HIV Frequently Asked Questions

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A. HIV (Human immunodeficiency virus) attacks the body's immune system. When it does, HIV weakens the body's ability to fight off infection. If left untreated, HIV will eventually weaken the immune system so much that the person will become sick from certain types of infections. When the person gets these infections, he or she is said to have AIDS (acquired immunodeficiency syndrome). For some, it takes a long time to develop these infections and therefore AIDS. For others it takes less time. Not everyone with HIV has AIDS and AIDS is not the same as HIV

A. HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their baby during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Most of these people will develop AIDS as a result of their HIV infection.

These body fluids have been proven to spread HIV:

* blood
* semen
* vaginal fluid
* breast milk
* other body fluids containing blood

These are additional body fluids that may transmit the virus that health care workers may come into contact with:

* cerebrospinal fluid surrounding the brain and the spinal cord
* synovial fluid surrounding bone joints
* amniotic fluid surrounding a fetus

The Symptoms of HIV
Remember Not to Rely On Symptoms...Get Tested

Because many people who have been infected with HIV have few or no symptoms initially, testing is the only way to know for sure if you are infected with HIV. There are, however, an assortment of symptoms that can be associated with HIV infection.

Symptoms Early After Infection - Acute HIV - In emergency departments and family practice offices, people come in with symptoms like fever, headache, muscle and joint pain, sore throat, rash and diarrhea. In response to these symptoms, physicians diagnose the flu and send the patient on their way. In the majority of cases, their diagnosis proves correct. But unfortunately, a number of people with these vague, indistinct symptoms have a more serious illness than the flu; these symptoms may signal the acute stages of HIV infection.

* Acute HIV - Recognize the Symptoms

Symptoms of the Immune System - The immune system is the body's natural defense

HIV attacks the immune system, weakening it and making the body more susceptible to infection. After infection, some symptoms affect the immune system.

* Swollen lymph nodes in the neck, axilla, or groin (lymphadenopathy)
* Fever / night sweats

Symptoms of the GI Tract - HIV can have a profound affect on the gastrointestinal system and nutrition. Like any virus, HIV can cause symptoms ranging from poor appetite to diarrhea. Here are some of the most common:

* Rapid weight loss
* Diarrhea
* Poor appetite
* Profound fatigue

Respiratory Symptoms - Some of the most serious symptoms of HIV involve the respiratory system. Symptoms associated with breathing and respiration usually occur later in course of the disease. Unfortunately, many people's first symptom of HIV involves the respiratory system, illustrating why HIV testing is so important. Any cough or shortness of breath could be a sign of bacterial pneumonia or pneumocystis (carinii) jiroveci pneumonia (PCP).

* Shortness of breath
* Dry cough / productive cough

Symptoms of the Skin and Mucous Membranes - Many of the symptoms of HIV are a result of infection by other viruses, fungi or bacteria. Often, these infections involve the skin or mucous membranes (for example, inside the mouth).

* Skin rash
* Red, brown, pink or purple lesion on the skin - suggestive of Kaposi's sarcoma
* White patches on the tounge, inside of the mouth, or gums - could be signs of thrush, candida, or hairy oral leukoplakia
* Canker sores / apthous ulcers

Neurological / Emotional Symptoms - Very early on in the epidemic, experts realized that HIV affected both the physical and emotional self. Neurological and emotional symptoms of HIV can include the following.

* Depression
* Numbness, tingling, or burning in the feet, hands, or face. (peripheral neuropathy)
* Confusion, weakness, or changes in level of conciousness

AIDS stands for acquired immunodeficiency syndrome. An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS defining illnesses. An HIV-positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts).

A positive HIV test result DOES NOT mean that a person has AIDS. A diagnosis of AIDS is made by a physician using certain clinical criteria (e.g., AIDS defining illnesses).

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.

Many of the infections that cause problems or may be life-threatening for people with AIDS are usually controlled by a healthy immune system.

Since 1992, scientists have estimated that about half the people with HIV develop AIDS within 10 years after becoming infected. This time varies greatly from person to person and can depend on many factors, including a person's health status and their health-related behaviors.

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. There are other treatments that can prevent or cure some of the illnesses associated with AIDS, though the treatments donot cure AIDS itself. As with other diseases, early detection offers more options for treatment and preventative health care.

There is a short window in time that you can test HIV negative and still be HIV infected. When HIV initially infects the body, your immune system begins to develop antibodies to the virus. It is those antibodies HIV tests look for when you get tested. It takes some time for enough of those antibodies to be produced for an HIV test to detect. Therefore if enough have not been produced when you are tested, the test can be negative when in fect you have been infected.

It is for this reason that experts suggest a series of HIV tests; one when you believe you have been exposed; one 6 weeks after exposure; and finally one 3 months after exposure. If you have a negative test at 3 months you can assume you have not been infected.

HIV is a virus that needs our genetic material to make more copies of itself or to replicate. The virus likes one particular cell in our immune system called a CD4 cell or t-cell. When it uses that cell's genetic material, it damages the T-cell to the point where it can no longer do its job in our immune system. The more of these t-cells that are damaged, the weaker your immune system becomes. Eventually, your immune system will become so weak that it will not be able to protect you from other illnesses and infections, thus you become sick. Simply put, HIV doesn't make you sick. It weakens your immune system, allowing other illnesses and infections to make you sick..

A. Your immune system contains different types of cells that help protect the body from infection. One of these types of specialized cells are called the CD4 or T-cells. HIV attacks these types of cells and uses them to make more copies of HIV. In doing so, the CD4 cell becomes unable to do its job of protecting the body. At first, the body can make more of these T-cells but eventually the body can't keep up and the number of working T-cells decreases. This weakens the immune system and leaves the body at risk for different types of infections.

On a regular basis, your doctor will draw blood and measure the number of T-cells. The higher the number the better able your immune system to do its job. Most people without HIV have about 700 to 1000 CD4 cells. HIV infected people are considered to have "normal" CD4 counts if the number is above 500.

If the number drops below 200, you are said to have AIDS and your doctor will start you on preventative medications to ward off infections and keep you healthy.

A. HIV medicines interfere with the formation of new HIV copies in the body. Fewer HIV copies means your immune system will stay healthier. HIV medications have been shown to delay progression from HIV to AIDS and to keep a person healthier longer.
HIV Medication Fact Sheets

Remember to always take medications exactly as prescribed and not to change or stop your medications without first speaking with your physician.

Entry Inhibitors

* Fuzeon
* Fuzeon Injection Instructions

Non-Nucleosides (NNRTI's)

* Viramune
* Rescriptor
* Sustiva

Nucleotide Analogs

* Viread
* Atripla - new

Protease Inhibitors (PI's)

* Prezista (darunavir) - new
* Crixivan
* Invirase
* Norvir
* Viracept
* Kaletra 200/50
* Reyataz (atazanavir)
* Lexiva
* Aptivus (tipranavir) - new

Nucleosides (NRTI's)

* Combivir
* Epivir
* Zerit
* Hivid
* Videx EC
* Generic Didanosine
* AZT
* Ziagen
* Trizivir
* Emtriva
* Epzicom
* Truvada

A. Resistance testing evaluates whether HIV has evolved resistance to particular drugs. It can help a physician decide on an initial antiretroviral regimen and help guide choices when treatment needs to be changed. There are two types of resistance testing.

Genotype assays
This test examines viral genetic material and identifies particular mutations responsible for resistance. Generally the viral load needs to be above a certain value, i.e. greater than 1000 copies/mL, in order for genotype testing to be of any use. If genotype testing reveals a mutation known to cause resistance to a particular drug, then an alternative therapy and drug choice must be considered.

Phenotype assays
This test measures the ability of the virus to grow and replicate in the presence of varying concentrations of drugs.
Q. What is viral load and why is it important?
A. Viral load is a measure of the amount of active HIV in your blood. The goal of treatment is to have the lowest viral load possible. People with higher viral loads tend to be at higher risk for infections and AIDS than those with lower viral loads. On a regular basis your doctor will draw blood to measure the amount of HIV. The amount can range from greater than 750,000 copies down to a level less than 50. The lower the number the better. Unfortunately, current therapies can not completely remove HIV from the body. But the goal is to decrease HIV numbers below the detectable range. At that point you are said to have an undetectable viral load.Your doctor will use your viral load levels to help decide when therapy should be started and what types of medications are best for you.
Q. What is the Goal of HIV Therapy?

Simply put, HIV therapy is used to keep you healthy. But what are the specific goals of HIV therapy?

A. There are several goals of HIV therapy:

1. Slow and reduce the progression of HIV to AIDS.
2. Reduce the amount of active HIV in your blood and keep it low as long as possible.
3. Restore and maintain the health and strength of your immune system by keeping your CD4 count as high as possible.
4. Allow you to stay healthier for longer.

A. There are several reasons for changing your combination therapy. Here are some of the most common.

* If you are having side effects, changing meds may make it easier to take your therapy. Better adherence to therapy means fewer HIV copies being made.

Dealing with Medication Side Effects

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Certain medicines need to be taken in certain ways...three times a day...twice a day...etc. If your schedule doesn't allow you to take your therapy correctly, a change may work with your schedule better, allowing you to better adhere to your therapy.

Medication Table - How to Take Your Meds

* If you experience a treatment failure, changing med combinations will most often be effective in interfering with the HIV life cycle.

A. Eventually, regardless of how well you adhere to your therapy, combinations of HIV medicines will become less effective. When your combination therapy no longer prevents HIV replication, the therapy is said to have failed. There are many causes of therapy failure. Most often your virus has changed (mutated) and has become less sensitive to your therapy. It is not unusual for a person to change combinations from time to time in order HIV rom multiplying.
HIV / AIDS Testing FAQ

A. Many places provide testing for HIV infection. Common testing locations include local health departments, offices of private doctors, hospitals, and sites specifically set up to provide HIV testing.

It is important to seek testing at a place that also provides counseling about HIV and AIDS. Counselors can answer any questions you might have about risky behavior and ways you can protect yourself and others in the future. In addition, they can help you understand the meaning of the test results and describe what AIDS-related resources are available in the local area.

The CDC National AIDS Hotline can answer questions about testing and can refer you to testing sites in your area.

A. A rapid test for detecting antibody to HIV is a screening test that produces very quick results, usually in 5 to 30 minutes. In comparison, results from the commonly used HIV antibody screening test, the EIA (enzyme immunoassay), are not available for 1-2 weeks.Only one rapid HIV test is currently licensed by the Food and Drug Administration for use in the United States. The availability of rapid HIV tests may differ from one place to another. The rapid HIV test is considered to be just as accurate as the EIA. Both the rapid test and the EIA look for the presence of antibodies to HIV. As is true for all screening tests (including the EIA), a reactive rapid HIV test result must be confirmed before a diagnosis of infection can be given.

A. If you test positive for HIV, the sooner you take steps to protect your health, the better. Early medical treatment and a healthy lifestyle can help you stay well. Prompt medical care may delay the onset of AIDS andprevent some life-threatening conditions. There are a number of important steps you can take immediately to protect your health:

*See a doctor, even if you do not feel sick. Try to find a doctor who has experience treating HIV. There are now many drugs to treat HIV infection and help you maintain your health. It is never too early to start thinking about treatment possibilities.

*Have a TB (tuberculosis) test done. You may be infected with TB and not know it. Undetected TB can cause serious illness, but it can be successfully treated if caught early.

*Smoking cigarettes, drinking too much alcohol, or using illegal drugs (such as cocaine) can weaken your immune system. There are programs available that can help you reduce or stop using these substances.

There is much you can do to stay healthy. Learn all that you can about maintaining good health. Call the CDC National AIDS Hotline to get additional information, order publications, and obtain referrals to local, state, and national resources that may be useful to you. The Hotline numbers are 1-800-342-2437 (English), 1-800-344-7432 (Spanish), and 1-800-243-7889 (TTY).