (helper cell) count of < 200/mcL
• A CD4+ cell percentage of ≤ 14%

AIDS-defining illnesses are

• Serious opportunistic infections
• Certain cancers (eg, Kaposi sarcoma, non-Hodgkin lymphoma) to which defective cell-mediated immunity predisposes
• Neurologic dysfunction

AIDS-Defining Illnesses

The Infection Process

HIV attaches to and penetrates host T cells via CD4+ molecules and chemokine receptors. After attachment, HIV RNA and several HIV-encoded enzymes are released into the host cell.

Viral replication requires that reverse transcriptase (an RNA-dependent DNA polymerase) copy HIV RNA, producing proviral DNA; this copying mechanism is prone to errors, resulting in frequent mutations and thus new HIV genotypes. These mutations facilitate the generation of HIV that can resist control by the host’s immune system and by antiretroviral drugs.

Proviral DNA enters the host cell’s nucleus and is integrated into the host DNA in a process that involves integrase, another HIV enzyme. With each cell division, the integrated proviral DNA is duplicated along with the host DNA. Subsequently, the proviral HIV DNA can be transcribed to HIV RNA and translated to HIV proteins, such as the envelope glycoproteins 41 and 120. These HIV proteins are assembled into HIV virions at the host cell inner membrane and budded from the cell surface within an envelop of modified human cell membrane. Each host cell may produce thousands of virions.

After budding, protease, another HIV enzyme, cleaves viral proteins, converting the immature virion into a mature, infectious virion.

Infected CD4+ lymphocytes produce > 98% of plasma HIV virions. A subset of infected CD4+ lymphocytes constitutes a reservoir of HIV that can reactivate (eg, if antiviral treatment is stopped).

Virions have a plasma half-life of about 6 hours. In moderate to heavy HIV infection, about 10⁸ to 10⁹ virions are created and removed daily. The high volume of HIV replication and high frequency of transcription errors by HIV reverse transcriptase result in many mutations, increasing the chance of producing strains resistant to host immunity and drugs.

Immune system

Two main consequences of HIV infection are

• Damage to the immune system, specifically depletion of CD4+ lymphocytes
• Immune activation

CD4+ lymphocytes are involved in cell-mediated and, to a lesser extent, humoral immunity. CD4+ depletion may result from the following:

• Direct cytotoxic effects of HIV replication
• Cell-mediated immune cytotoxicity
• Thymic damage that impairs lymphocyte production

Infected CD4+ lymphocytes have a half-life of about 2 days, which is much shorter than that of uninfected CD4+ cells. Rates of CD4+ lymphocyte destruction correlate with plasma HIV level. Typically, during the initial or primary infection, HIV levels are highest (> 10⁶ copies/mL), and the CD4 count drops rapidly.

The normal CD4 count is about 750/mcL, and immunity is minimally affected if the count is > 350/mcL. If the count drops below about 200/mcL, loss of cell-mediated immunity allows a variety of opportunistic pathogens to reactivate from latent states and cause clinical disease.

Other tissues

HIV also infects nonlymphoid monocytic cells (eg, dendritic cells in the skin, macrophages, brain microglia) and cells of the brain, genital tract, heart, and kidneys, causing disease in the corresponding organ systems.

HIV strains in several compartments, such as the nervous system (brain and CSF) and genital tract (semen), can be genetically distinct from those in plasma, suggesting that they have been selected by or have adapted to these anatomic compartments. Thus, HIV levels and resistance patterns in these compartments may vary independently from those in plasma.

Disease progression

During the first few weeks of primary infection, there are humoral and cellular immune responses:

• Humoral: Antibodies to HIV are usually measurable within a few weeks after primary infection; however, antibodies cannot fully control HIV infection because mutated forms of HIV that are not controlled by the patient’s current anti-HIV antibodies are generated.
• Cellular: Cell-mediated immunity is a more important means of controlling the high levels of viremia (usually over 10⁶ copies/mL) at first. But rapid mutation of viral antigens that are targeted by lymphocyte-mediated cytotoxicity subvert control of HIV in all but a small percentage of patients.

Plasma HIV virion levels, expressed as number of HIV RNA copies/mL, stabilize after about 6 months at a level (set point) that varies widely among patients but averages 30,000 to 100,000/mL (4.2 to 5 log₁₀/mL). The higher this set point, the more quickly the CD4 count decreases to a level that seriously impairs immunity (< 200/mcL) and results in the opportunistic infections and cancers that define AIDS.

Risk and severity of opportunistic infections, AIDS, and AIDS-related cancers are determined by 2 factors:

• CD4 count
• Exposure to potentially opportunistic pathogens

Risk of specific opportunistic infections increases below threshold CD4 counts of about 200/mcL for some infections and 50/mcL for others, as in the following:

• CD4 count < 200/mcL: Increased risk of Pneumocystis jirovecii pneumonia, toxoplasmic encephalitis, and cryptococcal meningitis
• CD4 count < 50/mcL: Increased risk of cytomegalovirus (CMV) and Mycobacterium avium complex (MAC) infections

For every 3-fold (0.5 log₁₀) increase in plasma HIV RNA in untreated patients, risk of progression to AIDS or death over the next 2 to 3 years increases about 50%.

Without treatment, risk of progression to AIDS is about 1 to 2%/year in the first 2 to 3 years of infection and about 5 to 6%/year thereafter. Eventually, AIDS almost invariably develops in untreated patients.

Transmission

Transmission of HIV requires contact with body fluids—specifically blood, semen, vaginal secretions, breast milk, saliva, or exudates from wounds or skin and mucosal lesions—that contain free HIV virions or infected cells. Transmission is more likely with the high levels of virions that are typical during primary infection, even when such infections are asymptomatic.

Transmission by saliva or droplets produced by coughing or sneezing, although conceivable, is extremely unlikely. HIV is not transmitted by casual nonsexual contact as may occur at work, school, or home.

Transmission is usually

• Sexual: Direct transmission through sexual intercourse
• Needle- or instrument-related: Sharing of blood-contaminated needles or exposure to contaminated instruments
• Maternal: Childbirth or breastfeeding
• Transfusion- or transplant-related

Sexual transmission of HIV

Sexual practices such as fellatio and cunnilingus appear to be relatively low risk but not absolutely safe. Risk does not increase significantly if semen or vaginal secretions are swallowed. However, open sores in the mouth may increase risk.

The sexual practices with the highest risks are those that cause mucosal trauma, typically intercourse. Anal-receptive intercourse poses the highest risk. Mucous membrane inflammation facilitates HIV transmission; sexually transmitted diseases, such as gonorrhea, chlamydial infection, trichomoniasis, and especially those that cause ulceration (eg, chancroid, herpes, syphilis), increase the risk several-fold. Other practices that cause mucosal trauma include fisting (inserting most or all of the hand into the rectum or vagina) and using sexual toys. When used during intercourse with an HIV-infected partner and/or with multiple concurrent sex partners, these practices increase the risk of HIV transmission.

In heterosexuals, the estimated risk per coital act is about 1/1000; however, risk is increased in the following:

• Early and advanced stages of HIV infection when HIV concentrations in plasma and genital fluids are higher
• Younger people
• People with ulcerative genital diseases

Circumcision seems to reduce the risk of males acquiring HIV infection by about 50% by removing the penile mucosa (underside of foreskin), which is more susceptible to HIV infection than the keratinized, stratified squamous epithelium that covers the rest of the penis.

Recent evidence shows that HIV infected people in whom antiretroviral therapy has reduced their viral load below the current detectable level (virally suppressed) do not sexually transmit the virus to their partners. Undetectable virus equals an untransmittable virus.

Epidemiology

HIV has spread in 2 epidemiologically distinct patterns:

• Male homosexual intercourse or contact with infected blood (eg, through sharing needles in injection drug users; before effective screening of donors, through transfusions)
• Heterosexual intercourse (affecting men and women about equally)

In most countries, both patterns occur, but the first pattern usually predominates in developed countries; the second pattern predominates in Africa, South America, and southern Asia.

In areas where heterosexual transmission is dominant, HIV infection follows routes of trade, transportation, and economic migration to cities and spreads secondarily to rural areas. In Africa, particularly southern Africa, the HIV epidemic has killed tens of millions of young adults, creating millions of orphans. Factors that perpetuate spread include

• Poverty
• Poor education
• Deficient systems of medical care that do not provide access to HIV testing and antiretroviral drugs

However, through international efforts, as of 2016, an estimated 19.5 million people living with HIV were accessing antiretroviral therapy, dramatically reducing deaths and transmission in many countries.

Many opportunistic infections that complicate HIV are reactivations of latent infections. Thus, epidemiologic factors that determine the prevalence of latent infections also influence risk of specific opportunistic infections. In many developing countries, prevalence of latent TB and toxoplasmosis in the general population is higher than that in developed countries. Dramatic increases in reactivated TB and toxoplasmic encephalitis have followed the epidemic of HIV-induced immunosuppression in these countries. Similarly in the United States, incidence of coccidioidomycosis, common in the Southwest, and histoplasmosis, common in the Midwest, has increased because of HIV infection.

Human herpesvirus 8 infection, which causes Kaposi sarcoma, is common among homosexual and bisexual men but uncommon among other HIV patients in the United States and Europe. Thus, in the United States, more than 90% of AIDS patients who have developed Kaposi sarcoma are homosexual or bisexual men.

The post The Human Immunodeficiency Virus (HIV), CD4+ T lymphoctyes and AIDS appeared first on Medika Life.

What unique challenges do women face in preventing HIV?

According to the Centers for Disease Control and Prevention, some prevention challenges are unique to women:

• Women can pass HIV to their babies during pregnancy and birth and through breastfeeding.
• A woman’s anatomy makes it easier to get HIV through sex compared with a man’s anatomy.
• Having a sexually transmitted infection (STI) raises a woman’s risk for HIV more than a man’s.
• Women are more likely to lack control in relationships and fear violence, stigma, or abandonment when trying to prevent HIV exposure.
• Women are more likely to be victims of sexual abuse. People with a history of sexual abuse are more likely to engage in high-risk sexual behaviors like exchanging sex for drugs, having multiple partners, or having sex with a partner who is physically abusive when asked to use a condom.

How can I prevent HIV?

The best way to prevent HIV is to not have vaginal, oral, or anal sex or share needles at any time. Sharing needles for any reason is very risky.

If you do have sex, lower your risk of getting an STI with the following steps:

• Use condoms. Male latex condoms are the most effective way to prevent HIV and other STIs when you have sex. Because a man does not need to ejaculate (come) to give or get some STIs, make sure to put the condom on before the penis touches the vagina, mouth, or anus. Female condoms can also help to prevent HIV infection. Other methods of birth control, like birth control pills, shots, implants, or diaphragms, will not protect you from STIs.
• Get tested. Be sure you and your partner are tested for HIV and other STIs. Talk to each other about the test results before you have sex. Having an STI increases your chances of becoming infected with HIV during sex. If your partner has an STI in addition to HIV, that also increases your risk of HIV infection. If you have an STI, you should also get tested for HIV.
• Be monogamous. Having sex with just one partner can lower your risk for HIV and other STIs. After being tested for STIs, be faithful to each other. That means that you have sex only with each other and no one else.
• Limit your number of sexual partners. Your risk of getting HIV and other STIs goes up with the number of partners you have.
• Get vaccinated. You can get a vaccine to protect against HPV and hepatitis B, which are STI’s. There is no vaccine to prevent or treat HIV.
• Don’t douche. Douching removes some of the normal bacteria in the vagina that protects you from infection. This may increase your risk of getting HIV and other STIs.
• Do not abuse alcohol or drugs. Alcohol or drug abuse may lead to risky behaviors such as sharing needles to inject drugs or not using a condom when you have sex.

The steps work best when used together. No single step can protect you from every single type of STI.

Male latex condoms are a highly effective way to prevent HIV and other STIs, but almost one in every five women who uses only condoms for birth control gets pregnant. The best way to prevent both STIs and pregnancy is to use a latex condom along with another highly effective method of birth control such as an intrauterine device (IUD), an implant, or the shot.

Can I take medicine to prevent getting or passing HIV?

Yes. Several medicines are available to help lower your risk of getting or passing HIV:

Pre-exposure prophylaxis (PrEP)

PrEP is an HIV prevention method for people who do not have HIV infection but who may be at high risk. PrEP is a pill you take by mouth every day.

Talk to your doctor about PrEP if:

• You are HIV-negative but your partner is HIV-positive (known as serodiscordant or mixed-status couples)
• You are not in a monogamous relationship (you or your partner also have sex with other people) and you do not always use condoms
• You inject illegal drugs or share needles
• You have a partner who is HIV-positive, and you want to get pregnant. PrEP may help protect you and your baby.

The Centers for Disease Control and Prevention estimates that PrEP could prevent transmission in as many as 140,000 serodiscordant heterosexual couples. Learn more about PrEP.

Post-exposure prophylaxis (PEP)

PEP is an anti-HIV medicine for people who may have been very recently exposed to HIV. If you think you have been exposed (for example, if a condom breaks), or if you were sexually assaulted, talk to your doctor or nurse about taking PEP.

You must take PEP within three days of exposure to help lower your risk for HIV. You then take two to three antiretroviral medicines for 28 days to prevent the virus from copying itself and spreading through your body.

While taking PEP, you still need to take steps to prevent HIV, including using a condom with sex partners. 

Antiretroviral medicines

If you are HIV-positive, taking antiretroviral (ARV) medicine can reduce your viral load (the amount of HIV in your blood) to keep you healthy. Knowing your viral load measurement and how to control it by reducing it to undetectable levels can protect your unborn baby during pregnancy, labor, and delivery. It can also help prevent spreading HIV to your sexual partner.

What are some behaviors that can raise a woman’s risk for HIV?

Behaviors that raise a woman’s risk for HIV include:

• Having sex with a male partner who has had sex with another man or who has used intravenous (IV) drugs. Sex with a man is the most common way women are infected with HIV.
• Using injection drugs and sharing needles. This is the second most common way that HIV is spread.
• Abusing drugs and alcohol. This can lead to risky behavior, including having sex without a condom, not knowing a partner’s HIV status, or injecting drugs.

Women who drink alcohol or use drugs may also be at higher risk of sexual assault or rape, which may put you at risk for HIV. If you are assaulted or raped, you need to see a doctor right away. Your doctor may decide that you should get post-exposure prophylaxis (PEP). These drugs may lower your chances of getting HIV after you have been exposed to the virus. But these drugs work only if you see a doctor within three days of exposure.

How can I prevent HIV if I inject drugs?

Intravenous (IV) drug users who share needles are at high risk for HIV. Sharing needles can place another person’s blood right into your body, even if the amount is so small that you can’t see it on the needle.

People who inject steroids, insulin, or medicines for other health problems are at risk for HIV if they do not use sterilized needles every time. Whenever you need to use a needle, be sure that it is sterilized. Do not share needles with anyone. You can also get HIV if the equipment used for body piercings and tattoos is not sterilized.

If you inject drugs or medicines, follow these steps to lower your risk of getting HIV:

• Never reuse or “share” needles, syringes, water, or drug preparation equipment.
• Only use needles and syringes that you got from a reliable source (such as drugstores or needle exchange programs).
• Use a new, sterile needle or syringe each time.
• If you must use a needle used by others, clean it with bleach before using it.
• If possible, use sterile water to prepare drugs; otherwise, use clean water from a reliable source (such as fresh tap water).
• Use a new or disinfected container (“cooker”) and a new filter (“cotton”) to prepare drugs.
• Clean the injection site with a new alcohol swab prior to injection.
• Throw away needles and syringes after one use. Do not throw them in the regular trash. You can use an old laundry detergent or milk jug to collect used needles and syringes and then seal the container before disposing of it. Check with your local health department about the correct way to throw away the container.
• Don’t share needles or syringes with friends or family.

How can I prevent HIV if I get tattoos or body piercings?

Follow these steps to lower your risk of getting HIV:

• Ask questions about how the staff sterilizes their equipment. Single-use instruments that cut the skin should be used once and then thrown away. Reusable instruments that cut the skin should be cleaned and sterilized between uses.
• Find out what steps the staff takes to prevent HIV and other infections, like hepatitis B and hepatitis C.
• Make sure your tattoo parlor follows state regulations and health inspections.

I’m pregnant and have HIV. Will my baby get HIV?

If you are getting treatment for HIV, the answer is most likely no. When HIV medicine is used consistently and correctly, a pregnant woman living with HIV who is treated for HIV early in her pregnancy can lower the risk of delivering a baby with HIV to less than 1%. Without treatment, this risk is about 25% in the United States.

All women need to be tested for HIV during their first prenatal care visit, early in the pregnancy. High-risk women who get a negative HIV test result should be tested again later in pregnancy.

Treatment, called antiretroviral therapy, works best when it is:

• Started as early as possible in pregnancy
• Also given during labor and delivery
• Given to the infant after birth

If you are HIV-positive and your viral load is greater than 1,000 copies per milliliter, your doctor may recommend delivering your baby by cesarean (C-section).

I have HIV. Can I breastfeed my baby?

No. If you have HIV, do not breastfeed. In the United states and other countries where clean water is available, using a breastmilk substitute like formula is strongly recommended for women with HIV, because you can pass the virus to your baby through breastmilk.

You can also ask your doctor, midwife, or pediatrician about getting human breastmilk from a milk bank. Find a human milk bank through the Human Milk Banking Association of North America.

Recommendations about breastfeeding with HIV may be different for other countries where clean water is not always available.

How can I help protect my children from HIV?

One way to help protect your children from HIV is to talk to them about HIV, AIDS, and the sexual behaviors that raise their risk for HIV and other sexually transmitted infections (STIs). The earlier you start talking about it, the better. By the third grade, almost all children have heard about HIV.

According to a 2013 national survey of high school students:

• About half of all students have had sex at least once
• One-third are sexually active (have had sex in the past three months)
• Nearly half of the students who are sexually active did not use a condom the last time they had sex

Offsite Resources

For more information about HIV prevention check out the following resources from other organizations:

• Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents — Clinical guidelines from AIDS on antiretroviral therapy (ART).
• HIV Risk and Prevention — Information from the CDC.
• The Basics of HIV Prevention — Fact sheet from AIDS.
• Preexposure Prophylaxis for the Prevention of HIV Infection in the United States — 2014 — Clinical practice guidelines from the Centers for Disease Control and Prevention and the U.S. Public Health Service.

The post HIV Prevention for Women appeared first on Medika Life.

Should I get tested for HIV?

According to the U.S. Preventive Services Task Force, get tested for HIV if you are:

• Older than 15. All women and girls older than 15 need to be tested at least once.
• Pregnant. Every pregnant woman should have an HIV test as early as possible in the pregnancy. You need to get tested even if you have been tested before. Also, consider getting tested for HIV if you plan to get pregnant.

Some women with HIV don’t know they have it, because HIV may not cause symptoms for several years. 
Even if HIV causes no symptoms, it is still causing problems with your body’s immune system that need to be treated as soon as possible.

Some women who test negative assume their partners must be HIV-negative too. But your HIV test reveals only your status, not your partner’s.

When should I get tested for HIV?

If you think you might have been exposed to HIV, get tested. But testing right away may not pick up early HIV infection. The first HIV test taken soon after infection may say that you do not have HIV even if you do. That is because some HIV tests look for antibodies (the body’s natural immune response to a foreign invader) that your body may not have developed yet.

If you get HIV, your body will usually begin to develop antibodies within three to 12 weeks (21 to 84 days). The time between being exposed and developing antibodies is called the “window period.”

There are newer HIV tests available that can tell whether you are HIV-positive early after exposure to the virus. One of the newer tests looks for the virus itself, by testing for viral load (the amount of HIV in your blood) and a marker on the virus called p24 antigen. This test is much more sensitive. It can detect HIV within nine to 11 days after exposure. This type of test may be more expensive. Ask your doctor if this test is available when you get tested for HIV.

How can I get free HIV testing?

Many clinics and doctors’ offices have free or low-cost HIV testing. If you have health insurance, you may be able to get free HIV testing under the Affordable Care Act (the health care law). HIV screening and counseling for women are covered without cost sharing in most private health insurance plans. Medicaid also covers certain recommended preventive services, including HIV screening for women at higher risk for HIV, without cost sharing or deductibles.

HIV testing for people with Medicare is usually covered once every 12 months. Pregnant women with Medicare can get up to three HIV tests for free during pregnancy.

Ask if the newer HIV test, which picks up infection earlier, is available when you get tested for HIV.

The Three HIV Tests explained

There are three types of tests available: nucleic acid tests (NAT), antigen/antibody tests, and antibody tests. HIV tests are typically performed on blood or oral fluid. They may also be performed on urine.

• A NAT looks for the actual virus in the blood and involves drawing blood from a vein. The test can either tell if a person has HIV or tell how much virus is present in the blood (known as an HIV viral load test). While a NAT can detect HIV sooner than other types of tests, this test is very expensive and not routinely used for screening individuals unless they recently had a high-risk exposure or a possible exposure and have early symptoms of HIV infection.
• An antigen/antibody test looks for both HIV antibodies and antigens. Antibodies are produced by your immune system when you’re exposed to viruses like HIV. Antigens are foreign substances that cause your immune system to activate. If you have HIV, an antigen called p24 is produced even before antibodies develop. Antigen/antibody tests are recommended for testing done in labs and are now common in the United States. This lab test involves drawing blood from a vein. There is also a rapid antigen/antibody test available that is done with a finger prick.
• HIV antibody tests only look for antibodies to HIV in your blood or oral fluid. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid. Most rapid tests and the only currently approved HIV self-test are antibody tests.

Talk to your health care provider about what type of HIV test is right for you.

How long does it take to get results?

• Laboratory tests (NATand antigen/antibody) require blood to be drawn from your vein into a tube and then that blood is sent to a laboratory for testing. The results may take several days to be available.
• With a rapid antibody screening test, usually done with blood from a finger prick or with oral fluid, results are ready in 30 minutes or less.
• The rapid antigen/antibody test is done with a finger prick and takes 30 minutes or less.
• The oral fluid antibody self-test provides results within 20 minutes.

How soon after an exposure to HIV can a test detect if I have the virus?

No HIV test can detect HIV immediately after infection. If you think you’ve been exposed to HIV in the last 72 hours, talk to your health care provider about post-exposure prophylaxis (PEP), right away.

The time between when a person may have been exposed to HIV and when a test can tell for sure whether they have the virus is called the window period. The window period varies from person to person and depends on the type of test used to detect HIV. Ask your health care provider or test counselor about the window period for the test you’re taking.

• A nucleic acid test (NAT)can usually tell you if you have HIV infection 10 to 33 days after an exposure.
• An antigen/antibody test performed by a laboratory on blood from a vein can usually detect HIV infection 18 to 45 days after an exposure. Antigen/ antibody tests done with blood from a finger prick can take longer to detect HIV (18 to 90 days after an exposure).
• Antibody tests can take 23 to 90 days to detect HIV infection after an exposure. Most rapid tests and self-tests are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid.

The post Getting Tested for HIV. What Women Need to Know. appeared first on Medika Life.

Who is at risk for HIV?

All women can get HIV, but your risk for getting HIV is higher if you:

• Have unprotected sex
• Have injected illegal drugs, either now or in the past
• Had sex with someone to get money or drugs in return or with someone who has traded sex for money or drugs
• Had sex with someone who
  • Has HIV
  • Has sex with both men and women
  • Injects drugs
• Have another sexually transmitted infection (STI)
• Had a blood transfusion between 1978 and 1985

Women who have sex with men

In the United States, most women get HIV from having sex with a man.

Women are more likely than men to get HIV during vaginal sex because:

• The vagina has a larger surface area (compared with the penis) that can be exposed to HIV-infected semen.
• Semen can stay in your vagina for several days after sex. This means you are exposed to the virus longer.
• Having a vaginal yeast infection, bacterial vaginosis, or an untreated sexually transmitted infection (STI) makes HIV transmission more likely. This is because the yeast or bacterial infection or STI brings white blood cells (and therefore CD4 cells that can be infected with HIV) into the vaginal area. Small cuts on the skin of your vagina (common with genital ulcers from herpes or syphilis) are hard to notice but may allow HIV to pass into your body.

As a woman, you are more likely to get HIV during vaginal sex when:

• You are unaware of your partner’s risk factors for HIV. Some men, for example, have sex with men as well as women but do not tell their female partners.
• Your male partner was recently infected. During this time, the amount of HIV in his semen is higher. Exposure during early infection may cause up to half of all HIV transmissions in the United States.
• Your partners do not use male latex condoms or you do not use female condoms correctly every time you have sex.
• You have a history of sexual abuse, which can lead to riskier future behavior.
• You have sex with multiple partners or have sex with someone who is having sex with multiple partners.
• You have sex in exchange for money or drugs.
• You misuse drugs or alcohol before or during sex.

Women who inject drugs or share needles

Women who use injection drugs or share needles or syringes and other injection equipment are at high risk for HIV. In fact, sharing needles is the second most common way that HIV is spread. (Sex is the most common way that HIV is spread.) Use of injected drugs also raises your risk for risky behaviors, such as not using a condom during sex. In a study of U.S. cities with high levels of HIV, 72% of women who injected drugs reported having sex without a condom in the past year.

If you use injection drugs, talk to your doctor about medicine, called pre-exposure prophylaxis (PrEP), to prevent getting HIV.

Women who have sex with women

Women who have sex only with women might think they are safe from HIV. This type of HIV transmission is rare. If you are a woman and your female partner has HIV, you can get it if you have cuts, bleeding gums, or sores in your mouth and you give oral sex. It is also possible to spread HIV through menstrual blood and shared sex toys.

As a woman who has sex with women, it is also possible to get HIV if:

• You inject or your partner injects drugs with someone who has HIV
• You have or your partner has sex with a man who has HIV
• You are trying to get pregnant and use semen that has not been tested for HIV or sexually transmitted infections (STIs)

Lower your risk of getting HIV or passing it to your partner:

• Know your HIV status and your partner’s HIV status.
• Take steps to protect yourself and others from HIV.
• Use latex condoms correctly and every time if you have sex with men.
• Use dental dams correctly.
• Never share sex toys.

Younger women

Young women are at risk for HIV:

• According to a 2013 survey, only half of female high school students used a condom the last time they had sex. Only one in eight female high school students in the study had ever been tested for HIV.
• Younger women are more likely to have a sexually transmitted infection (STI). Having an untreated STI makes HIV transmission more likely. An untreated vaginal yeast or bacterial infection can also increase the risk of transmission. This is because the infection brings white blood cells (and therefore CD4 cells that can be infected with HIV) into the area. This is especially true for women, because small cuts on the skin of the vagina are hard to notice but may allow HIV to pass into your body.
• Teen girls and younger women are at higher risk for HIV infection than adult women, because their reproductive tract is still developing.

Older women

Women over 50 are still at risk for HIV. Older women are more likely than younger women to be diagnosed with HIV much later after they are first infected.

This may be because older women may think they do not need condoms, because they do not worry about getting pregnant. They may not talk about safe sex with their doctors or partner or get tested regularly for HIV and other sexually transmitted infections (STIs). Their doctors may also not suspect their symptoms could be caused by HIV. A later diagnosis can mean a later start to treatment and possibly more damage to your immune system. It can also raise the risk of spreading HIV to other people.

You can get HIV at any age. In fact, the decrease in hormone levels during and after menopause means your vagina will probably not be as lubricated (wet) as it used to be. This means that you have a greater risk for tiny cuts in your vagina during sex that can make it easier for HIV to get in.

Other health concerns

Older women with HIV also need to think about other health problems, such as heart disease and osteoporosis. If you have HIV, talk to your doctor about steps you can take to lower your risk of these problems. Ask about screening tests you might need as you age.

African-American and Hispanic women

Women of color, especially African-American and Hispanic women, are disproportionately affected by HIV.

• African-American women made up more than 61% of new HIV infections among women in 2015 but are only 14% of the female population in the United States. African-American women face the highest risk of HIV and other sexually transmitted infections (STIs) compared with women of other groups. However, many African-American women do not know their HIV status. Poverty, stigma, and fear of discrimination may prevent women from getting tested or seeking care if infected.
• Hispanic women made up 15% of new HIV infections among women in 2015. Cultural challenges may raise Hispanic women’s risk for HIV. Hispanic women may avoid seeking testing, counseling, or treatment if infected because of their immigration status, stigma, or fear of discrimination. Poverty may also prevent Hispanic women from getting care.

Act Against AIDS: Take Charge. Take the Test.

Take Charge. Take the Test.™ urges African-American women to get tested for HIV. The program is part of the Act Against AIDS campaign by the Centers for Disease Control and Prevention. The effort helps you recognize your risk of getting HIV and the need for HIV testing. It provides you with the information and help you need to take charge of your life — whatever your HIV test result.

The post Women and HIV in the US appeared first on Medika Life.

When taken daily, PrEP is highly effective for preventing HIV. Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily. Among people who inject drugs, PrEP reduces the risk of getting HIV by at least 74% when taken daily. PrEP is much less effective if it is not taken consistently.

As PrEP only protects against HIV, condoms are important for the protection against other STDs.

How does PrEP work?

What is the difference between PrEP and PEP?

• Post = after
• Exposure = coming into contact with HIV
• Prophylaxis = treatment to prevent an infection from happening

Post-exposure prophylaxis (PEP) is an HIV prevention strategy where HIV-negative individuals take HIV medications after coming into contact with HIV to reduce their risk of becoming infected. PEP is a month-long course of drugs and must be started within 72 hours after possible exposure.

Who does PrEP work for

PrEP has been shown to help reduce HIV infection risk in multiple studies. The iPrEx trial showed that PrEP reduces the risk of HIV infection among gay and bisexual men and transgender women. Two large trials, Partners PrEP and TDF2, showed that PrEP also reduces the risk of HIV infection among heterosexual men and women. The Bangkok Tenofovir Study demonstrated that PrEP works for people who inject drugs.

Effectiveness

Truvada for PrEP provides 92%-99% reduction in HIV risk for HIV-negative individuals who take the pills every day as directed. If a daily dose is missed, the level of HIV protection may decrease. It only works if you take it. People who use PrEP correctly and consistently have higher levels of protection against HIV.
According to data analysis from the iPrEx study that found PrEP to be effective:

• For people who take 7 PrEP pills per week, their estimated level of protection is 99%.
• For people who take 4 PrEP pills per week, their estimated level of protection is 96%.
• For people who take 2 PrEP pills per week, their estimated level of protection is 76%.

There are not enough data available to provide specific timing guidance on non-daily use, so the FDA recommends PrEP be used daily to achieve the highest level of protection.
A few things to note:

• When starting PrEP, it takes at least seven days to reach high levels of protection against HIV.
• When stopping PrEP, individuals should continue using PrEP for four weeks after the last significant exposure.
• PrEP does not protect against other sexually transmitted infections (STI) or pregnancy. It is not a cure for HIV.

Medication options for PrEP

Two medications, sold under the brand names Truvada® and Descovy® are approved for daily use as PrEP to help prevent a person without HIV from getting the virus from sex or injection drug use. You need to discuss your individual needs with your doctor and consider the possible side effects of each drug.

Truvada and Descovy belong to a drug class known as NRTIs, which inhibit and block the virus enzyme called reverse transcriptase. By blocking the action of reverse transcriptase, both drugs in combination with another ARV work together to prevent HIV from multiplying in the body. Both drugs are highly effective in reducing the amount of HIV in the T-cells (white blood cells).

Truvada® 

Truvada is an NRTIs drug designed to intercept and inhibit or block the HIV virus enzyme called reverse transcriptase. This enzyme actively infects the DNA and uses it to make copies of the virus. Once these cells are infected, the body’s immune function becomes weaker as the viral load count increases.

Truvada, combined with another ARV medicine, work together to prevent the virus from increasing or replicating in the CD4 cells. The more a patient uses Truvada, the more its concentration in the body increases and becomes highly effective in reducing the amount of HIV in the T-cells (white blood cells).

As PrEP, Truvada intercepts the virus before it enters into the body. PrEP is an effective strategy where the active substances in Truvada stay alert to kill the virus in its early stages before it inhibits the cell DNA causing AIDS.

• You must be HIV-negative before you start and while taking TRUVADA for PrEP. Do not take TRUVADA to reduce the risk of getting HIV-1 unless you are confirmed to be HIV-negative.
  • Get tested for HIV-1 immediately before and at least every 3 months while taking TRUVADA.
  • If you think you were exposed to HIV-1, tell your healthcare provider right away.
• Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. If you have flu-like symptoms, you could have recently become infected with HIV-1. Tell your healthcare provider if you had a flu-like illness within the last month before starting or at any time while taking TRUVADA.
  • Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin.
• You must continue to use safer sex practices. Just taking TRUVADA for PrEP may not keep you from getting HIV-1.
  • Do not miss any doses of TRUVADA. Missing doses may increase your risk of getting HIV-1 infection.

Serious side effects of TRUVADA may also include:

• Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to stop taking TRUVADA.
• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.
• Bone problems, including bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

Common side effects in people taking TRUVADA for PrEP are headache, stomach-area (abdomen) pain, and decreased weight. Tell your healthcare provider if you have any side effects that bother you or do not go away.

Descovy®

Descovy® for PrEP is recommended to prevent HIV for people at risk through sex, excluding people at risk through receptive vaginal sex. Because Descovy has not yet been studied for HIV prevention for receptive vaginal sex, it may not be appropriate for some people.

Descovy works the same way as Truvada. It is a nucleoside reverse transcriptase inhibitor which actively undergoes intracellular metabolism where tenofovir alafenamide is first hydrolyzed to tenofovir-alanine, and converted into parent tenofovir.

The action of tenofovir (tenofovir diphosphate) as it enters the body is to inhibit the activity of virus reverse transcriptase, causing viral DNA chain termination. Once the virus’ active action is terminated, there is no more replication of the virus and the CD4 cell count begins to increase in number, restoring the body’s immune function.

Note that Descovy doesn’t cure HIV. It reduces its viral count in the T-cells and the more you consistently use this medication, the more the viral load count decreases.

Before and while taking DESCOVY for PrEP:

• You must be HIV-negative before you start and while taking DESCOVY for PrEP. You must get tested for HIV-1 immediately before and at least every 3 months while taking DESCOVY. If you think you were exposed to HIV-1, tell your healthcare provider right away. They may want to do more tests to confirm that you are still HIV-negative.
• Many HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. Tell your healthcare provider if you had a flu-like illness within the last month before starting or while taking DESCOVY. Symptoms of new HIV-1 infection include tiredness, fever, joint or muscle aches, headache, sore throat, vomiting, diarrhea, rash, night sweats, and/or enlarged lymph nodes in the neck or groin.
• DESCOVY by itself is not a complete treatment for HIV-1. Do not take DESCOVY for PrEP unless you are confirmed to be HIV-1 negative.
• DESCOVY does not prevent other sexually transmitted infections (STIs). Practice safer sex by using a latex or polyurethane condom to reduce the risk of getting STIs.
• To further help reduce your risk of getting HIV-1:
  • Do not miss any doses of DESCOVY. Missing doses may increase your risk of getting HIV-1.
  • Know your HIV status and the HIV status of your partners. If your partner is living with HIV, your risk of getting HIV is lower if your partner consistently takes HIV treatment every day.
  • Get tested for other STIs. Some STIs make it easier for HIV-1 to infect you.
  • Talk to your healthcare provider about all the ways to help reduce HIV risk.

DESCOVY can cause serious side effects:

• Worsening of hepatitis B (HBV) infection. Your healthcare provider will test you for HBV. If you have HBV and stop taking DESCOVY, your HBV may suddenly get worse. Do not stop taking DESCOVY without first talking to your healthcare provider, as they will need to check your health or give you HBV medicine.

Who should not take DESCOVY for PrEP?

Do not take DESCOVY for PrEP if you:

• Already have HIV-1 or if you do not know your HIV-1 status. If you have HIV-1, you need to take other medicines with DESCOVY to treat HIV-1. If you have HIV-1 and take only DESCOVY, your HIV-1 may become harder to treat now and in the future.

What are the other possible side effects of DESCOVY for PrEP?

Serious side effects of DESCOVY may also include:

• Kidney problems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with DESCOVY. If you develop kidney problems, your healthcare provider may tell you to stop taking DESCOVY.
• Too much lactic acid in your blood (lactic acidosis), which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
• Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.

Common side effects in people taking DESCOVY for PrEP are diarrhea, nausea, headache, fatigue, and stomach pain. Tell your healthcare provider if you have any side effects that bother you or do not go away.

Want to know more?

This website, dedicated to everything related to PrEP will answer any questions you may have relating to PrEP. PREPFACTS

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