Acquired immunodeficiency syndrome (AIDS) is a chronic, potentially life-threatening condition caused by the human immunodeficiency virus (HIV). By damaging your immune system, HIV interferes with your body's ability to fight the organisms that cause disease.
HIV is a sexually transmitted infection (STI). It can also be spread by contact with infected blood or from mother to child during pregnancy, childbirth or breast-feeding. Without medication, it may take years before HIV weakens your immune system to the point that you have AIDS.
There's no cure for HIV/AIDS, but there are medications that can dramatically slow the progression of the disease. These drugs have reduced AIDS deaths in many developed nations.
The symptoms of HIV and AIDS vary, depending on the phase of infection.
Primary infection (Acute HIV)
Most people infected by HIV develop a flu-like illness within a month or two after the virus enters the body. This illness, known as primary or acute HIV infection, may last for a few weeks. Possible signs and symptoms include:
- Muscle aches and joint pain
- Sore throat and painful mouth sores
- Swollen lymph glands, mainly on the neck
These symptoms can be so mild that you might not even notice them. However, the amount of virus in your bloodstream (viral load) is quite high at this time. As a result, the infection spreads more easily during primary infection than during the next stage.
Clinical latent infection (Chronic HIV)
In some people, persistent swelling of lymph nodes occurs during this stage. Otherwise, there are no specific signs and symptoms. HIV remains in the body and in infected white blood cells.
This stage of HIV infection generally lasts around 10 years if you're not receiving antiretroviral therapy. But sometimes, even with this treatment, it lasts for decades. Some people develop more severe disease much sooner.
Symptomatic HIV infection
As the virus continues to multiply and destroy your immune cells — the cells in your body that help fight off germs — you may develop mild infections or chronic signs and symptoms such as:
- Swollen lymph nodes — often one of the first signs of HIV infection
- Weight loss
- Oral yeast infection (thrush)
- Shingles (herpes zoster)
Progression to AIDS
Thanks to better antiviral treatments, most people with HIV in the U.S. today don't develop AIDS. Untreated, HIV typically turns into AIDS in about 10 years.
When AIDS occurs, your immune system has been severely damaged. You'll be more likely to develop opportunistic infections or opportunistic cancers — diseases that wouldn't usually trouble a person with a healthy immune system.
The signs and symptoms of some of these infections may include:
- Soaking night sweats
- Recurring fever
- Chronic diarrhea
- Persistent white spots or unusual lesions on your tongue or in your mouth
- Persistent, unexplained fatigue
- Weight loss
- Skin rashes or bumps
When to see a doctor
If you think you may have been infected with HIV or are at risk of contracting the virus, see a health care provider as soon as possible.
HIV is caused by a virus. It can spread through sexual contact or blood, or from mother to child during pregnancy, childbirth or breast-feeding.
How does HIV become AIDS?
HIV destroys CD4 T cells — white blood cells that play a large role in helping your body fight disease. The fewer CD4 T cells you have, the weaker your immune system becomes.
You can have an HIV infection for years before it turns into AIDS. AIDS is diagnosed when the CD4 T cell count falls below 200 or you have an AIDS-defining complication.
How HIV spreads
To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. This can happen in several ways:
- By having sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity.
- From blood transfusions. In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the blood supply for HIV antibodies, so this risk is very small.
- By sharing needles. Sharing contaminated intravenous drug paraphernalia (needles and syringes) puts you at high risk of HIV and other infectious diseases, such as hepatitis.
- During pregnancy or delivery or through breast-feeding. Infected mothers can pass the virus on to their babies. HIV-positive mothers who get treatment for the infection during pregnancy can significantly lower the risk to their babies.
How HIV doesn't spread
You can't become infected with HIV through ordinary contact. That means you can't catch HIV or AIDS by hugging, kissing, dancing or shaking hands with someone who has the infection.
HIV isn't spread through the air, water or insect bites.
When HIV/AIDS first appeared in the United States, it mainly affected men who had sex with men. However, now it's clear that HIV also spreads through heterosexual sex.
Anyone of any age, race, sex or sexual orientation can be infected. However, you're at greatest risk of HIV/AIDS if you:
- Have unprotected sex. Use a new latex or polyurethane condom every time you have sex. Anal sex is more risky than is vaginal sex. Your risk of HIV increases if you have multiple sexual partners.
- Have an STI. Many STIs produce open sores on your genitals. These sores act as doorways for HIV to enter your body.
- Use intravenous drugs. People who use intravenous drugs often share needles and syringes. This exposes them to droplets of other people's blood.
- Are an uncircumcised man. Studies suggest that lack of circumcision increases the risk of heterosexual transmission of HIV.
HIV infection weakens your immune system, making you much more likely to develop numerous infections and certain types of cancers.
Infections common to HIV/AIDS
- Tuberculosis (TB). In resource-limited nations, TB is the most common opportunistic infection associated with HIV. It's a leading cause of death among people with AIDS.
- Cytomegalovirus. This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other organs.
- Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick, white coating on the mucous membranes of your mouth, tongue, esophagus or vagina.
- Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with HIV, caused by a fungus found in soil.
- Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, which may then spread to other animals and humans. Seizures occur when it spreads to the brain.
- Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly found in animals. You get it when you eat or drink contaminated food or water. The parasite grows in your intestines and bile ducts, leading to severe, chronic diarrhea in people with AIDS.
Cancers common to HIV/AIDS
- Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is rare in people not infected with HIV, but common in HIV-positive people. It usually appears as pink, red or purple lesions on the skin and mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal organs, including the digestive tract and lungs.
- Lymphoma. This cancer starts in the white blood cells. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.
- Wasting syndrome. Aggressive treatment approaches have reduced the number of cases of wasting syndrome, but it still affects many people with AIDS. It's defined as a loss of at least 10 percent of body weight, often accompanied by diarrhea, chronic weakness and fever.
- Neurological complications. Although AIDS doesn't appear to infect the nerve cells, it can cause neurological symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. One of the most common neurological complications is AIDS dementia complex, which leads to behavioral changes and reduced mental functioning.
- Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your kidneys that remove excess fluid and wastes from your blood and pass them to your urine. It most often affects blacks or Hispanics. Anyone with this complication should be started on antiretroviral therapy.
There's no vaccine to prevent HIV infection and no cure for AIDS. But you can protect yourself and others from infection.
To help prevent the spread of HIV:
- Use a new condom every time you have sex. Use a new condom every time you have anal or vaginal sex. Women can use a female condom. If using lubricant, make sure it's water-based. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a nonlubricated, cut-open condom or a dental dam — a piece of medical-grade latex.
- Consider the drug Truvada. The drug emtricitabine-tenofovir (Truvada) can reduce the risk of sexually transmitted HIV infection in people at very high risk. You need to take it every day. It doesn't prevent other STIs, so you'll still need to practice safe sex. If you have hepatitis B you should be evaluated by an infectious disease or liver specialist before beginning therapy. You will need a blood test to check your kidney function before taking this drug.
- Tell your sexual partners if you have HIV. It's important to tell all your current and past sexual partners that you're HIV-positive. They'll need to be tested.
- Use a clean needle. If you use a needle to inject drugs, make sure it's sterile and don't share it. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
- If you're pregnant, get medical care right away. If you're HIV-positive, you may pass the infection to your baby. But if you receive treatment during pregnancy, you can cut your baby's risk significantly.
- Consider male circumcision. There's evidence that male circumcision can help reduce a man's risk of getting HIV infection.
HIV is most commonly diagnosed by testing your blood or saliva for antibodies to the virus. Unfortunately, it takes time for your body to develop these antibodies — usually up to 12 weeks.
A quicker test checks for HIV antigen, a protein produced by the virus immediately after infection. It can confirm a diagnosis soon after infection and allow the person to take swifter steps to prevent the spread of the virus to others.
At least two Food and Drug Administration-approved home test kits for HIV are available. Depending on which you choose, you'll need a drop of dried blood or sample of saliva. If the test is positive, you'll need to see your doctor to confirm the diagnosis and discuss your treatment options. If the test is negative, it needs to be repeated in a few months to confirm the results.
Tests to stage disease and treatment
If you receive a diagnosis of HIV/AIDS, several tests can help your doctor determine the stage of your disease and the best treatment. These tests include:
- CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 T cell count dips below 200.
- Viral load (HIV RNA). This test measures the amount of virus in your blood. A higher viral load has been linked to a worse outcome.
- Drug resistance. Some strains of HIV are resistant to medications. This test helps your doctor determine if your specific form of the virus has resistance and guides treatment decisions.
Tests for complications
Your doctor might also order lab tests to check for other infections or complications, including:
- Sexually transmitted infections
- Liver or kidney damage
- Urinary tract infection
There's no cure for HIV/AIDS, but many different drugs are available to control the virus. Such treatment is called antiretroviral therapy, or ART. Each class of drug blocks the virus in different ways. ART is now recommended for everyone, regardless of CD4 T cell counts. It's recommended to combine three drugs from two classes to avoid creating drug-resistant strains of HIV.
The classes of anti-HIV drugs include:
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
- Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir (Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-zidovudine (Combivir).
- Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan).
- Entry or fusion inhibitors Tblock HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
- Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include raltegravir (Isentress) and dolutegravir (Tivicay).
When to start treatment
Everyone with HIV infection, regardless of CD4 T cell count, should be offered antiviral medication.
HIV therapy is particularly important for the following situations:
- You have severe symptoms.
- You have an opportunistic infection.
- Your CD4 T cell count is under 350.
- You're pregnant.
- You have HIV-related kidney disease.
- You're being treated for hepatitis B or C.
Treatment can be difficult
HIV treatment plans may involve taking several pills at specific times every day for the rest of your life. Each medication comes with its own unique set of side effects. It's critical to have regular follow-up appointments with your doctor to monitor your health and treatment.
Some of the treatment side effects are:
- Nausea, vomiting or diarrhea
- Heart disease
- Weakened bones or bone loss
- Breakdown of muscle tissue (rhabdomyolysis)
- Abnormal cholesterol levels
- Higher blood sugar
Treatment for age-related diseases
Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It's important to talk to your doctor about your other health conditions and the medications you are taking.
Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. CD4 T cell counts should be checked every three to six months.
Viral load should be tested at the start of treatment and then every three to four months during therapy. Treatment should lower your viral load so that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it.
Along with receiving medical treatment, it's essential to take an active role in your own care. The following suggestions may help you stay healthy longer:
- Eat healthy foods. Fresh fruits and vegetables, whole grains, and lean protein help keep you strong, give you more energy and support your immune system.
- Avoid raw meat, eggs and more. Foodborne illnesses can be especially severe in people who are infected with HIV. Cook meat until it's well-done. Avoid unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi.
- Get the right immunizations. These may prevent infections such as pneumonia and the flu. Make sure the vaccines don't contain live viruses, which can be dangerous for people with weakened immune systems.
- Take care with companion animals. Some animals may carry parasites that can cause infections in people who are HIV-positive. Cat feces can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry cryptococcus or histoplasmosis. Wash hands thoroughly after handling pets or emptying the litter box.
People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or counteract side effects of anti-HIV drugs. However, there is no scientific evidence that any nutritional supplement improves immunity, and many may interfere with other medications you are taking.
Supplements that may be helpful
- Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain in people with diabetes. It may also ease nerve pain linked to HIV if you're lacking in the substance.
- Whey protein. Early evidence suggests that whey protein, a cheese byproduct, can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase CD4 T cell counts.
Supplements that may be dangerous
- St. John's wort. A common depression remedy, St. John's wort can reduce the effectiveness of several types of anti-HIV drugs by more than half.
- Garlic supplements. Although garlic itself may help strengthen the immune system, garlic supplements interact with several anti-HIV drugs and reduce their ability to work. Occasionally eating garlic in food appears to be safe.
Be sure to discuss the use of any dietary supplement with your doctor before trying it to ensure that it won't adversely interact with any of your medications.
Receiving a diagnosis of any life-threatening illness is devastating. The emotional, social and financial consequences of HIV/AIDS can make coping with this illness especially difficult — not only for you but also for those closest to you.
But today, there are many services and resources available to people with HIV. Most HIV/AIDS clinics have social workers, counselors or nurses who can help you directly or put you in touch with people who can.
Services they may provide:
- Arrange transportation to and from doctor appointments
- Help with housing and child care
- Assist with employment and legal issues
- Provide support during financial emergencies
It's important to have a support system. Many people with HIV/AIDS find that talking to someone who understands their disease provides comfort.
If you think you might have HIV infection, you're likely to start by seeing your family doctor. You may be referred to an infectious disease specialist.
What you can do
Before your appointment, consider answering these questions and take them to your doctor's visit:
- How do you think you were exposed to HIV?
- What are your symptoms?
- Do you have risk factors, such as participating in unprotected sex or using intravenous drugs?
- What prescription drugs or supplements do you take?
What to expect from your doctor
Your doctor will ask you questions about your health and lifestyle. Your doctor will perform a complete physical exam, checking you for:
- Swollen lymph nodes
- Lesions on your skin or in your mouth
- Problems with your nervous system
- Abnormal sounds in your lungs
- Swollen organs in your abdomen
What you can do in the meantime
If you think you might have HIV infection, take steps to protect yourself and others before your appointment. Don't have unprotected sex. If you use injectable drugs, always use a fresh, clean needle. Don't share needles with others.