What Is HIV
What Is HIV
HIV is a virus that damages the immune system. The immune system helps the body fight off infections.
Untreated HIV infects and kills CD4 cells, which are a type of immune cell called T cells. Over time, as HIV
kills more CD4 cells, the body is more likely to get various types of infections and cancers.
blood
semen
vaginal and rectal fluids
breast milk
HIV is a lifelong condition and currently there is no cure, although many scientists are working to find
one. However, with medical care, including treatment called antiretroviral therapy, it’s possible to
manage HIV and live with the virus for many years.
Without treatment, a person with HIV is likely to develop a serious condition called AIDS. At that point,
the immune system is too weak to fight off other diseases and infections. Untreated, life expectancy with
AIDS is about three years. With antiretroviral therapy, HIV can be well-controlled and life expectancy can
be nearly the same as someone who has not contracted HIV.
It’s estimated that 1.1 million Americans are currently living with HIV. Of those people, 1 in 5 don’t know
they have the virus.
HIV can cause changes throughout the body. Learn about the effects of HIV on the different systems in
the body.
What is AIDS?
AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV. But just
because a person has HIV doesn’t mean they’ll develop AIDS.
HIV kills CD4 cells. Healthy adults generally have a CD4 count of 500 to 1,500 per cubic millimeter. A
person with HIV whose CD4 count falls below 200 per cubic millimeter will be diagnosed with AIDS.
A person can also be diagnosed with AIDS if they have HIV and develop an opportunistic infection or
cancer that’s rare in people who don’t have HIV. An opportunistic infection, such as pneumonia, is one
that takes advantage of a unique situation, such as HIV.
Untreated, HIV can progress to AIDS within a decade. There’s no cure for AIDS, and without treatment,
life expectancy after diagnosis is about three years. This may be shorter if the person develops a severe
opportunistic illness. However, treatment with antiretroviral drugs can prevent AIDS from developing.
If AIDS does develop, it means that the immune system is severely compromised. It’s weakened to the
point where it can no longer fight off most diseases and infections. That makes the person vulnerable to
a wide range of illnesses, including:
pneumonia
tuberculosis
oral thrush, a fungal infection in the mouth or throat
cytomegalovirus (CMV), a type of herpes virus
cryptococcal meningitis, a fungal infection in the brain
toxoplasmosis, a brain infection caused by a parasite
cryptosporidiosis, an infection caused by an intestinal parasite
cancer, including Kaposi’s sarcoma (KS) and lymphoma
The shortened life expectancy linked with untreated AIDS isn’t a direct result of the syndrome itself.
Rather, it’s a result of the diseases and complications that arise from having an immune system
weakened by AIDS. Learn more about possible complications that can arise from HIV and AIDS.
As HIV lowers the CD4 cell count, the immune system weakens. A typical adult’s CD4 count is 500 to
1,500 per cubic millimeter. A person with a count below 200 is considered to have AIDS.
How quickly a case of HIV progresses through the chronic stage varies significantly from person to
person. Without treatment, it can last up to a decade before advancing to AIDS. With treatment, it can
last indefinitely.
There is no cure for HIV, but it can be controlled. People with HIV often have a near-normal lifespan with
early treatment with antiretroviral therapy. Along those same lines, there’s technically no cure for AIDS.
However, treatment can increase a person’s CD4 count to the point where they’re considered to no
longer have AIDS. (This point is a count of 200 or higher.) Also, treatment can typically help manage
opportunistic infections.
HIV and AIDS are related, but they’re not the same thing. Learn more about the difference between HIV
and AIDS.
blood
semen
vaginal and rectal fluids
breast milk
through vaginal or anal sex — the most common route of transmission, especially among men who
have sex with men
by sharing needles, syringes, and other items for injection drug use
by sharing tattoo equipment without sterilizing it between uses
during pregnancy, labor, or delivery from a woman to her baby
during breastfeeding
through “pre-mastication,” or chewing a baby’s food before feeding it to them
through exposure to the blood of someone living with HIV, such as through a needle stick
The virus can also be transmitted through a blood transfusion or organ and tissue transplant. However,
rigorous testing for HIV among blood, organ, and tissue donors ensures that this is very rare in the
United States.
It’s theoretically possible, but considered extremely rare, for HIV to spread through:
oral sex (only if there are bleeding gums or open sores in the person’s mouth)
being bitten by a person with HIV (only if the saliva is bloody or there are open sores in the person’s
mouth)
contact between broken skin, wounds, or mucous membranes and the blood of someone living with
HIV
skin-to-skin contact
hugging, shaking hands, or kissing
air or water
sharing food or drinks, including drinking fountains
saliva, tears, or sweat (unless mixed with the blood of a person with HIV)
sharing a toilet, towels, or bedding
mosquitoes or other insects
It’s important to note that if a person with HIV is being treated and has a persistently undetectable viral
load, it’s virtually impossible to transmit the virus to another person. Learn more about HIV transmission.
Causes of HIV
HIV is a variation of a virus that infects African chimpanzees. Scientists suspect the simian
immunodeficiency virus (SIV) jumped from chimps to humans when people consumed infected
chimpanzee meat. Once inside the human population, the virus mutated into what we now know as HIV.
This likely occurred as long ago as the 1920s.
HIV spread from person to person throughout Africa over the course of several decades. Eventually, the
virus migrated to other parts of the world. Scientists first discovered HIV in a human blood sample in
1959.
It’s thought that HIV has existed in the United States since the 1970s, but it didn’t start to hit public
consciousness until the 1980s. Learn more about the history of HIV and AIDS in the United States.
Causes of AIDS
AIDS is caused by HIV. A person can’t get AIDS if they haven’t contracted HIV.
Healthy individuals have a CD4 count of 500 to 1,500 per cubic millimeter. Without treatment, HIV
continues to multiply and destroy CD4 cells. If a person’s CD4 count falls below 200, they have AIDS.
Also, if someone with HIV develops an opportunistic infection associated with HIV, they can still be
diagnosed with AIDS, even if their CD4 count is above 200.
Antibody/antigen tests
Antibody/antigen tests are the most commonly used tests. They can show positive results typically
within 18–45 days after someone initially contracts HIV.
These tests check the blood for antibodies and antigens. An antibody is a type of protein the body
makes to fight an infection. An antigen, on the other hand, is the part of the virus that activates the
immune system.
Antibody tests
These tests check the blood solely for antibodies. Between 23 and 90 days after transmission, most
people will develop detectable HIV antibodies, which can be found in the blood or saliva.
These tests are done using blood tests or mouth swabs, and there’s no preparation necessary. Some
tests provide results in 30 minutes or less and can be performed in a healthcare provider’s office or
clinic.
If someone suspects they’ve been exposed to HIV but tested negative in a home test, they should repeat
the test in three months. If they have a positive result, they should follow up with their healthcare
provider to confirm.
Nucleic acid test (NAT)
This expensive test isn’t used for general screening. It’s for people who have early symptoms of HIV or
have a known risk factor. This test doesn’t look for antibodies; it looks for the virus itself. It takes from 5
to 21 days for HIV to be detectable in the blood. This test is usually accompanied or confirmed by an
antibody test.
Today, it’s easier than ever to get tested for HIV. Learn more about HIV home testing options.
The time between exposure to HIV and when it becomes detectable in the blood is called the HIV
window period. Most people develop detectable HIV antibodies within 23 to 90 days after infection.
If a person takes an HIV test during the window period, it’s likely they’ll receive a negative result.
However, they can still transmit the virus to others during this time. If someone thinks they may have
been exposed to HIV but tested negative during this time, they should repeat the test in a few months
to confirm (the timing depends on the test used). And during that time, they need to use condoms to
prevent possibly spreading HIV.
Someone who tests negative during the window might benefit from post-exposure prophylaxis (PEP).
This is medication taken after an exposure to prevent getting HIV. PEP needs to be taken as soon as
possible after the exposure; it should be taken no later than 72 hours after exposure, but ideally before
then.
Another way to prevent getting HIV is pre-exposure prophylaxis (PrEP). A combination of HIV drugs
taken before potential exposure to HIV, PrEP can lower the risk of contracting or spreading HIV when
taken consistently.
Timing is important when testing for HIV. Learn more about how timing affects HIV test results.
During this stage, some people have no symptoms at first. However, many people experience symptoms
in the first month or two after contracting the virus, but often don’t realize they’re caused by HIV. This is
because symptoms of the acute stage can be very similar to those of the flu or other seasonal viruses.
They may be mild to severe, they may come and go, and they may last anywhere from a few days to
several weeks.
fever
chills
swollen lymph nodes
general aches and pains
skin rash
sore throat
headache
nausea
upset stomach
Because these symptoms are similar to common illnesses like the flu, the person with them might not
think they need to see a healthcare provider. And even if they do, their healthcare provider might
suspect the flu or mononucleosis and might not even consider HIV.
Whether a person has symptoms or not, during this period their viral load is very high. The viral load is
the amount of HIV found in the bloodstream. A high viral load means that HIV can be easily transmitted
to someone else during this time.
Initial HIV symptoms usually resolve within a few months as the person enters the chronic, or clinical
latency, stage of HIV. This stage can last many years or even decades with treatment.
HIV symptoms can vary from person to person. Learn more about the early symptoms of HIV.
As with the early stage, HIV is still infectious during this time even without symptoms and can be
transmitted to another person. However, a person won’t know they have HIV unless they get tested. If
someone has these symptoms and thinks they may have been exposed to HIV, it’s important that they
get tested.
HIV symptoms at this stage may come and go, or they may progress rapidly. This progression can be
slowed substantially with treatment. With the consistent use of this antiretroviral therapy, chronic HIV
can last for decades and will likely not develop into AIDS, if treatment was started early enough. Learn
more about how HIV symptoms can progress over time.
HIV makes someone more susceptible to skin problems because the virus destroys immune system cells
that fight infection. Co-infections that can cause rash include:
molluscum contagiosum
herpes simplex
shingles
The appearance of the rash, how long it lasts, and how it can be treated depends on the cause.
While rash can be caused by HIV co-infections, it can also be caused by medication. Some drugs used to
treat HIV or other infections can cause a rash. This type of rash usually appears within a week or two of
starting a new medication. Sometimes the rash will clear up on its own. If it doesn’t, a change in
medications may be needed.
Rash due to an allergic reaction to medication can be serious. Other symptoms of an allergic reaction
include trouble breathing or swallowing, dizziness, and fever.
Stevens-Johnson syndrome (SJS) is a rare allergic reaction to HIV medication. Symptoms include fever
and swelling of the face and tongue. A blistering rash, which can involve the skin and mucous
membranes, appears and spreads quickly. When 30 percent of the skin is affected it’s called toxic
epidermal necrolysis, which is a life-threatening condition. If this develops, emergency medical care is
needed.
While rash can be linked with HIV or HIV medications, it’s important to keep in mind that rashes are
common and can have many other causes. Learn more about HIV rash.
Both men and women with HIV are at increased risk of sexually transmitted infections (STIs). However,
women may be less likely than men to notice small spots or other changes to their genitals.
While not related to HIV symptoms, another risk for women with HIV is that the virus can be transmitted
to a baby during pregnancy. However, antiretroviral therapy is considered safe during pregnancy.
Women who are treated with antiretroviral therapy are at very low risk of passing HIV to their baby
during pregnancy and delivery.
Breastfeeding is also affected in women with HIV. The virus can be passed to a baby through breast milk.
In the United States and other settings where formula is accessible and safe, it’s recommended that
women with HIV not breastfeed their babies. For these women, use of formula is encouraged. Options
besides formula include pasteurized banked human milk (https://www.hmbana.org).
For women who may have been exposed to HIV, it’s important to know what symptoms to look
for. Learn more about HIV symptoms in women.
People with HIV may develop AIDS if their HIV is not diagnosed until late, or if they know they have HIV
but don’t consistently take their antiretroviral therapy. They may also develop AIDS if they have a type of
HIV that’s resistant to (doesn’t respond to) the antiretroviral treatment.
Without proper and consistent treatment, people living with HIV can develop AIDS sooner. By that time,
the immune system is quite damaged and has a harder time fighting off infection and disease. With the
use of antiretroviral therapy, a person can maintain chronic HIV infection without developing AIDS for
decades.
recurrent fever
chronic swollen lymph glands, especially of the armpits, neck, and groin
chronic fatigue
night sweats
dark splotches under the skin or inside the mouth, nose, or eyelids
sores, spots, or lesions of the mouth and tongue, genitals, or anus
bumps, lesions, or rashes of the skin
recurrent or chronic diarrhea
rapid weight loss
neurologic problems such as trouble concentrating, memory loss, and confusion
anxiety and depression
Antiretroviral therapy controls the virus and usually prevents progression to AIDS. Other infections and
complications of AIDS can also be treated. That treatment must be tailored to the individual needs of the
person.
Antiretroviral therapy helps keep HIV from progressing to AIDS. It also helps reduce the risk of
transmitting HIV to others.
When treatment is effective, the viral load will be “undetectable.” The person still has HIV, but the virus is
not visible in test results. However, the virus is still in the body. And if that person stops taking
antiretroviral therapy, the viral load will increase again and the HIV can again start attacking CD4
cells. Learn more about how HIV treatments work.
HIV medications
More than 25 antiretroviral therapy medications are approved to treat HIV. They work to prevent HIV
from reproducing and destroying CD4 cells, which help the immune system fight infection. This helps
reduce the risk of developing complications related to HIV, as well as transmitting the virus to others.
Treatment regimens
The U.S. Department of Health and Human Services (HHS) generally recommends a starting regimen of
three HIV medications from at least two of these drug classes. This combination helps prevent HIV from
forming resistance to medications. (Resistance means the drug no longer works to treat the virus.)
Many of the antiretroviral medications are combined with others so that a person with HIV typically
takes only one or two pills a day.
A healthcare provider will help a person with HIV choose a regimen based on their overall health and
personal circumstances. These medications must be taken every day, exactly as prescribed. If they’re not
taken appropriately, viral resistance can develop, and a new regimen may be needed.
Blood testing will help determine if the regimen is working to keep the viral load down and the CD4
count up. If an antiretroviral therapy regimen isn’t working, the person’s healthcare provider will switch
them to a different regimen that’s more effective.
Side effects of antiretroviral therapy vary and may include nausea, headache, and dizziness. These
symptoms are often temporary and disappear with time. Serious side effects can include swelling of the
mouth and tongue and liver or kidney damage. If side effects are severe, the medications can be
adjusted.
Costs for antiretroviral therapy vary according to geographic location and type of insurance coverage.
Some pharmaceutical companies have assistance programs to help lower the cost. Learn more about the
drugs used to treat HIV.
HIV prevention
Although many researchers are working to develop one, there’s currently no vaccine available to prevent
the transmission of HIV. However, taking certain steps can help prevent the spread of HIV.
Safer sex
The most common way for HIV to spread is through anal or vaginal sex without a condom. This risk can’t
be completely eliminated unless sex is avoided entirely, but the risk can be lowered considerably by
taking a few precautions. A person concerned about their risk of HIV should:
Get tested for HIV. It’s important they learn their status and that of their partner.
Get tested for other sexually transmitted infections (STIs). If they test positive for one, they should
get it treated, because having an STI increases the risk of contracting HIV.
Use condoms. They should learn the correct way to use condoms and use them every time they have
sex, whether it’s through vaginal or anal intercourse. It’s important to keep in mind that pre-seminal
fluids (which come out before male ejaculation) can contain HIV.
Limit their sexual partners. They should have one sexual partner with whom they have an exclusive
sexual relationship.
Take their medications as directed if they have HIV. This lowers the risk of transmitting the virus to
their sexual partner.
Avoid sharing needles or other drug paraphernalia. HIV is transmitted through blood and can be
contracted by using contaminated materials.
Consider PEP. A person who has been exposed to HIV should contact their healthcare provider about
obtaining post-exposure prophylaxis (PEP). PEP can reduce the risk of contracting HIV. It consists of
three antiretroviral medications given for 28 days. PEP should be started as soon as possible after
exposure, but before 36 to 72 hours have passed.
Consider PrEP. A person at a high risk of HIV should talk to their healthcare provider about pre-
exposure prophylaxis (PrEP). If taken consistently, it can lower the risk of contracting HIV. PrEP is a
combination of two drugs available in pill form.
Healthcare providers can offer more information on these and other ways to prevent the spread of
HIV. Check here for more information on STI prevention.
The most important thing is to start antiretroviral treatment as soon as possible. By taking medications
exactly as prescribed, people living with HIV can keep their viral load low and their immune system
strong. It’s also important to follow up with a healthcare provider regularly.
Other ways people living with HIV can improve their health include:
Make their health their top priority. Steps to help people living with HIV feel their best include:
o fueling their body with a well-balanced diet
o exercising regularly
o getting plenty of rest
o avoiding tobacco and other drugs
o reporting any new symptoms to their healthcare provider right away
Focus on their emotional health. They could consider seeing a licensed therapist who is experienced
in treating people with HIV.
Use safer sex practices. Talk to their sexual partner(s). Get tested for other sexually transmitted
infections (STIs). And use condoms every time they have vaginal or anal sex.
Talk to their healthcare provider about PrEP and PEP. When used consistently by a person without
HIV, pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) can lower the chances of
transmission. PrEP is most often recommended for people without HIV in relationships with people
with HIV, but it can be used in other situations as well. Online sources for finding a PrEP provider
include PrEP Locator and PleasePrEPMe.
Surround themselves with loved ones. When first telling people about their diagnosis, they can
start slow by telling someone who can maintain their confidence. They may want to choose someone
who won’t judge them, and who will support them in caring for their health.
Get support. They can join an HIV support group, either in person or online, so they can meet with
others who face the same concerns they have. And their healthcare provider can steer them toward a
variety of resources in their area.
There are many ways to get the most out of life when living with HIV. Hear some real stories of people
living with HIV.
It’s a dramatic improvement, due in large part to antiretroviral therapy. With proper treatment, many
people with HIV can expect a normal or near normal lifespan.
Of course, many things affect life expectancy for a person with HIV. Among them are:
Where a person lives also matters. People in the United States and other developed countries may be
more likely to have access to antiretroviral therapy. Consistent use of these drugs helps prevent HIV
from progressing to AIDS. When HIV advances to AIDS, life expectancy without treatment is about three
years. In 2017, about 20.9 million people living with HIV were using antiretroviral therapy.
Life expectancy statistics are just general guidelines. People living with HIV should talk to their
healthcare provider to learn more about what they can expect. Learn more about life expectancy and
long-term outlook with HIV.
The first HIV vaccine efficacy study in seven years is currently underway in South Africa. The experimental
vaccine is an updated version of one used in a 2009 trial that took place in Thailand. A 3.5-year follow-
up after vaccination showed the vaccine was 31.2 percent effective in preventing HIV infection. It’s the
most successful HIV vaccine trial to date.
The study involves 5,400 men and women from South Africa. In 2016 in South Africa, about 270,000
people contracted HIV. The results of the study are expected in 2021.
While there’s still no vaccine to prevent HIV, people with HIV can benefit from other vaccines to prevent
HIV-related illnesses, such as:
pneumonia
influenza
hepatitis A and B
meningitis
shingles
Other research into an HIV vaccine is also ongoing. Learn why an HIV vaccine is so difficult to develop.
HIV statistics
Here are today’s HIV numbers:
In 2016, about 36.7 million people worldwide were living with HIV. Of those, 2.1 million were children
below the age of 15.
In 2017, only 20.9 million people living with HIV were using antiretroviral therapy.
Since the pandemic began, 76.1 million people have contracted HIV, and AIDS-related complications
have claimed 35 million lives.
In 2016, 1 million people died from AIDS-related diseases. This is a decline from 1.9 million in 2005.
Eastern and southern Africa are hardest hit. In 2016, 19.4 million people in these areas were living with
HIV, and 790,000 more contracted the virus. The region has more than half of all people living with
HIV worldwide.
Every 9.5 minutes, someone in the United States contracts the virus. That’s more than 56,000 new
cases a year. It’s estimated that 1.1 million Americans are currently living with HIV, and 1 in 5 don’t
know that they have it.
About 180,000 American women are living with HIV. In the United States, almost half of all new cases
occur in African-Americans.
Untreated, a woman with HIV has a 25 percent chance of passing HIV to her baby during pregnancy
or breastfeeding. With antiretroviral therapy throughout pregnancy and avoidance of breastfeeding,
the risk is less than 2 percent.
In the 1990s, a 20-year-old person with HIV had a life expectancy of 19 years. By 2011, it had
improved to 53 years. Today, life expectancy is near normal if antiretroviral therapy is started soon
after contracting HIV.
As access to antiretroviral therapy continues to improve around the world, these statistics will hopefully
keep changing. Learn more statistics about HIV.