What Is HIV?

HIV, or human immunodeficiency virus, weakens the body’s immune system by damaging and destroying the crucial cells that guard against diseases and fight off infections. If uncontrolled, HIV will most often progress to AIDS, which is fatal without treatment.

Once a veritable death sentence, today HIV and AIDS, while not exactly curable, can often be successfully treated and made into chronic conditions that don’t lessen a person’s lifespan. Medications can even make it so that an HIV-positive person can completely eliminate their risk of transmitting the virus.

Learn more about HIV and AIDS, including what the virus and disease do to the body, how prevalent the virus is and how advances in medical science have completely changed the picture of HIV and AIDS.

In This Section

• HIV Symptoms
• HIV Transmission
• HIV Prevalence
• At-Risk Groups
• HIV Complications
• HIV & Pregnancy
• HIV Testing
• HIV Treatment
• HIV Prevention

HIV/AIDS Symptoms

Many people who contract HIV are unaware they have become infected because they often do not feel sick or mistake the brief illness that they’re experiencing for something else. For many people, within a couple of weeks of infection, they begin to notice flu-like symptoms that can last for a few weeks. During this period, newly infected people are highly contagious, as the amount of virus in their bloodstream is quite high. But this is just the first stage of an HIV infection.

In the second stage, infected individuals will likely have no symptoms at all. This stage is often referred to as chronic HIV infection, and without treatment, infected people can remain in this second, dormant stage for a decade or more. Many people who take medication to suppress their viral load can remain in this phase for the remainder of their lives.

In HIV’s third phase, the virus depletes the body’s supply of CD4 cells, often called T-cells, and the immune system is so badly damaged that the infected person is diagnosed with AIDS, acquired immune deficiency syndrome. AIDS patients are susceptible to many other infections, called opportunistic illnesses, and symptoms of AIDS include chills, fever, swollen glands, weight loss and weakness.

HIV/AIDS Transmission

HIV cannot be transmitted through casual contact, like holding hands, sharing food or drinks or even kissing. The virus is carried in bodily fluids, including blood, semen, vaginal fluids and breast milk, and for the virus to be transmitted, those fluids must be introduced to the bloodstream or come into contact with certain areas of the body like the mouth, penis, vagina or rectum.

It’s also possible to spread HIV from mother to child during pregnancy or birth or while breastfeeding, though pregnant women with HIV who are on medication regimens can essentially eliminate this risk.

People who work in healthcare settings also could be at risk of exposure through a stick from a contaminated needle or other sharp object, and it’s possible, though less common, for HIV to be transmitted during oral sex.

HIV/AIDS Prevalence

The number and rate of new HIV infections has consistently fallen in the U.S. over the past decade. According to CDC data, HIV infections in 2018 occurred at a rate of 13.6 per 100,000 in 2018, which represents a decline of more than 25% since 2008.

Gonorrhea is among the most common sexually transmitted infections that are tracked nationally by federal health officials, impacting hundreds of thousands of Americans per year. While chlamydia, a disease that often has similar symptoms to gonorrhea, is more common, the clap has seen the number of cases and the population-adjusted rate rise dramatically in recent decades.

In 2018, the Centers for Disease Control and Prevention estimate that nearly 600,000 gonorrhea infections took place in the U.S., compared to 115,000 syphilis cases and 1.8 million cases of chlamydia.

Cases of gonorrhea in the U.S. have climbed every year since 2013, though numbers are down from the historic high recorded in 1978. Since 1994, the population-adjusted gonorrhea rate is up by only about 10%, but it’s climbed more than 80% over just the past 10 years.

New HIV infections and rate per 100,000 by year

Outside of the District of Columbia, which has the highest population-adjusted rate of new HIV infections in the U.S., Georgia has the highest rate among the states at 24.3 new infections per 100,000 people. On the other end of the spectrum, HIV infections are least common in Wyoming, Maine and Idaho.

New HIV infections per 100,000 people by state

At-Risk Groups

Anybody who is sexually active could potentially be at risk of exposure to HIV, but the virus is more common among a few groups, particularly those who engage in anal sex as well as injection drug users.

Still, sex is the primary risk behavior associated with HIV. Male-to-male sexual contact accounted for about two-thirds of all new infections in 2018, while heterosexual contact accounted for another nearly 25%.

Overall, those between the ages of 25 and 34 have the highest rates of HIV, accounting for more than 1 in 3 new infections in 2018. Across all age groups, men consistently have higher HIV rates than women, with the overall gap between men and women standing at about 40%.

HIV infections by age at diagnosis and sex per 100,000 people

African-Americans have the highest rate of new HIV infections among all ethnic groups, with Hispanics and those who are multiracial in a distant second and third place. Asians and whites have the lowest rates of HIV infections.

New HIV infections per 100,000 people by race or ethnicity

HIV/AIDS Complications

For individuals with untreated HIV or AIDS, the health consequences can be dire. In most cases, untreated AIDS will lead to death. HIV-positive people need to closely monitor their viral load and CD4 cell count to ensure they don’t begin developing the opportunistic infections common in AIDS patients. Several of these infections are common in those with AIDS:

• Candidiasis of bronchi, trachea, esophagus or lungs
• Invasive cervical cancer
• Coccidioidomycosis
• Cryptococcosis
• Cytomegalovirus diseases
• Encephalopathy
• Herpes simplex virus
• Histoplasmosis
• Kaposi’s sarcoma
• Lymphoma,
• Tuberculosis
• Mycobacterium avium complex
• Pneumocystis carinii pneumonia
• Progressive multifocal leukoencephalopathy
• Salmonella septicemia
• Toxoplasmosis of brain
• Wasting syndrome

In addition to opportunistic infections that become a major concern with AIDS, HIV also can raise a person’s risk of contracting other STDs, such as gonorrhea, chlamydia and syphilis, and HIV-positive individuals face enormous societal stigma and have unique mental health challenges.

Discrimination against those with a positive HIV diagnosis or who have AIDS remains rampant, both in the U.S. and around the world despite decades of research and expanding awareness about the virus and how it is transmitted. HIV-positive people have a homelessness rate that’s about three times higher than the overall population.

HIV/AIDS & Pregnancy

Pregnant women who are HIV-positive can take medicines that prevent transmission of the virus to their babies as well as protecting the woman’s health. Even without treatment, the risk of passing HIV to a baby during pregnancy is about 25%; treatment lowers that to less than 1%. The number of mother-to-baby HIV infections has declined by more than 95% since the early 1990s.

All women who are pregnant or considering pregnancy should be screened for several diseases and STDs, including HIV. The sooner a diagnosis is made, the more precautions can be taken to reduce the risk of transmission to the baby.

HIV/AIDS Testing

There is no way to diagnose HIV on sight, and the only way to know your status is to get tested. Everyone between the ages of 13 and 64 should get at least one screening for HIV in their lifetimes, but an estimated 1 in 7 Americans with HIV are unaware they have the virus.

In addition to getting tested after a known exposure to HIV, the federal government recommends several groups get tested, whether once or regularly:

• Everyone: Almost all people, those between 13 and 64, should be screened at least once in their lives for HIV.
• Pregnant women: All should be screened for HIV early in their pregnancies. For many women, one test will suffice, but those in high-risk groups may need repeated screenings.
• Injection drug users and those who engage in unsafe sex: Everyone who falls into this group should be tested for HIV at least annually, and perhaps more frequently depending on other risk factors.
• Gay and bisexual men: Men who have sex with men should have an HIV test at least annually, and those who have multiple partners may benefit from testing every three to six months.

Testing for HIV is readily available at thousands of locations, and many sites offer this testing free of charge. Many places also have rapid HIV testing that can provide results in just a few minutes, though this varies depending on the testing provider.

The resources available near you will vary, but here are some of the most commonly available sources of HIV screenings:

• Doctor’s office
• Planned Parenthood
• Pharmacy clinic
• Urgent care center
• Community health clinics
• Campus health clinic
• At-home test kits

HIV/AIDS Treatment

It is not technically possible to completely cure someone of HIV or AIDS. However, medication has made it possible for HIV-positive people to reduce their viral load to an undetectable level. If a patient reaches this state, it’s no longer possible for them to transmit the virus to others, though their bodies still are infected.

Treatment for HIV consists of medications called antiretrovirals that reduce the amount of the virus present in the body, reducing the ability of the virus to attack the immune system. It’s usually a combination of three or more drugs, though some people are able to take just one pill that combines the necessary medications. Common brand names of these drugs include Ziagen, Emtriva, Epivir and Retrovir.

An estimated 75% of HIV-positive people in states where data is available are undergoing medical treatment for HIV, ranging from 90% in Montana to 58% in South Dakota.

Percentage of HIV-positive individuals receiving treatment for HIV

For individuals who have developed AIDS, doctors will first focus on treating any opportunistic infections that may have developed, often through antibiotics and antifungal drugs. People with AIDS still should take antiretroviral drugs to lower their viral load and strengthen their immune systems.

HIV/AIDS Prevention

No vaccination for HIV exists, but in addition to smart sexual and other health practices, medications called PrEP, pre-exposure prophylaxis, can reduce the risk of contracting HIV through sex.

These medications, when taken every day, can reduce the risk of getting HIV through sex by up to 99% for people who are HIV-negative, and for people who use injection drugs, daily PrEP can lower their HIV risk by more than 70%. There currently are two federally approved PrEP medications, Truvada and Descovy.

It also may be possible to reduce the risk of contracting HIV by taking antiretrovirals after being exposed. These PEP, post-exposure prophylaxis, drugs are only approved for emergency use within 72 hours of a possible HIV exposure in a person who is HIV-negative.

With PrEP, PEP and antiretrovirals, the risk of passing along HIV has declined considerably, and thousands of people who are HIV-positive have successfully repressed their viral loads. In the states where data is available, an average of about 63% of HIV-positive individuals have achieved viral suppression.

Conclusion

A few decades ago, a diagnosis of HIV was little more than a death sentence. But as infection rates have fallen and medications have made it possible for HIV-positive people to live for decades without developing AIDS, that’s all changing. In future years, it may be possible for HIV to go into remission, and science is advancing seemingly by the day. Still, for people who contract HIV today, getting tested so you can begin treatment is crucial.

Additional References

• Centers for Disease Control and Prevention, HIV Basics. (2019.) Retrieved from https://www.cdc.gov/hiv/basics/index.html
• Centers for Disease Control and Prevention, 2015 STD Treatment Guidelines, Screening Recommendations and Considerations Referenced in Treatment Guidelines and Original Sources. (2015.) Retrieved from https://www.cdc.gov/std/tg2015/screening-recommendations.htm
• Centers for Disease Control and Prevention, AtlasPlus, HIV, custom tables. Accessed here https://www.cdc.gov/nchhstp/atlas/index.htm
• Doorways Housing.org, Homelessness and HIV. (Undated.) Retrieved from https://www.doorwayshousing.org/about-housing-hiv/homelessness-and-hiv/
• U.S. Department of Health and Human Services, HIV Treatment, FDA-Approved HIV Medicines. (2019.) Retrieved from https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/21/58/fda-approved-hiv-medicines

by AtHomeSTDKit

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