HIV/AIDS

What Is HIV?

To understand what HIV is, let’s break it down:
H – Human – This particular virus can only infect human beings.
I – Immunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A "deficient" immune system can't protect you.
V – Virus – A virus can only reproduce itself by taking over a cell in the body of its host.
Human Immunodeficiency Virus is a lot like other viruses, including those that cause the "flu" or the common cold. But there is an important difference – over time, your immune system can clear most viruses out of your body. That isn't the case with HIV – the human immune system can't seem to get rid of it. Scientists are still trying to figure out why.
We know that HIV can hide for long periods of time in the cells of your body and that it attacks a key part of your immune system – your T-cells or CD4 cells. Your body has to have these cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself, and then destroys them.
Over time, HIV can destroy so many of your CD4 cells that your body can't fight infections and diseases anymore. When that happens, HIV infection can lead to AIDS.

What Is AIDS?

To understand what AIDS is, let’s break it down:
A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.
I – Immuno – Your body's immune system includes all the organs and cells that work to fight off infection or disease.
D – Deficiency – You get AIDS when your immune system is "deficient," or isn't working the way it should.
S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.
Acquired Immunodeficiency Syndrome is the final stage of HIV infection. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (OIs).
You will be diagnosed with AIDS if you have one or more specific OIs, certain cancers, or a very low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to prevent death.

Where Did HIV Come From?

Scientists believe HIV came from a particular kind of chimpanzee in Western Africa. Humans probably came in contact with HIV when they hunted and ate infected animals. Recent studies indicate that HIV may have jumped from monkeys to humans as far back as the late 1800s.

How Do You Get HIV?

HIV is found in specific human body fluids. If any of those fluids enter your body, you can become infected with HIV.

Which Body Fluids Contain HIV?

HIV lives and reproduces in blood and other body fluids. We know that the following fluids can contain high levels of HIV:

• Blood
• Semen (cum)
• Pre-seminal fluid (pre-cum)
• Breast milk
• Vaginal fluids
• Rectal (anal) mucous

Other body fluids and waste products-like feces, nasal fluid, saliva, sweat, tears, urine, or vomit-don’t contain enough HIV to infect you, unless they have blood mixed in them and you have significant and direct contact with them.
For more information, see CDC’s HIV Transmission: Which Body Fluids Transmit HIV?
Healthcare workers may be exposed to some other body fluids with high concentrations of HIV, including:

• Amniotic fluid
• Cerebrospinal fluid
• Synovial fluid

How Is HIV Transmitted Through Body Fluids?

HIV is transmitted through body fluids in very specific ways:

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• During sexual contact: When you have anal, oral, or vaginal sex with a partner, you will usually have contact with your partner’s body fluids. If your partner has HIV, those body fluids can deliver the virus into your bloodstream through microscopic breaks or rips in the delicate linings of your vagina, vulva, penis, rectum, or mouth. Rips in these areas are very common and mostly unnoticeable. HIV can also enter through open sores, like those caused by herpes or syphilis, if infected body fluids get in them.
  You need to know that it’s much easier to get HIV (or to give it to someone else), if you have a sexually transmitted disease (STD). For more information, see CDC's The Role Of STD Detection And Treatment In HIV Prevention.
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• During pregnancy, childbirth, or breastfeeding: Babies have constant contact with their mother’s body fluids-including amniotic fluid and blood-throughout pregnancy and childbirth. After birth, infants can get HIV from drinking infected breast milk.
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• As a result of injection drug use: Injecting drugs puts you in contact with blood-your own and others, if you share needles and “works”. Needles or drugs that are contaminated with HIV-infected blood can deliver the virus directly into your body.
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• As a result of occupational exposure: Healthcare workers have the greatest risk for this type of HIV transmission. If you work in a healthcare setting, you can come into contact with infected blood or other fluids through needle sticks or cuts. A few healthcare workers have been infected when body fluids splashed into their eyes, mouth, or into an open sore or cut.
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• As a result of a blood transfusion with infected blood or an organ transplant from an infected donor: Screening requirements make both of these forms of HIV transmission very rare in the United States.
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How Do You Get AIDS?

You can develop AIDS when HIV damages your immune system so badly that it can no longer protect you from infections and disease.

Prevention

Every year, another 56,000 Americans become infected with HIV—but it doesn’t have to be that way! It’s easy to protect yourself and others from HIV if you know the facts.
Your risk for getting HIV—or transmitting it to others—is extremely low if:

• You aren’t having sex of any kind (anal, oral, or vaginal)
• You aren’t injecting drugs
• You aren’t pregnant
• You aren’t likely to have contact with infected body fluids in your workplace

But if you are having sex, injecting drugs, pregnant, or might be exposed to HIV at work, here’s what you need to know...

Safer Sex

Most people who get HIV get it by having unprotected sex (anal, oral, or vaginal) with a partner who is HIV-positive. “Unprotected” means without a condom or other barrier to protect you from infected body fluids.

Prevention Before and During Sex

Here’s what you can do to protect yourself and others if you are sexually active:

• Know your own HIV status and your partner’s too
• Use condoms, correctly and consistently
• Limit your number of sexual partners

Knowledge Is Power
Have you been tested for HIV and other sexually transmitted infections (STIs)? Has your partner? Knowing your health status, and that of your sex partner(s), is the best way to protect each of you from STIs, including HIV.
Condoms Keep You Safer
Condoms offer excellent protection against HIV if you use them correctly. Both male condoms and female condoms are effective in preventing HIV infection.

Male Condom

Female Condom

A word of warning: Condoms are highly effective in preventing most STIs, including HIV—but they will not protect you against all of them. You can get—or give—some STIs, like herpes or genital warts, even if you or your partner are wearing a condom. But condoms still significantly reduce your risk, even for those STIs.

You are always safer using a condom!

Fewer Partners Means Less Risk
The more sexual partners you have, the greater your risk of getting HIV, or passing it to someone else.
If you are sexually active, mutual monogamy is the safest way to go. That means: 1) You are in a sexual relationship with only one person, and 2) Both of you are having sex only with each other. In addition, both of you need to be tested for HIV and other STIs before you have sex without a condom.

Prevention After Sex

Protecting yourself and your partner before sex is best, but we don’t live in a perfect world. Sometimes you may not have the option to protect yourself during sex—if, for example, you have been sexually assaulted (raped).
Or you might be regretting your choice to have sex without a condom—or the condom broke or came off during sex.
If you believe you may have been exposed to HIV through unprotected sex, you can take medications that will lower your risk of getting HIV. The treatment is called PEP (post-exposure prophylaxis).
But for PEP to work, you need to get medical care ASAP. The meds are most effective if you start them within 36 hours of possible exposure. You can get PEP at hospital emergency rooms, urgent care clinics, or your local HIV clinic.

Safer Drug Use

Using illegal drugs greatly increases your risk for getting, or transmitting, HIV.
That’s especially true if you are injecting illegal drugs (like narcotics or steroids) and you share any of your needles or “works” with others. That’s because used needles and works can easily deliver infected blood into your body.
Drugs can also affect your ability to make good choices. If you are high, you are more likely to do things that can lead to HIV infection, such as forgetting to use a condom or having multiple sex partners.
If you are injecting illegal drugs, the best thing you can do to protect yourself from HIV is to quit. There are drug-abuse treatment services and counseling available to help you.
But if you can’t stop injecting drugs, here are some things you can do to reduce your risk of getting HIV or transmitting it to others:

• Never reuse or share anything you use to prepare or inject your drugs.
• Only use syringes obtained from a reliable source (such as pharmacies or needle-exchange programs).
• Use a new, sterile syringe each time to prepare and inject drugs.
• 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") each time you prepare drugs.
• Clean the injection site with a new alcohol swab before you inject.
• Safely dispose of syringes after one use.

For more information, see CDC’s How can injection drug users reduce their risk for HIV infection? and AIDS.gov’s Reduce Your Risk: Substance Abuse.
If you use illegal drugs, your sex partner(s) are also at risk for HIV. You can help to protect others by being tested for HIV and by using condoms consistently and correctly.
A Note About NeedlesYou may use needles/syringes to inject legal prescription drugs, like insulin or allergy medicines—or for body piercing and tattooing. No matter why you use needles/syringes, you should always use a new, sterile syringe every time you prepare and inject drugs—or for each piercing or tattoo. This will help protect you and others from HIV.

Safer Moms & Babies

If you are pregnant, or think you might be, please talk to a doctor or your local health department about getting an HIV test. If you are HIV-positive, there are medications that can dramatically reduce your chance of passing HIV to your baby. The sooner you take those medications, the more likely your baby will be protected.

Safer Work

Very few people have ever gotten HIV because of their work. You are most at risk for job-related HIV infection if you work in healthcare.
Healthcare-Related Risks
You can protect yourself from HIV by: following standard infection-control guidelines in your workplace. These include:

• Using safer techniques with sharp objects, like needles or lancets:
  • Don’t recap sharps after you use them
  • Dispose of used sharps in the correct container
• Wear gloves, eye and face protection, and gowns to protect yourself from contact with blood or other body fluids
• Treat all blood and body fluids as if they are infectious

For more information, see CDC’s Preventing Occupational HIV Transmission to Healthcare Personnel.
Prevention After Work-Related Exposure 
If you believe you have been exposed to HIV at work, you can take medications that will lower your risk of getting HIV. The treatment is called PEP (post-exposure prophylaxis).
But for PEP to work, you need to get medical care ASAP. The meds are most effective if you start them within 36 hours of possible exposure. You can get PEP at hospital emergency rooms, urgent care clinics, or your local HIV clinic.

Testing & Early Treatment

You can help prevent HIV infections by getting an HIV test. That’s because knowing your HIV status can keep you from accidentally passing the virus to someone else.
Early treatment is another important part of prevention. If you test positive for HIV, you can get the medical care that will help keep you healthy. Treatment can make you less infectious to others, and help you to protect your partner(s).

Testing

What Is an HIV Test?

An HIV test looks for signs of HIV in your body. When you get tested for HIV, you will usually give a sample of blood, but there are other kinds of HIV tests that use urine or a swab of fluids from your mouth instead. Some tests take a few days for results, but rapid HIV tests can give results in about 20 minutes.

Where Can I Get an HIV Test?

Many places offer HIV tests. Here are some great ways to find an HIV testing location near you:

• Use the HIV Prevention and Services Locator on the right side of your screen. Just enter your ZIP code and you'll get a map that shows you nearby testing locations.
• Visit HIVtest.org. Enter your ZIP code and you'll get a list of HIV testing sites, including those that offer free HIV tests.
• Call 1-800 CDC-INFO (1-800-232-4636).
• Text your ZIP code to KNOWIT (566948) and you'll receive a message in reply that lists the nearest testing locations.
• Contact your state or local health department.

You can also ask your healthcare provider for an HIV test. Many medical clinics, substance abuse programs, community health centers, and hospitals offer them too.

 

How Does an HIV Test Work?

Most HIV tests look for antibodies to the virus, not HIV itself. Antibodies to HIV appear in your blood, urine, and oral fluid as your immune system begins trying to fight the virus. Your body makes different antibodies to fight different threats—so the test looks specifically for HIV antibodies to see if you are infected with HIV.

Should I Be Tested?

HIV is spread through risky behaviors. If you answer "Yes" to any of the following questions, you should get an HIV test:

• Have you injected drugs or steroids or shared equipment (such as needles, syringes, works) with others?
• Have you had unprotected anal, oral, or vaginal sex with a partner whose HIV status is unknown?
• Have you exchanged sex for drugs or money?
• Have you been diagnosed with, or treated for, hepatitis, tuberculosis (TB), or a sexually transmitted infection (STI)?
• Have you had unprotected sex with someone who could answer "Yes" to any of the above questions?
• Are you pregnant or planning to become pregnant?
• Have you been sexually assaulted?

If you continue to engage in high-risk behaviors, the CDC recommends that you get an HIV test at least once a year, and possibly more often. Talk with your healthcare provider about a testing schedule that is right for you.

Why Should I Be Tested?

Getting tested can give you some important information and can help keep you—and others—safe. For example:

• Knowing your own HIV status can give you peace of mind—and testing is the only way you can know for sure.
• When you and your partner know each other's HIV status, you can make informed decisions about your sexual behaviors and how to stay safe.
• If you are pregnant, or planning to get pregnant, knowing your status can help protect your baby from being infected.
• If you find out you are HIV-positive, you can get into early treatment. This increases your chances of staying healthy.
• If you know you are HIV-positive, you can also take steps to protect your sex or drug-using partners from becoming infected.

When Should I Be Tested?

On average, you may need to wait 1-3 months from the time of possible exposure to get an accurate test result. That's because, if you are infected, it can take your body a while to start making HIV antibodies. This time between when you are exposed to HIV and the time you could test positive for HIV antibodies is called the window period.
If you took an HIV test within the first 3 months after possible exposure, you should consider getting another test 3 months later to confirm your results.
For more information, see CDC's HIV Testing Basics for Consumers.

How Accurate Are My HIV Test Results and What Do They Mean?

HIV tests are over 99% accurate if you take one 3 months after a possible exposure. (Before then, the tests may not pick up the presence of HIV antibodies.)
What Does A "Negative" Result Mean?
If your test comes back negative, it means the test didn't find any evidence of HIV antibodies in your body. But a negative result only means that the test couldn't find HIV. Depending on when you were exposed, it is still possible that you might have HIV. If you are tested earlier than 3 months after exposure, the test may miss any HIV in your body fluids. That's why most healthcare providers encourage you to have a follow-up test 3 months later.
If you engage in risky behaviors between the time you take the test and get your results, or between your first test and a follow-up test, your test result may not be accurate. The test only tells you what your HIV status is when you took it—so if you were exposed to HIV after you took the test, the results may not show your current HIV status.
To get an accurate result, while you are waiting to take your test, or get your results:

• Don't inject drugs—or always use clean equipment and don't share needles or works
• Don't have sex—or always use protection (condom or dental dam) if you do

What Does a "Positive" Result Mean?
If your test comes back positive, it means that it found evidence of HIV antibodies in your blood. If you have a positive HIV test, the testing center will give you another test to make sure the first test result was correct.
Reputable testing centers always do these "confirmatory" tests, because there is a very small chance that the first test was wrong. If the second test has the same outcome, you will be diagnosed as being "HIV-positive."

What Do I Do If I Am Diagnosed as Being HIV-Positive?

If you are diagnosed with HIV, you should do the following things—even if you don't feel sick:

• Find a healthcare provider who has experience treating HIV. The testing center can usually recommend someone.
• Get screened for other STIs and for TB. If you have HIV, these infections can cause serious health problems.
• Maintain a healthy lifestyle. Smoking, drinking too much, or taking illegal drugs can weaken your immune system and allow HIV to increase in your body.
• Practice safer sex. Condoms are very effective in preventing HIV transmission when used correctly and consistently.
• Tell your partner or partners about your HIV status before you have any type of sexual contact with them (anal, oral, or vaginal) and don't share needles or syringes with anyone.

See AIDS.gov's Diagnosed with HIV and Staying Healthy with HIV sections for more information and resources.

If I Test Positive for HIV, Does That Mean I Have AIDS?

No. Being diagnosed with HIV does NOT mean you have AIDS. Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV disease. You get AIDS only after HIV has severely damaged your immune system. This is why it is so important to get treatment as soon as you test positive for HIV—early treatment can keep HIV under control and prevent it from developing into AIDS. For more information, see CDC's Basic Information about HIV and AIDS.

Will Other People Know My HIV Test Results & Status?

Your test results are protected by state and Federal privacy laws.
Whether anyone can know about your test results or your HIV status depends on what kind of test you take. There are two types of HIV tests—confidential tests and anonymous tests.
Most HIV tests are confidential tests. If you take a confidential HIV test, your name and other identifying information will be attached to your test results. The results will go in your medical record and may be shared with your healthcare providers and your insurance company. Otherwise, no one else has access to your HIV test results unless you tell them.
Some places still offer anonymous HIV tests. If you take an anonymous HIV test, nothing connects your test results to you. When you take the test, you will get a special number or code that allows you to get your results.
If you test positive for HIV, the testing site will report the results to your state health department and the CDC. All personally identifying information will be stripped out. Public health officials do not share this information with anyone else, including insurance companies.
Many states have moved away from anonymous tests because confidential tests help public health officials do a better job of keeping track of how many people have HIV and which areas of the country have the highest rates of HIV. This allows them to get resources to the areas that need them most.
For more information, see CDC's Questions about Privacy, Insurance, and Cost.

Should I Share My HIV Status with Others?

Partners
If you test positive for HIV, your sex or drug-using partners may also be infected. It's important that they know they have been exposed so that they can be tested too.
You can tell them yourself—but if you're nervous about doing that, you can ask your doctor or the local health department to tell them for you. Health departments do not reveal your name to your partners. They will only tell your partners that they have been exposed to HIV and should get tested.
Most states have laws that require you to tell your sexual partners if you are HIV-positive before you have sex (anal, oral, or vaginal). You can be charged with a crime in many places if you don't tell—even if your partner doesn't become infected.
Family/Friends
In most cases, your family and friends will not know your test results or HIV status unless you tell them yourself.
If you are under 18, there may be exceptions to this. All 50 states and the District of Columbia will allow you to get tested and treated for sexually transmitted infections (STI)—but some states allow your healthcare provider to tell your parent(s) if they think doing so is in your best interest. For more information, see the Guttmacher Institute's State Policies in Brief: Minors' Access to STI Services .
Employers
In most cases, your employer will not know your HIV status unless you tell. But your employer does have a right to ask if you have any health conditions that would affect your ability to do your job or pose a serious risk to others. (An example might be a healthcare professional, like a surgeon, who does procedures where there is a risk of blood or other body fluids being exchanged.)
If you have health insurance through your employer, the insurance company cannot legally tell your employer that you have HIV. But it is possible that your employer could find out if the insurance company provides detailed information to your employer about the benefits it pays or the costs of insurance.
All people with HIV are covered under the Americans with Disabilities Act (ADA). This means that your employer cannot discriminate against you because of your HIV status as long as you can do your job. For more information, see AIDS.gov's Civil Rights.

Signs & Symptoms

HIV-Positive without Symptoms

Many people who are HIV-positive do not have symptoms of HIV infection. Often people only begin to feel sick when they progress toward AIDS (Acquired Immunodeficiency Syndrome). Sometimes people living with HIV go through periods of being sick and then feel fine.
While the virus itself can sometimes cause people to feel sick, most of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that attack a damaged immune system. It is important to remember that some symptoms of HIV infection are similar to symptoms of many other common illnesses, such as the flu, or respiratory or gastrointestinal infections.

Early Stages of HIV: Signs and Symptoms

As early as 2-4 weeks after exposure to HIV (but up to 3 months later), people can experience an acute illness, often described as “the worst flu ever.” This is called acute retroviral syndrome (ARS), or primary HIV infection, and it’s the body’s natural response to HIV infection. During primary HIV infection, there are higher levels of virus circulating in the blood, which means that people can more easily transmit the virus to others.
Symptoms can include:

• Fever
• Chills
• Rash
• Night sweats
• Muscle aches
• Sore throat
• Fatigue
• Swollen lymph nodes
• Ulcers in the mouth

It is important to remember, however, that not everyone gets ARS when they become infected with HIV. For more information, see NIH’s Acute HIV Infection.

Chronic Phase or Latency: Signs and Symptoms

After the initial infection and seroconversion, the virus becomes less active in the body, although it is still present. During this period, many people do not have any symptoms of HIV infection. This period is called the “chronic” or “latency” phase. This period can last up to 10 years—sometimes longer.

AIDS: Signs and Symptoms

When HIV infection progresses to AIDS, many people begin to suffer from fatigue, diarrhea, nausea, vomiting, fever, chills, night sweats, and even wasting syndrome at late stages. Many of the signs and symptoms of AIDS come from opportunistic infections which occur in patients with a damaged immune system. For more information, see NIH’s AIDS.

Treatment

What Kind of Treatments Are Available?

Today, people who are infected with HIV are treated with antiretroviral therapy (ART). ART uses different kinds of medications to keep HIV from growing and multiplying in your body. Most people on ART take a combination of several meds prescribed by their doctors to keep their HIV disease under control.

How Does ART Work?

The goal of ART is to lower the amount of HIV in your body, so that your immune system can stay strong and healthy. Some ART drugs keep the virus from reproducing and some block HIV from entering your body's cells. For more information, see NIH’s AIDS Medicines.
ART works best when you and your doctor can find a combination of drugs and a treatment plan that will keep your HIV in check and have the fewest side effects.

Does ART Cure HIV?

No; at this time, there is no cure for HIV/AIDS. When it works, ART keeps HIV from damaging your immune system—but it cannot cure HIV disease.

When Should I Start ART?

Even though you are HIV-positive, you may not need to start treatment right away. When to start anti-HIV (also called antiretroviral) medications depends on:

• your overall health
• how well your immune system is working (CD4 count)
• the amount of virus in your blood (viral load)

You and your doctor will determine the best time to start treatment.
HIV experts agree that you should start ART immediately if:

• You have an AIDS-defining illness
• Your CD4 cell count is below 350
• You are pregnant
• You have HIV-associated nephropathy (a kidney disorder)
• You also need treatment for hepatitis B

Many experts also agree that you should start ART if your CD4 count is below 500.
If your CD4 count is over 500, there is no clear recommendation about starting treatment. Although there is still some debate, some experts believe that you should start ART immediately after you test positive for HIV because new evidence suggests that ART can:

• Help you live longer
• Lower your risk of developing non-HIV-related illnesses (e.g., heart disease, diabetes)
• Reduce the chances that you will transmit HIV to others

Other HIV experts feel that there is not yet enough data showing benefits of starting treatment with a CD4 count >500. They worry that we don’t know enough about the long-term effects of ART and that it might be hard for people to stick with their HIV treatment plan if they have to do it for longer periods of time. They also worry that long-term use of HIV drugs could make the meds less effective over time—or cause them to stop working completely. These experts support waiting until there is more evidence before starting healthy patients on ART. If your CD4 count is >500 you may want to discuss the risks and benefits of starting treatment early with your doctor or health care provider.
Treatment should only be started once the person is ready. A lot of commitment is needed, since following a drug regime can be quite demanding and in most circumstances, the treatment will have to be taken for life. If you and your doctor decide you should begin treatment, your doctor will work with you to choose meds that meet your individual health needs and fit your lifestyle.

Does ART Work for Everyone?

No. Some people respond very well to ART—but ART is not effective for everyone. It depends on many different factors, including your overall level of health and how much damage HIV has already done to your immune system.
There are some things you can do to increase the effectiveness of ART:

• Follow your healthcare provider’s instructions for taking your meds. Taking too few or too many—or taking them at the wrong time—can cause health problems and can make your meds less effective or even make them stop working.
• Take only the ART medications that your healthcare provider prescribes for you. If you take ART meds that are not in your treatment plan, you may have fewer options if one of your meds stops working and you need to switch to a new one.

Can ART Medications Stop Working?

Yes. Sometimes, when HIV has been exposed to a medication for a long time, the virus will learn how to get around it. If that happens, your healthcare provider will change your medication to a new one that the virus doesn’t recognize.
Taking your meds according to schedule—and taking only those drugs prescribed for you by your doctor—can increase the effectiveness of ART and give you more options to choose from if one of your meds stops working.

What Else Can I Do to Take Care of Myself?

Treatment for HIV/AIDS is more than just taking pills every day—it’s about taking care of yourself. While medications are very important for treating HIV, there are other things that will help keep your immune system healthy:

• A well-balanced and nutritious diet
• Daily exercise
• Plenty of rest
• Regular check-ups with your doctor and dentist
• Avoiding use of tobacco, alcohol or illicit drugs

Each of these things helps to boost your immune system and keep it strong. Taking care of yourself will also help prevent other chronic diseases, such as heart disease, diabetes, or high blood pressure.