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Human Immunodeficiency Virus (HIV)
Human Immunodeficiency Virus, better known as HIV, is a viral infection transmitted from person to person through sexual contact, blood exposure, childbirth, or breastfeeding. If left untreated, HIV can eventually lead to AIDS (acquired immunodeficiency syndrome).
HIV is a retrovirus, meaning it infects human CD4 T cells and uses them to replicate additional viral copies. The viral DNA produced during infection can also remain latent in long-lived cells, allowing HIV to persist for life.
While there is currently no cure for HIV, treatment options are available that suppress the virus’s ability to replicate, enabling people living with HIV to lead healthy lives.
HIV medication, if taken as prescribed, can make your viral load so low that lab tests are unable to detect it. This is called an “Undetectable Viral Load”.
Undetectable = Untransmittable; also referred to as "U = U", is a revolutionary medical concept that was launched in 2016 by the Prevention Access Campaign. In simplest terms it means:
Someone living with HIV who is taking their medication as prescribed and maintains an Undetectable Viral Load, is unable to transmit HIV to others. Hence the term, "Undetectable = Untransmittable".
Getting into care and taking the medication as prescribed is the only way to achieve and maintain Undetectable status.
Click Here to find out more about HIV viral supression from the U.S. Department of Health and Human Services.
It is important to note that HIV medications, better known as Antiretroviral Therapy or 'ART', do not cure HIV. The medications supress the virus' ability to replicate, but it is not completely eliminated. That is why strict adherence to medication as prescribed is important to keep the viral load supressed and immune cells at optimal levels.
HIV treatment options are ever evolving as new research studies are conducted, and medications are created.
Currently avalible options exist as:
- Oral Medications
- Injectable Medications
FAQs
You can have a normal life with some adjustments. Compared to someone without any chronic medical conditions, you’ll have more medical visits and will take more medications. However, treatment for HIV infection has become much easier than it was in the past.
Many patients now take one or two pills once a day, or an injection every other month, and see their medical provider two to four times per year. They’re busy with work or school, are able to travel, to stay physically active, and to maintain relationships.
The biggest adjustments are often the ones that have to do with your relationships with others. Friends and family members may have to be educated on the topic. Sexual relationships present a special challenges, and entering into new relationship involves the complex issues of disclosure and the fear of rejection or loss of confidentiality.
It may be hard to believe now, but in time HIV infection may be low on your list of daily concerns, having little impact on the life you lead and the decisions you make. Getting to that point takes time, support, and sometimes counselling. You may not be there yet, but stick with it.
Simply put, AIDS just refers to a more advanced stage of HIV infection. Everyone who has AIDS has HIV, but not everyone with HIV has AIDS.
AIDS stands for acquired immunodeficiency syndrome. The term AIDS was coined in 1982. HIV hadn’t been discovered yet, so there was no way to know whether people were sick until they were truly sick. Someone was said to have AIDS if they developed one of a long list of opportunistic infections and cancers that don’t occur in people with otherwise healthy immune systems.
After HIV was discovered and a test became available, being HIV-positive was added to the definition of AIDS. In 1993, the Centers for Disease Control and Prevention (CDC) expanded the definition of AIDS to include people with CD4 counts of less than 200.
Telling people about HIV status is a big step, especially when you’ve just found out, you’re positive. Some people should be told right away; with others, you have time to think it over.
It’s important to tell people you might have infected or who might have infected you—sex partners or people you’ve shared needles with. They need to find out so they can get tested. Your provider, counsellor, or case manager may also be able to help you inform partners. If those don’t seem like good options, health departments can notify your contacts and advise them to get tested without revealing your name.
Think about telling friends or family members you rely on for emotional support. It’s critical to have a support system when dealing with HIV infection. Think about the important people in your life. Will they be there for you? Will they respect your confidentiality? If so, think about telling them. Family members don’t need to know just because they’re family members. You pose no risk to them, and you may outlive them anyway. You should tell them if they’ll become part of your support network.
If you’re not comfortable telling friends or family members, then you need to look elsewhere. Ask about support groups, counsellors, peer advocates, or therapists in your community. Internet chat groups, while not the best source of reliable medical information, can be helpful places to share your experiences with others HIV-positive people in an anonymous setting.
You should also inform your health care providers including doctors, dentists, counselors, and therapists. They need to know your HIV status to be able to take care of your properly. If you have a provider, you don’t feel you can tell, then it may be time to change providers.
You don’t have to tell to your boss, your co-workers, your plumber, or the guy sitting next to you on the bus.
HIV causes illness mainly by damaging the immune system. It can infect many human cells, but the most important target is the CD4 lymphocyte (also known as the CD4 cell, T-helper cell, or helper cell). The CD4 cell is a type of white blood cell (WBC) that is responsible for controlling or preventing infection with many common viruses, bacteria, fungi, and parasites, as well as some cancers. HIV infection leads to destruction of CD4 cells. Over time, the number of CD4 cells (the CD4 count) declines. Although it may take years, the CD4 count eventually becomes so low that there aren’t enough cells to fight infection, which allows symptoms or complications to occur. The speed at which the CD4 count falls varies from person to person and depends on a number of factors, including genetic characteristics, characteristics of the viral strain, and the amount of virus in the blood (viral load).
The reason for the loss of CD4 cells still isn’t completely understood. It’s not simply a matter of HIV infecting and directly killing the cells, because the proportion of cells that are infected is small. Scientists now believe that HIV infection may cause a chronic immune activation (stimulation of the immune system) that leads to a gradual reduction in the number of CD4 cells.
In addition to damaging the immune system, HIV can directly affect many of the body’s organs, such as the nervous system and the kidneys. It can also cause weight loss, night sweats, and diarrhea. When deaths due to AIDS were common, it was often said that people didn’t die of HIV itself, but one of its complications, such as a cancer or infection. While that may have been technically true in most cases, HIV infection was still the underlying problem that led to death from AIDS.
When people get HIV and don’t receive treatment, they will typically progress through three stages of disease.
Stage 1: Acute HIV infection
Within 2 to 4 weeks after infection with HIV, people may experience a flu-like illness, which may last for a few weeks. This is the body’s natural response to infection. When people have acute HIV infection, they have a large amount of virus in their blood and are very contagious. But people with acute infection are often unaware that they’re infected because they may not feel sick right away or at all. To know whether someone has acute infection, either a fourth-generation antibody/antigen test or a nucleic acid (NAT) test is necessary. If you think you have been exposed to HIV through sex or drug use and you have flu-like symptoms, seek medical care and ask for a test to diagnose acute infection.
Stage 2: Clinical latency (HIV inactivity or dormancy)
This period is sometimes called asymptomatic HIV infection or chronic HIV infection. During this phase, HIV is still active but reproduces at very low levels. People may not have any symptoms or get sick during this time. For people who aren’t taking medicine to treat HIV, this period can last a decade or longer, but some may progress through this phase faster. People who are taking medicine to treat HIV (ART) the right way, every day may be in this stage for several decades. It’s important to remember that people can still transmit HIV to others during this phase, although people who are on ART and stay virally suppressed (having a very low level of virus in their blood) are much less likely to transmit HIV than those who are not virally suppressed. At the end of this phase, a person’s viral load starts to go up and the CD4 cell count begins to go down. As this happens, the person may begin to have symptoms as the virus levels increase in the body, and the person moves into Stage 3.
Stage 3: acquired immunodeficiency syndrome (AIDS)
AIDS is the most severe phase of HIV infection. People with AIDS have such badly damaged immune systems that they get an increasing number of severe illnesses, called opportunistic illnesses.
Common symptoms of AIDS include chills, fever, sweats, swollen lymph glands, weakness, and weight loss. People are diagnosed with AIDS when their CD4 cell count drops below 200 cells/mm or if they develop certain opportunistic illnesses. People with AIDS can have a high viral load and be very infectious.
*Information is from the CDC Website www.cdc.gov
Treatment as Prevention (TasP) is when an individual that has HIV takes medication as prescribed and achieves an undetectable viral load. Once an individual is undetectable, they cannot transmit the virus even in a condomless act of sex.
*People with HIV should take medicine to treat HIV as soon as possible. HIV medicine is called antiretroviral therapy, or ART. If taken as prescribed, HIV medicine reduces the amount of HIV in the body (viral load) to a very low level, which keeps the immune system working and prevents illness. This is called viral suppression—defined as having less than 200 copies of HIV per milliliter of blood. HIV medicine can even make the viral load so low that a test can’t detect it. This is called an undetectable viral load.
Getting and keeping an undetectable viral load* is the best thing people with HIV can do to stay healthy. Another benefit of reducing the amount of virus in the body is that it helps prevent transmission to others through sex or syringe sharing, and from mother to child during pregnancy, birth, and breastfeeding. This is sometimes referred to as treatment as prevention. There is strong evidence about treatment as prevention for some of the ways HIV can be transmitted, but more research is needed for other ways.
The “Treatment as Prevention (TasP)” commonly used in CDC information and in the medical community. Treatment as Prevention (TasP) is also known as Undetectable Equals Untransmittable. See our section on Undetectable Equals Untransmittable for additional information.
If you have any questions, we’re always here to help. Please ask your provider for additional information and what this means to your individual care plan.
*Information is from the CDC Website www.cdc.gov