HIV 101

I would very much like to continue my story from where I left off, but I felt that I first have an obligation to get some facts and information on here to answer some of the questions that people may have about HIV. Therefore, I spent some time today getting down the basics. Please take some time to read through the questions and answers I have posted, even if you think you already have the knowledge. In addition PLEASE PLEASE contact me if you have any questions of any sort, and I will take the time to answer them the best I can. Thanks!

· What is HIV?

o       HIV stands for Human Immuno-deficiency Virus. It is a virus that can only infect human beings. HIV reproduces by taking over human cells and attacking the body’s immune system.

· What is AIDS?

o       AIDS stands for Acquired Immune Deficiency Syndrome. AIDS is a condition that someone acquires or is infected with. AIDS makes the body’s immune system deficient (makes it not work properly). When the immune system does not work properly, people with AIDS may be vulnerable to a number of different diseases and opportunistic infections.

· What is the difference between HIV and AIDS?

o       Someone is said to have HIV or be HIV+ if they have been infected with the HIV virus. This means that the HIV virus is living in their body. People with HIV may or may not have any symptoms of the infection. HIV is the virus that causes or leads to AIDS.

o       Someone is diagnosed with AIDS when the HIV virus in their body causes their immune system to be compromised. This is measured by the CD4 Count and/or the presence of Opportunistic Infections. A person is diagnosed with AIDS when their CD4 count goes below a 200 level or if they experience one or more Opportunistic Infections.

· What is the CD4 Count?

o       CD4 Cells are a type of white blood cells that fight infection. They may also be called T-Helper Cells. HIV damages a person’s CD4 Cells. A normal CD4 count is from 500 to 1,500 cells per cubic millimeter of blood. A low or decreasing CD4 count means that the person’s immune system is weaker, and they may be more likely to get sick. A higher CD4 count means that a person’s immune system is stronger.

o       When a person’s CD4 count falls below 200, they are diagnosed with AIDS and may be more likely to develop opportunistic infections.

· What are Opportunistic Infections?

o       When a person’s immune system is compromised, they may become more vulnerable to certain infections. These are called 'opportunistic infections' because they take advantage of the opportunity offered by a weakened immune system.

o       Some of the most common HIV related opportunistic infections include: Bacterial diseases such as tuberculosis, MAC, bacterial pneumonia and septicemia (blood poisoning); Protozoal diseases such as toxoplasmosis, microsporidiosis, cryptosporidiosis, isopsoriasis and leishmaniasis; Fungal diseases such as PCP, candidiasis, cryptococcosis and penicilliosis; Viral diseases such as those caused by cytomegalovirus, herpes simplex and herpes zoster virus; and HIV-associated malignancies such as Kaposi's sarcoma, lymphoma and squamous cell carcinoma.

· What is the Viral Load?

o       Viral load is the term used to describe the amount of HIV in your blood. The result of a viral load test is described as the number of 'copies' of HIV RNA per milliliter (copies/ml). The more HIV in your blood, the faster your CD4 cells (immune system cells that fight infection) reduce, and the greater your risk of developing symptoms in the next few years.

· Is there a cure for HIV/AIDS?

o       Although there have been many advances in HIV treatments and therapies in recent years that have dramatically improved the quality of life and life expectancy of persons with HIV/AIDS in the US and other developed countries, there is, as of yet, no cure.

o       Very recently there has been one confirmed case of an HIV patient Timothy Brown being “functionally cured” of the virus.

· How is HIV transmitted/contracted/passed/spread?

o       HIV can be transmitted from an infected person to another through:

§         Blood (including menstrual blood)

§         Semen

§         Vaginal secretions

§         Breast milk

o       Blood contains the highest concentration of the virus, followed by semen, followed by vaginal fluids, followed by breast milk.

o       These specific fluids must come in contact with a mucous membrane or damaged tissue or be directly injected into the blood-stream (from a needle or syringe) for transmission to possibly occur.

o       The following are additional body fluids that may transmit the virus that health care workers may come into contact with:

§         fluid surrounding the brain and the spinal cord

§         fluid surrounding bone joints

§         fluid surrounding an unborn baby

· What activities CAN spread HIV?

o       Unprotected sexual contact (including vaginal intercourse, anal intercourse, or oral sex)

o       Direct blood contact, particularly through sharing injection drug needles.

o       Infections due to blood transfusions, accidents in health care settings or certain blood products are possible, although they are extremely rare nowadays in the United States.

o       Mother to baby (during pregnancy, during birth, or through breast milk)

o       There is a remote risk from deep, open-mouth kissing if there are sores or bleeding gums and blood is exchanged.

o       There is a remote risk of transmission by human bite. All documented cases where transmission did occur included severe trauma with extensive tissue damage and the presence of blood.

· What activities DO NOT spread HIV?

o       The following "bodily fluids" are NOT infectious:

§         Saliva

§         Tears

§         Sweat

§         Feces

§         Urine

o       HIV is not transmitted by day-to-day contact in the workplace, schools, or social settings. HIV is not transmitted through shaking hands, hugging, or a casual kiss. You cannot become infected from a toilet seat, a drinking fountain, a door knob, dishes, drinking glasses, food, insect bites, or pets.

o       HIV is not an airborne or food-borne virus, and it does not live long outside the body.

· How can transmission of HIV be prevented?

o       Abstain from sexual intercourse or be in a long-term mutually monogamous relationship with a partner who has been tested and you know is uninfected.

o       Latex condoms, when used consistently and correctly, are highly effective in preventing heterosexual sexual transmission of HIV.

o       Never reuse or "share" syringes, water, or drug preparation equipment. Do not share other tools that may come into contact with blood, such as razors.

o       Get tested and know your status. Make sure your partner(s) are tested and know their status.

o       Follow guidelines to prevent Mother to Child Transmission.

· What is Acute HIV Infection?

o       Primary or acute HIV infection occurs 2 - 4 weeks after infection with the human immunodeficiency virus (HIV). Acute HIV infection can appear like infectious mononucleosis, flu, or other viral illnesses. If symptoms occur, they are usually seen 1 - 4 weeks after becoming infected. These symptoms can last from a few days to 4 weeks, and then subside. Any of the following symptoms can occur:

§         Decreased appetite

§         Fatigue

§         Fever

§         Headache

§         Malaise

§         Muscle stiffness or aching

§         Rash

§         Sore throat

§         Swollen lymph glands

§         Ulcers of the mouth and esophagus

o       Symptoms may be subtle or non-existent in many people infected with HIV, and it is therefore uncommon for HIV to be recognized and diagnosed during the Acute Infection period.

· What is the treatment for HIV?

o       Antiretroviral therapy (ART) is the recommended treatment for HIV infection. ART involves taking a combination (regimen) of three or more anti-HIV medications daily. ART prevents HIV from multiplying and destroying infection-fighting CD4 cells. This helps the body fight off life-threatening infections and cancer. Although anti-HIV medications can’t cure HIV, people with HIV are enjoying healthy lives and living longer thanks to ART.

· Can treatment prevent HIV from advancing to AIDS?

o       Yes! Treatment with anti-HIV medications prevents HIV from multiplying and destroying the immune system. This helps the body fight off life-threatening infections and cancers and prevents HIV from advancing to AIDS.

· When should someone start on treatment?

o       Even though you have HIV, you may not need to start treatment right away. When to start anti-HIV medications (also called antiretrovirals) depends on several factors, including:

§         Your overall health

§         How well your immune system is working (CD4 count)

§         The amount of HIV in your blood (viral load)

§         Whether you’re pregnant

§         Your ability and willingness to commit to lifelong treatment

o       It’s time to start treatment if:

§         Your CD4 count is less than 500 cells/mm³

§         You have AIDS

§         You’re pregnant

§         You have HIV-related kidney disease

§         You need treatment for hepatitis B virus (HBV)

· What treatments are available?

o       The best combination of anti-HIV medications for you depends on your individual needs. Factors that you and your health care provider will consider when selecting your HIV regimen include:

§         Other diseases or conditions you may have

§         Possible side effects of anti-HIV medications

§         How anti-HIV medications may interact with other medications you take

§         Your drug-resistance testing results

§         Complexity of the regimen—how many pills to take every day and how often, and if pills must be taken with or without food

§         Any personal issues that may make following a regimen difficult (such as depression or alcohol or drug abuse)

· Are there side effects?

o       Anti-HIV medications can cause side effects. Side effects vary depending on the anti-HIV medication. And people taking the same medication may not have the same side effects. Before starting treatment, discuss possible side effects with your health care provider or pharmacist.

o       Most side effects from anti-HIV medications are manageable. However, side effects that become unbearable or life threatening call for a change in medications. Side effects that may seem minor, such as fever, nausea, fatigue, or rash, can indicate serious problems. Once you start treatment, always discuss any side effects from your anti-HIV medications with your health care provider.

· What does it mean to have an Undetectable Viral Load?

o       The amount of HIV in your blood is so low that a viral load test can’t detect the virus. However, having an undetectable viral load doesn’t mean you’re cured. You still have HIV. And although having an undetectable viral load reduces the risk of HIV transmission, you can still infect another person with the virus.

· What is Adherence?

o       Treatment adherence means adhering to (following) your treatment regimen—taking the correct dose of each anti-HIV medication at the correct time and exactly as prescribed. Adherence is very important for successful HIV treatment.

· What is Drug Resistance?

o       Drug resistance develops when the virus mutates (changes form), becoming “resistant” to certain anti-HIV medications. One or more anti-HIV medications in a treatment regimen can become ineffective as a result of drug resistance.

o       Skipping medications makes it easier for drug resistance to develop. HIV can develop resistance to the anti-HIV medications in a person’s current regimen or to other, similar anti-HIV medications not yet taken, limiting options for successful HIV treatment. And drug-resistant strains of HIV can be transmitted to others, too.

· What is PEP?

o       PEP is short for Post-Exposure Prophylaxis and is the use of antiretroviral drugs as soon as possible after a high-risk exposure to HIV, to reduce (but not eliminate) the possibility of HIV infection. PEP is not the morning after pill for HIV. PEP is a four-week program of two or three antiretroviral medications, several times a day. The medications have serious side effects that can make it difficult to finish the program.

o       Treatment should be started promptly, preferably within the first several hours after an exposure. It should be administered within 48 hours of a high-risk exposure (not to exceed 72 hours). After 72 hours PEP is considerably less effective in preventing HIV infection. The sooner PEP is administered, the more effective it is.

· What is PrEP?

o       PrEP is short for PreExposure Prophylaxis and may be part of comprehensive HIV prevention services in which HIV negative people who are at high risk, take antiretroviral medication daily to try to lower their chances of becoming infected with HIV if they are exposed to it. To date, PrEP has been shown to be effective in men who have sex with men (MSM) and heterosexual men and women. A CDC study is also underway to evaluate whether it is safe and effective in reducing HIV infection among injection drug users, but those results are not yet available.

· What kind of life can a person with HIV expect to have?

o       An HIV diagnosis is not a death sentence. Treatment is highly effective and a person with HIV can expect to live an almost normal life. Just because someone is diagnosed with HIV does not mean that they will be sick, dying, or restricted from any normal activities in life that others have.

· Can someone with HIV have a relationship with someone who doesn’t have HIV?

o       Yes. HIV+ people do not have to only date other HIV+ people. Up to fifty percent of people living with HIV who are in relationships are estimated to be part of discordant couples, where one partner has HIV and the other has not.

o       Through safe sexual practices discordant couples can have healthy relationships and remain discordant.

o       Furthermore, studies have confirmed that taking antiretroviral drugs and maintaining an undetectable viral load reduces a HIV+ person’s risk of transmitting the virus to HIV- partners by 96% among heterosexual couples.

· Can someone with HIV have a baby?

o       Yes. HIV+ women can have healthy and HIV- babies without complications. There are specific regimens of drugs and guidelines that pregnant women should follow to prevent transmission to their babies. When following recommended guidelines and treatments, risk of mother to child transmission is very low.

o       An HIV+ man can have his sperm “washed” of HIV and then implanted into his HIV- negative partner in order to conceive safely.

· Can someone with HIV get a job?

o       Yes. People living with HIV can have and perform any job that others can.

o       HIV+ people are not required by law to disclose their status to employers and are protected from discrimination in the workplace and other settings by the Americans With Disabilities Act.

· Do people with HIV have to disclose their status to anyone?

o       People with HIV are not required by law to disclose their status to anyone other than their sexual partners. Each state has different laws about disclosure to sexual partners.

o       Furthermore, HIV+ people have the right to confidentiality in all settings. It is ILLEGAL for someone to disclose the status of another person without their permission.