HIV and AIDS are complex illnesses that generate many questions and concerns. We have answered the following commonly asked questions to help you better understand HIV and AIDS. Additionally, you should always feel comfortable asking further questions and discussing your concerns with your doctor and health care professionals.
What is HIV? HIV stands for the Human Immunodeficiency Virus. This is the virus that causes HIV disease and AIDS. When the virus enters the body it attaches itself to certain white blood cells, called T-lymphocytes or CD4 lymphocytes. CD4 cells are cells in your body that fight infection. HIV infects CD4 cells and uses them to make more copies of HIV. As it does this, it kills off CD4 cells. As these cells die, the body's ability to fight infection is weakened, and you are more likely to become ill.
What is HIV Disease? What is AIDS?
HIV Disease means that you have been infected with HIV. Infection with HIV can weaken the immune system to the point that it has difficulty fighting off certain infections. These types of infections are known as "opportunistic" infections because they take the opportunity a weakened immune system gives to cause illness. If your CD4 count has never been below 200 cells/uL and you have never had an opportunistic infection (OI), we say that you have HIV Disease. However, if your CD4 count has at one time fallen below 200, or you have had an OI, we say that you have AIDS. These definitions were established by the U.S. Centers for Disease Control and Prevention (CDC). Both are stages of HIV infection, but the infection is labeled as AIDS when the immune system has been significantly weakened.
In addition to all HIV-infected people who have fewer than 200 CD4+ T cells, the CDC's definition of AIDS includes 26 clinical conditions that affect people with advanced HIV disease. Most AIDS-defining conditions are opportunistic infections, which rarely cause harm in healthy individuals. In people with AIDS, however, these infections are often severe and sometimes fatal because the immune system is so ravaged by HIV that the body cannot fight off certain bacteria, viruses and other microbes.
How many cases of AIDS are there in the U.S.?
According to the CDC, the organization responsible for tracking the spread of AIDS in the United States, more than 790,000 cases of AIDS have been reported in the United States since 1981, and as many as 900,000 Americans may be infected with HIV. The epidemic is growing most rapidly among minority populations and is a leading killer of African-American males ages 25 to 44. The prevalence of AIDS is seven times higher in African-Americans and three times higher among Hispanics than among whites.
What are the symptoms of HIV?
Many people do not develop any symptoms when they first become infected with HIV. However, some people have a flu-like illness within a month or two after exposure to the virus. They may have fever, headache, malaise and enlarged lymph nodes (organs of the immune system easily felt in the neck and groin). These symptoms usually disappear within a week to a month and are often mistaken for those of another viral infection. People are very infectious during this period, and HIV is present in large quantities in genital secretions.
More persistent or severe symptoms may not surface for a decade or more after HIV first enters the body in adults, or within two years in children born with HIV infection. This period of "asymptomatic" infection is highly variable. Some people may begin to have symptoms as soon as a few months, whereas others may be symptom-free for more than 10 years. However, during the asymptomatic period, HIV is actively multiplying, infecting and killing cells of the immune system. HIV's effect is seen most obviously in a decline in the blood levels of CD4+ T cells. The virus initially disables or destroys these cells without causing symptoms.
As the immune system deteriorates, a variety of complications begin to surface. One of the first symptoms experienced by many people infected with HIV is large lymph nodes or "swollen glands" that may be enlarged for more than three months. Other symptoms often experienced months to years before the onset of AIDS include a lack of energy, weight loss, frequent fevers and sweats, persistent or frequent yeast infections (oral or vaginal), persistent skin rashes or flaky skin, pelvic inflammatory disease that does not respond to treatment, or short-term memory loss.
Some people develop frequent and severe herpes infections that cause mouth, genital or anal sores, or a painful nerve disease known as shingles. Children may have delayed development or failure to thrive.
What are some of the symptoms and illnesses associated with AIDS?
People with AIDS are particularly prone to developing various cancers, especially those caused by viruses such as Kaposi's sarcoma and cervical cancer, or cancers of the immune system known as lymphomas. These cancers are usually more aggressive and difficult to treat in people with AIDS. Signs of Kaposi's sarcoma in light-skinned people are round brown, reddish or purple spots that develop on the skin or in the mouth. In dark-skinned people, the spots are more pigmented.
Many people are so debilitated by the symptoms of AIDS that they are unable to hold steady employment or do household chores. Other people with AIDS may experience phases of intense life-threatening illness followed by phases of normal functioning.
What about babies and children who are infected with HIV?
Babies born to mothers infected with HIV may or may not be infected with the virus, but all carry their mothers' antibodies to HIV for several months. If these babies lack symptoms, a definitive diagnosis of HIV infection using standard antibody tests cannot be made until after 15 months of age. By then, babies are unlikely to still carry their mothers' antibodies and will have produced their own, if they are infected. New technologies to detect HIV itself are being used to more accurately determine HIV infection in infants between ages 3 months and 15 months. A number of blood tests are being evaluated to determine if they can diagnose HIV infection in babies younger than 3 months.
Although children with AIDS are susceptible to the same opportunistic infections as adults with the disease, they also experience severe forms of the bacterial infections to which children are especially prone, such as conjunctivitis (pink eye), ear infections and tonsillitis.
Why do some people with HIV not develop AIDS?
A small number of people (less than 50) initially infected with HIV 10 or more years ago have not developed symptoms of AIDS. Scientists are trying to determine what factors may account for their lack of progression to AIDS, such as particular characteristics of their immune systems, or whether they were infected with a less aggressive strain of the virus, or if their genetic make-up may protect them from the effects of HIV. Scientists hope that understanding the body's natural method of control may lead to ideas for protective HIV vaccines and use of vaccines to prevent disease progression.
HIV can infect anyone who practices risky behaviors such as:
Sharing drug needles or syringes;
Having sexual contact without using a latex male condom with an infected person or with someone whose HIV status is unknown.
Having another sexually transmitted disease such as syphilis, herpes, chlamydial infection, gonorrhea or bacterial vaginosis appears to make someone more susceptible to acquiring HIV infection during sex with an infected partner.
How is HIV spread?
HIV is spread most commonly by sexual contact with an infected partner. The virus can enter the body through the lining of the vagina, vulva, penis, rectum or mouth during sex.
HIV also is spread through contact with infected blood. Prior to the screening of blood for evidence of HIV infection and before the introduction in 1985 of heat-treating techniques to destroy HIV in blood products, HIV was transmitted through transfusions of contaminated blood or blood components. Today, because of blood screening and heat treatment, the risk of acquiring HIV from such transfusions is extremely small.
HIV frequently is spread among IV drug users by the sharing of needles or syringes contaminated with minute quantities of blood of someone infected with the virus. However, transmission from patient to health care worker or vice-versa via accidental sticks with contaminated needles or other medical instruments is rare.
Women can transmit HIV to their fetuses during pregnancy or birth. Approximately one-quarter to one-third of all untreated pregnant women infected with HIV will pass the infection to their babies. HIV also can be spread to babies through the breast milk of mothers infected with the virus. If the drug AZT is taken during pregnancy, the chance of transmitting HIV to the baby is reduced significantly. If AZT treatment of mothers is combined with caesarean sectioning to deliver infants, infection rates can be reduced to one percent.
Can HIV be spread by saliva or casual contact?
Although researchers have detected HIV in the saliva of infected individuals, no evidence exists that the virus is spread by contact with saliva. Laboratory studies reveal that saliva has natural compounds that inhibit the infectiousness of HIV. Studies of people infected with HIV have found no evidence that the virus is spread to others through saliva, such as by kissing. However, no one knows the risk of infection from so-called "deep" kissing, involving the exchange of large amounts of saliva or by oral intercourse. Scientists also have found no evidence that HIV is spread through sweat, tears, urine or feces.
Studies of families of HIV-infected people have shown clearly that HIV is not spread through casual contact such as the sharing of food utensils, towels and bedding, swimming pools, telephones or toilet seats, nor is HIV spread by biting insects such as mosquitoes or bedbugs.
How can I avoid getting HIV?
Since no vaccine for HIV is available, the only way to prevent infection by the virus is to avoid behaviors that put you at risk of infection, such as sharing needles and having unprotected sex.
Because many people infected with HIV have no symptoms, there is no way of knowing with certainty whether a sexual partner is infected unless he or she has been repeatedly tested for the virus or has not engaged in any risky behavior. CDC recommends that people either abstain from sex or protect themselves by using male latex condoms whenever having oral, anal or vaginal sex. Only male condoms made of latex should be used, and water-based lubricants should be used with latex condoms. Natural and lambskin condoms should be avoided. Although some laboratory evidence shows that spermicides can kill HIV organisms, researchers have not found that these products can prevent HIV.
When should I be tested for HIV?
People exposed to HIV should be tested for HIV infection as soon as they are likely to develop antibodies to the virus. Early testing will enable you to receive appropriate treatment at a time when you are most able to combat HIV and prevent the emergence of certain opportunistic infections. Early testing also alerts HIV-infected people to avoid high-risk behaviors that could spread HIV to others.
Henry Ford Hospital
Monday - Wednesday
4:00 p.m. - 7:00 p.m.
(By appointment)
(313) 916-2556
Henry Ford Medical Center -- Fairlane:
Monday
5:30 p.m. - 9:30 p.m.
(By appointment)
(313) 593-8351
Mobile Testing:
(313) 916-5085
Clinic partially funded by Ryan White Title I, C.A.R.E. Act Funds.
What type of tests will be done to detect HIV?
Two different types of antibody tests -- ELISA and Western Blot -- are used to diagnose HIV infection. If a person is highly likely to be infected with HIV and yet both tests are negative, a doctor may test for the presence of HIV itself in the blood. The person also may be told to repeat antibody testing at a later date, when antibodies to HIV are more likely to have developed.
You must tell all sexual partners that you are HIV positive. It is a felony punishable by jail in the State of Michigan to have sex with another person without telling them you are HIV positive.
You must notify prior partners who may have been exposed to your HIV. This is public health policy in the State of Michigan. The Health Department or your physician can assist you in partner notification.
You cannot donate blood, organs, semen or other body parts.
If you are using IV drugs, do not share needles.
In the household, do not share any item that may have touched your blood or body fluids.
What treatments are available for HIV and AIDS?
When AIDS first surfaced in the United States, no drugs were available to combat the underlying immune deficiency and few treatments existed for the opportunistic diseases that resulted. However, over the past 10 years, therapies have been developed to fight both HIV infection and its associated infections and cancers.
The U.S. Food and Drug Administration (FDA) has approved a number of drugs for treating HIV infection. The first group of drugs used to treat HIV infection, called nucleoside reverse transcriptase (RT) inhibitors, interrupts an early stage of the virus making copies of itself. Included in this class of drugs (called nucleoside analogs) are AZT, ddC (zalcitabine), ddI (dideoxyinosine), d4T (stavudine), 3TC (lamivudine), abacavir (ziagen), and tenofovir (viread). These drugs may slow the spread of HIV in the body and delay the start of opportunistic infections.
Health care providers can prescribe non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as delvaridine (Rescriptor), nevirapine (Viramune), and efravirenz (Sustiva), in combination with other antiretroviral drugs.
More recently, FDA has approved a second class of drugs for treating HIV infection. These drugs, called protease inhibitors, interrupt virus replication at a later step in its life cycle. They include:Ritonavir (Norvir); Saquinivir (Invirase; Fortovase); Indinavir (Crixivan); Amprenivir (Agenerase; Lexiva); Nelfinavir (Viracept); Lopinavir (Kaletra); Atazanavir (Reyataz).
The newest class of drugs which have become available are called fusion inhibitors. These drugs prevent the HIV virus from attaching to cells. Currently there is only one marketed fusion inhibitor, envufurtide (Fuzeon).
A number of drugs are available to help treat opportunistic infections to which people with HIV are especially prone. These drugs include: Foscarnet and ganciclovir to treat eye infections; Fluconazole to treat yeast and other fungal infections; and Trimethoprim/sulfamethoxazole (TMP/SMX) or pentamidine to treat Pneumocystis carinii pneumonia (PCP).
In addition to antiretroviral therapy, adults with HIV whose CD4+ T-cell counts drop below 200 are given treatment to prevent the occurrence of PCP, which is one of the most common and deadly opportunistic infections associated with HIV. Children are given PCP preventive therapy when their CD4+ T-cell counts drop to levels considered below normal for their age group.
HIV-infected individuals who develop Kaposi's sarcoma or other cancers are treated with radiation, chemotherapy or injections of alpha interferon, a genetically engineered naturally occurring protein.
For a more detailed listing and explanation of medications, please check out the Medications page.
