HIV/AIDS

The human immunodeficiency virus (HIV) is an infection that damages specific cells of the immune system. HIV makes the body less able to clear out infections and diseases. If HIV infection is not treated, over time it can cause an illness called acquired immunodeficiency syndrome (AIDS).

HIV spreads through contact with some body fluids. The virus can spread during sex, when people share needles or syringes, or during pregnancy, delivery or breastfeeding. The only way to know if you have HIV is to get tested.

HIV is treatable and preventable. Medicine can control HIV levels in the blood. This keeps the infection from getting worse, so some people never get AIDS.

The symptoms of HIV and AIDS vary depending on the person and the stage of infection.

The first stage, when a person gets HIV, can feel like the flu. This infection, called the primary infection or acute HIV, happens around 2 to 4 weeks after the virus enters the body.

Common symptoms of acute HIV include:

• Fever.
• Swollen lymph glands, also called nodes, mainly on the neck.
• Sore throat.
• Rash.
• Muscle aches.
• Diarrhea.
• Weight loss.

Other symptoms with new HIV infections include headache, joint pain, dry cough, night sweats and mouth sores.

These symptoms can last for days or weeks. Symptoms may be serious, but some people have mild or no symptoms during this stage. Even if symptoms are mild or you don't have symptoms, HIV spreads easily to others during the acute stage.

After the acute stage, symptoms often go away. HIV stays in the body, and the infection enters the next stage, called the clinical latent infection or chronic HIV. This stage can last for many years.

Over time, an HIV infection weakens the body's ability to clear out germs.

People with symptomatic HIV infection may get other infections, such as:

• Shingles, also called herpes zoster.
• Yeast infection in the mouth, called thrush.
• Lung infections called pneumonia.

Symptomatic HIV infection also can cause symptoms that don't go away, including:

• Fever.
• Fatigue.
• Swollen lymph glands.
• Diarrhea.
• Weight loss.

Without treatment, an HIV infection continues to damage the immune system.

After 7 to 10 years, the infection can progress to AIDS. People with AIDS are more likely to have infections that would be easily controlled by a working immune system. Some cancers are also more common in people who have AIDS.

Symptoms of AIDS include symptoms from earlier stages of HIV infection, such as fever that keeps coming back, swollen lymph glands, ongoing diarrhea and rapid weight loss.

Other symptoms of AIDS include:

• Sweats.
• Chills.
• White spots or lesions on the tongue or mouth that don't go away.
• Fatigue.
• Skin rashes or bumps.

Thanks to treatment for HIV, many people do not develop AIDS.

When to see a doctor

If you might have come into contact with HIV, see a healthcare professional right away. There is medicine that can help stop the virus. This medicine, called post-exposure prophylaxis (PEP), works best if you start taking it within three days after contact with virus.

HIV is caused by a virus that attacks white blood cells called CD4 T cells. This weakens the immune system and allows germs to cause infection and disease. The immune system can't clear HIV from the body. That means HIV must be treated with medicine to prevent damage.

People with untreated HIV can spread it through:

• Sexual contact.
• Sharing needles or syringes.
• Contact with blood.
• During pregnancy, delivery or breastfeeding, from birth parent to child.

Over time, even without symptoms, untreated HIV infection causes CD4 T cell levels to drop. In someone with a typical immune system, there are between 500 and 1,600 CD4 T cells in a blood sample. When the CD4 number falls below 200 cells, HIV infection has progressed to AIDS.

You are more likely to get HIV if you:

• Are sexually active.
• Have contact with infected blood.
• Share needles or syringes.
• Are diagnosed with a sexually transmitted infection.

HIV can spread through sexual activity, including oral sex. Your risk of getting HIV is higher if your partner has HIV or is at high risk of HIV. This risk goes up if you don't regularly use a condom or other barrier during sexual activity.

Your HIV risk is higher if you have been diagnosed with a sexually transmitted infection, especially syphilis. People who have anal sex also have a higher risk.

For males, the risk of HIV is higher if you are not circumcised.

Other factors that raise a person's risk include bleeding during sex or having sex during a menstrual period. Children born to a parent with untreated HIV have a higher risk of HIV during pregnancy, birth or breastfeeding.

Your HIV risk goes up if you share needles or syringes. Getting a tattoo also may raise your risk of HIV exposure. People in certain jobs with regular exposure to blood may be at higher risk of HIV infection. Also, HIV can be transmitted through blood products or transfusion if blood isn't screened. The risk of getting HIV in this way is very low in the United States because donated blood is screened and tested for HIV.

HIV risk factors do not include casual contact.

• You cannot get HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection.
• Sharing dishes does not spread HIV.
• Toilet seats do not spread HIV.
• HIV is not spread through the air, water or insect bites.
• You cannot get HIV by donating blood.

You can't get HIV from someone's sweat, tears or saliva.

HIV infection weakens your immune system. The infection makes you much more likely to get many infections and certain types of cancers.

Infections that are linked with HIV and AIDS include:

• Pneumonia. This includes bacterial pneumonia and Pneumocystis pneumonia (PCP).
• Candidiasis, also called thrush. Candidiasis is an infection caused by fungus. It causes a thick, white coating on the mouth, tongue, esophagus or vagina.
• Tuberculosis (TB). This is a bacterial infection that mainly affects the lungs. People with HIV have a higher risk of catching this serious illness.
• Cytomegalovirus (CMV). This illness, caused by the cytomegalovirus, spreads through body fluids and stays in the body for life after infection. If the immune system weakens, the virus becomes active, causing damage to the eyes, digestive system, lungs or other organs.
• Cryptococcal meningitis. Meningitis is inflammation of the membranes and fluid around the brain and spinal cord. This form of meningitis, caused by a fungus, is a central nervous system infection linked to HIV.
• Toxoplasmosis. This infection is caused by the parasite Toxoplasma gondii. It may be a new infection or one from earlier in life that becomes active again. Toxoplasmosis can cause severe lung or brain disease in people with a weakened immune system. Rarely it may show up in other tissues throughout the body.

Cancers linked to HIV and AIDS include:

• Lymphoma. This type of cancer affects the system of immune organs, glands, vessels and lymph nodes. Symptoms may include swollen lymph nodes in the neck, armpit and groin.
• Kaposi sarcoma. This is a tumor of the blood vessel walls. Kaposi sarcoma may appear pink, red, purple, brown or black, depending on your skin color. Kaposi sarcoma also can affect the internal organs.
• Cancers related to human papillomavirus (HPV). There are many strains of HPV. Some are linked to cancer of the vulva, vagina, cervix, anus, penis and throat.

Other complications can include:

• Wasting syndrome. Untreated HIV/AIDS can cause a great deal of weight loss. Diarrhea and fever often happen with the weight loss.
• Brain and nervous system complications. HIV can cause brain and nervous system symptoms such as confusion, forgetfulness and difficulty walking. HIV-associated neurological conditions can range from mild symptoms such as behavior changes and reduced mental functioning to severe dementia causing weakness and not being able to function.
• Kidney disease. HIV-associated nephropathy (HIVAN) is inflammation of the tiny filters in the kidneys. These filters remove excess fluid and waste from the blood and pass them to the urine.
• Liver disease. Liver disease also is a major complication, mainly in people who also have hepatitis B or hepatitis C.

To prevent HIV, take actions that lower your risk of getting HIV, such as:

• Get tested and treated for any sexually transmitted infections. These types of infections make it easier to get or spread HIV.
• Ask sexual partners if they have HIV, and tell your partners if you have HIV.
• Use condoms correctly, every time.
• Do not share needles or syringes. Use new, sterile equipment each time.
• If you are pregnant, get medical care that includes an HIV test right away.

Some people may consider having the foreskin of the penis removed, called circumcision. People who have a foreskin seem to get HIV through sexual contact at a higher rate than people who've been circumcised.

Also consider pre-exposure prophylaxis (PrEP). Medicines can be used for what's called pre-exposure prophylaxis, often shortened to PrEP. These medicines help prevent HIV infection when taken as directed among people at high risk.

Some PrEP medicines can be swallowed. Other medicines are given as a shot.

Options may include:

• Tenofovir disoproxil fumarate and emtricitabine (Truvada). This medicine is a tablet swallowed once a day.
• Tenofovir alafenamide fumarate and emtricitabine (Descovy). This medicine is a tablet swallowed once a day. It is approved for use by males and transgender women. It is not approved for people who have receptive vaginal sex.
• Cabotegravir (Apretude). This medicine is given as an injection every two months.
• Lenacapavir (Yeztugo). The first dose of this medicine is given as both a tablet and injection. After that, the medicine is given by injection only every six months.

Before you start PrEP, your healthcare professional will do an HIV test. This test is repeated every three months. You need to take PrEP pills every day or closely follow the shot schedule. Also, PrEP protects only against HIV. Use safe sex practices and get tested for sexually transmitted infections as recommended.

If you have HIV, taking antiretroviral therapy (ART) as directed can lower the amount of virus in your blood to where it is not detectable by tests. At this level, people are highly unlikely to spread HIV through sex. You may see this referred to as Undetectable = Untransmittable, shortened to U=U.

If you think you've been exposed to HIV, wash the area with soap and water. If there is eye exposure, rinse with water or use an eye wash station for 15 minutes. Then contact your healthcare professional or workplace health resource or go to an emergency room.

After contact or possible contact with HIV, medicines to block HIV are started within the first 72 hours. This is called post-exposure prophylaxis, also known as PEP. These medicines are very effective in lowering your risk of getting HIV. You need to take the medicine for 28 days.

The human immunodeficiency virus (HIV) can be found in the body with blood tests or tests on fluid from your mouth. Blood may be collected from a vein or from a finger stick. Testing can be done in a clinic or healthcare professional's office. You also may be able to order an at-home test for HIV.

Screening at least once for HIV is recommended for all people age 13 to 65. Getting tested for HIV more often may be recommended if you have risk factors.

One HIV test looks for genetic material from the virus in the blood. This test measures the amount of virus present, called the viral load. The test will identify an infection around 10 to 33 days after exposure.

Other tests look for a part of the virus called an antigen or for the immune system's response to HIV infection, called an antibody. A test that looks for both antigens and antibodies can identify HIV infection around 18 to 90 days after exposure. A test that looks only for antibodies will identify infection around 23 to 120 days after exposure.

If done too early, these tests may not catch an infection. So a test with a negative result may need to be repeated. If there is a detectable amount of genetic material from HIV in the blood but the antibody or antigen tests are negative, this result suggests an early HIV infection. The test may be repeated to rule out a false positive result.

If your results are positive and you live in the United States, a state health department staff member may contact you.

People diagnosed with HIV may be able to work with a specialist. HIV specialists help you decide on baseline tests and follow-up testing. The specialist also can help guide your treatment, including selecting HIV antiretroviral therapy (ART). In general, the specialist helps you manage your health.

Testing may include:

• CD4 T cell counts. This helps determine the stage of an HIV infection. AIDS is diagnosed if CD4 counts fall below 200 cells in the blood sample.
• Viral load measurements. This also is called HIV RNA. The goal of treatment is to lower viral load to a level that can't be detected.
• Medicine resistance. Some HIV strains are not affected by medicines any longer. Testing to see what strain of HIV is present helps identify the best treatment.

You also may get tests and screening for other infections or complications. These may include:

• Tuberculosis.
• Hepatitis B or hepatitis C virus infection.
• Sexually transmitted infections.
• Liver or kidney damage.
• Cervical and anal cancer.
• Cytomegalovirus.
• Toxoplasmosis.

Once you have an HIV infection, your body can't get rid of it. Medicines are used to control HIV and to prevent complications. Medicine to treat HIV is called antiretroviral therapy (ART). It is a mix of two or more medicines that work together to lower the amount of HIV in the blood. This also helps prevent HIV from becoming resistant to the medicine.

Treatment should lower your viral load so that it can't be found in the blood. Regular blood tests are used to check viral load and CD4 T cell counts. Even if HIV cannot be found in the blood, that doesn't mean your HIV is gone. HIV is still in your body, but ART prevents it from making viral particles.

There are many ART options that mix more than one type of HIV medicine into a single pill taken once a day. Different types of HIV medicine include:

• Integrase inhibitors. These medicines stop an enzyme called integrase. That keeps HIV from putting viral genetic material into a cell.
• Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). These medicines stop HIV from copying its RNA into DNA. That means that HIV can't make viral copies easily.
• Protease inhibitors. These medicines block an enzyme called protease. That damages HIV's ability to make new virus particles.

ART is a part of treatment for everyone with HIV, no matter your CD4 T cell count or symptoms. For the best results, take ART medicines as prescribed. Don't miss or skip doses.

Talk with your healthcare professional about possible side effects or trouble you may have taking medicines. Treatment side effects depend on the type, also called class, of ART medicine you take.

Possible side effects of some ART medicines can include:

• Nausea, vomiting or diarrhea.
• Heart disease.
• Kidney and liver damage.
• Weakened bones or bone loss.

ART medicines can make cholesterol levels harder to manage. Mental health conditions or substance use issues can make it hard to stay on ART. Talk with a healthcare professional about ways these issues can be managed.

Regular follow-ups let your healthcare team check your response to treatment and respond to any concerns you have about ART. To see how you're responding, viral load of HIV is checked 4 to 6 weeks after starting ART. After that, viral load is checked every three months for at least the first two years of treatment.

Some health issues that are a part of aging may be harder to manage if you have HIV. Some medicines that are common for age-related heart, bone or metabolic conditions, for example, may not mix well with anti-HIV medicines. Talk with your healthcare professional about your other health conditions and the medicines you take for them.

If another health professional prescribes a medicine for another condition, be sure to mention your HIV therapy. Then the health professional can make sure there are no issues with taking the medicines together.

Taking antiretroviral therapy medicine on schedule and working with your healthcare team are vital for HIV management. There also are things you can do every day to support your health.

Get all recommended vaccinations. Common vaccines prevent illnesses such as pneumonia, influenza, COVID-19 and mpox. Other vaccines that may be recommended include HPV, hepatitis A and hepatitis B. Some vaccines that use weakened but infectious viruses may only be safe if your CD4 T cell counts are high enough. Other types of vaccines may be offered regardless of your CD4 count.

Avoid foods that are high risk of foodborne illness. People with HIV can become seriously ill from foodborne illness. Thoroughly cook food to a safe temperature. Avoid eating raw eggs, meat or seafood. Wash all raw vegetables and fruit thoroughly. Don't leave food out for too long. Avoid dairy and juices that haven't been heated to kill bacteria, called pasteurized. Don't drink water that isn't treated to remove germs.

Focus on hand hygiene if you have a pet. Caring for a pet can raise your risk of some infections. Wash hands thoroughly after handling pets or emptying litter boxes.

Nothing replaces the benefit of antiretroviral therapy for HIV treatment. Also important is the need to avoid risky behavior or habits that aren't healthy, such as smoking.

If you're interested in dietary supplements, talk with your healthcare professional before taking any supplements to make sure they won't affect the way your medicines work.

Supplements that are known to interfere with HIV medicines include St. John's wort and garlic.

People living with HIV can find it overwhelming. Negative reactions are common. These feelings may go away over time. HIV infection can be treated, and people with HIV often live long and healthy lives.

But if you or someone you're caring for is considering suicide, get help now. You can call a local emergency number or a suicide hotline.

• In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, every day. Or use the Lifeline Chat. Services are free and confidential.
• If you're a U.S. veteran or service member in crisis, call 988 and then press 1, or text 838255. Or chat online. The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454.

If it's safe to do so, talk about your diagnosis with people who can support you. Ask for help if you need it, and talk with them about how you're feeling. Also, seeing a therapist can help you manage the feelings this diagnosis can cause.

Joining a support group for people with HIV also may help you connect with other people going through the same diagnosis.

If you think you might have an HIV infection, you're likely to start by seeing your family healthcare professional. You may see an infectious disease specialist who focuses on treating HIV/AIDS.

What you can do

Before your appointment, think about the answers to these questions and be prepared to talk about them at your appointment:

• How do you think you were exposed to HIV?
• What are your symptoms?
• Do you have risk factors, such as having sex without protection or shooting illicit drugs?
• What medicines or supplements do you take?

What to expect from your doctor

Your healthcare professional asks you questions about your health and lifestyle and does a physical exam, checking you for:

• Swollen lymph nodes.
• Sores on your skin or in your mouth.
• Issues with your nervous system.
• Unusual sounds in your lungs.
• Swollen organs in your belly.

What you can do in the meantime

If you think you might have an HIV infection, protect yourself and others before your appointment. Don't have sex without using protection. If you shoot illicit drugs, always use a fresh, clean needle. Don't share needles with others.