What Everyone Needs to Know About HIV
HIV may be the story line of your favorite movies (Bohemian Rhapsody, Dallas Buyers Club, Philadelphia, Rent). But unfortunately, because these films take place in the early 1990s, many people wrongly assume HIV is a virus of the past.
With the U.S. Department of Health & Human Services reporting nearly 35,000 new infected individuals in the United States in 2019 — for a total of more than 1.2 million HIV-positive people in the country — data shows that HIV continues to touch (and take) the lives of people today.
Here, HIV expert Emily Rymland, D.N.P., F.N.P-C, clinical development manager at Nurx, and Amy Pearlman, M.D., a health expert with Promescent, are sharing their expertise on the virus and the disease it can cause. Learn more about the prevalence of HIV, the difference between HIV vs AIDS, HIV symptoms, how it typically spreads, and how to treat HIV.
What Is HIV — and How Is It Transmitted?
HIV, short for human immunodeficiency virus, is a viral infection that attacks the immune system. Specifically, it attacks a type of cells that make up the immune system called "T cells" or "CD4 cells," which are the white blood cells that are designed to be bodyguards, fighting off potential invaders within your body, says Dr. Pearlman. The virus destroys these protective cells, leaving the body susceptible to other infections, she explains.
HIV can be transmitted when the body fluids (breast milk, semen, vaginal secretion, blood, anal secretion, etc.) of an infected individual enter the body of an uninfected individual.
Specifically, the virus can enter your body through mucosal surfaces including the anus, vagina, penis, or mouth during sex, says Dr. Pearlman. HIV can also be transmitted through direct blood injection during blood transfusion, intravenous drug use, or other needle sharing, she says.
For the record, HIV cannot be transmitted through saliva or casual contact such as sharing a glass of wine or hugging. (Also worth knowing: What's the Difference Between an STI and STD?)
HIV vs. AIDS
AIDs, which stands for acquired immunodeficiency syndrome, is what HIV can become if left undiagnosed and/or untreated. (In fact, AIDs is sometimes also referred to as Stage III HIV). If an HIV-positive individual begins treatment early enough, the virus may never progress into AIDs, explains Rymland.
An infected individual might be diagnosed with AIDs if their T cell count falls below 200 (for reference, a healthy person's T cell count is 500 to 1200), she says. Or, if they have an opportunistic infection, which is an illness that occurs more frequently and/or severely in someone with a damaged immune system. Some of the most common opportunistic infections include cervical cancer, candidiasis (a severe yeast infection), pneumonia, herpes, Kaposi's sarcoma, lymphoma, and tuberculosis, according to the Centers for Disease Control and Prevention.
What Are the HIV Treatment Options?
HIV is an incurable disease which means it never goes away entirely, but it's not that simple.
These days, there's a type of medication called antiretroviral therapy (ART) that HIV-positive individuals can take to help several aspects of the condition. First, the medication helps to prevent the virus from replicating further (and thus doing more harm to the body), and, second, helps the body repair any damage the virus has previously done. With the proper medication, individuals with HIV can live long, happy lives, says Rymland. In fact, recent research shows that HIV-positive individuals have the same life expectancy as those who are negative.
It can be helpful to think about HIV as a chronic condition much like diabetes, says Rymland. "Just as sugars can be controlled when diet and medications are done properly, and it's similar for HIV," she says. "This is a chronic disease and can be very well managed and result in a long and full life."
What Are the Most Common HIV Symptoms?
Not everyone who is positive will even experience HIV symptoms, according to Rymland. "A lack of symptoms doesn't mean you don't have HIV," however, she says. Getting tested for HIV regularly if you're at risk for the virus is important because if left undiagnosed (and therefore untreated) "you can still transmit the virus, and may eventually develop symptoms," she explains. (FYI, many STIs can be asymptomatic.)
Some newly infected individuals will experience flu-like symptoms (fever, chills, night sweats, sore throat, fatigue, swollen glands, diarrhea, and headaches), she says. Generally, these symptoms take hold within three weeks of transmission, she says. "But after these initial symptoms go away, an HIV-positive person may experience no symptoms for years and years," she says. "And again, not everyone will have symptoms at all."
If HIV progresses to AIDs, you may experience more noticeable symptoms such as rapid weight loss, recurring fever, extreme fatigue, prolonged swelling of the lymph nodes, diarrhea that lasts more than a week, sores on the mouth, anus, or genitals, and red, brown, pink, or purple blotches on or under the skin or inside the mouth, nose, or eyelids, according to the U.S. Department of Health & Human Services. It could also mean experiencing various types of illnesses such as pneumonia, brain infection, and cancer of the lymph nodes, says Dr. Pearlman.
How Do You Know If You Have HIV?
Get tested! "HIV tests are simple and usually performed on blood or oral fluid, though it can also be done on urine," says Dr. Pearlman. Plus, they're accessible. "Most medical clinics and hospitals offer HIV testing," she says. To find an HIV testing center near you, enter your zip code into this HIV testing database.
Another option is to use an at-home HIV test. (Yes, that's a thing!) At-home HIV tests (including these options from Nurx) allow you to collect a small amount of blood at home through a finger prick. Simply ship the collection to the lab and you'll get your results online within a week. Rymland notes that if you do test positively, Nurx has a team of people dedicated to making sure that people get care — both physical and emotional — after HIV diagnosis. (Related: The Complete Guide to At-Home STI Tests)
How Often Should You Get Tested for HIV?
It depends. The CDC recommends that every person between 13 and 64 get tested at least once in their lifetime and that those at higher risk — which the organization defines as intravenous drug users, sex workers, and gay, bisexual, and other men who report male-to-male sexual contact — should be tested more often.
However, because viruses do not discriminate based on gender, sexuality, or profession, most sexual health pros recommend getting tested more frequently than that. "Anybody who is sexually active and isn't 100-percent sure of their partner's current status should be getting tested regularly," says Rymland. (More here: How Often Should You Really Get Tested for STIs?)
Exactly How to Protect Yourself from HIV
The good news is that there are plenty of steps you can take to protect yourself from unwanted HIV transmission.
Most notably, a prescription medication called PrEP which, when ingested orally, greatly reduces the risk of an HIV-negative individual acquiring HIV if they come into contact with it, either via sex or drugs. "PrEP is a safe, incredibly effective medication for preventing HIV that anyone who thinks they may be at risk of HIV should consider," says Rymland. Thankfully, the Affordable Care Act now requires many insurance plans to cover PrEP with no cost to the patient, she adds.
Beyond that, HIV prevention includes all the same things you're familiar with for protecting yourself against other sexually transmitted infections: knowing your own status, talking about STI status with any new partners, and using protection (condoms, internal condoms, dental dams) with individuals who do not know their current status and/or those who are positive. Because HIV can also be spread through dirty needles, avoid sharing needles, syringes, and other injection equipment.