Frequently Asked Questions (FAQs) About HIV

HIV (human immunodeficiency virus) is a virus that lives in the blood and infects CD4 cells in the body. It has been estimated that roughly 1.1 million Americans are living with HIV, and about 15 percent are unaware of their status (have not yet been diagnosed).^1,2 Beyond the United States, HIV is a global concern. The World Health Organization (WHO) estimates that nearly 37 million people are living with HIV across the world.^1-3

What is HIV?

HIV (human immunodeficiency virus) is a virus that infects and destroys CD4 cells in the body. CD4 cells, also known as T cells, are important to the immune system because CD4 cells help our bodies fight off infection.⁴ As HIV progresses, the number of CD4 cells within the body decreases. When the number of CD4 cells (also called a CD4 count) decreases, people can become more susceptible to serious and life-threatening illnesses like infections and certain cancers.

This is why HIV treatment is so important! HIV treatment stops HIV replication, lowering viral load or the amount of HIV in the body. As the viral load decreases, this gives the CD4 cells of the immune system a chance to recover, increasing CD4 count.⁵

What bodily fluids transmit HIV?

HIV can affect anyone. Although the virus is transmitted by certain sexual behaviors or during injection drug use, the virus can be transmitted as long as there is a transmission event. A transmission event occurs when HIV-containing bodily fluids come into contact with an opening in the skin (such as a wound) or the mucous membranes of an individual without the virus. Mucous membranes are the surfaces that line the inside of the mouth, penis, vagina, and rectum. Mucous membranes are also found in the eyes and nose.

Bodily fluids that can contain and transmit the virus include:

• Blood
• Semen
• Rectal fluids
• Vaginal fluids
• Breast milk
• Pre-seminal fluid (also called precum)¹

What are the stages of HIV?

There are three stages of HIV progression: early-stage HIV, clinical latency, and late-stage HIV (also known as AIDS). Each stage of HIV progression has its own characteristics. In early-stage HIV, an individual who has newly acquired the virus may show symptoms early on, and then have no symptoms for years after. This depends on how quickly the virus progresses in their body.

The second stage of HIV is called the clinical latency stage. Although HIV replication never stops, it slows down during the clinical latency stage. During this time, the body reaches a balance point where HIV replication and CD4 cell death (the human immune cells that HIV infects) level off. Without treatment, the clinical latency stage can last anywhere from two to 15 years, or more, depending on a variety of factors. As time progresses, the HIV replication will slowly out-pace the CD4 cells. This leads to a significant decrease in CD4 count over time.^6-10

The third stage is late-stage HIV. This advanced stage of HIV is most commonly known as AIDS (acquired immunodeficiency virus). Eventually, the slowly replicating HIV will lead to a significant decrease in the CD4 cell count. For an individual who is not HIV positive, a normal CD4 count can be anywhere from 500-1,500 cells/microliter. When an individual has AIDS, their CD4 count is below 200 cells/microliter (also referred to as a CD4 count of 200). When a person's CD4 count gets very low, such as below 50, their case is considered to be very advanced.⁸

How can I reduce the risk of HIV transmission?

There are methods available for reducing the risk of HIV transmission. HIV antiretroviral therapy is essential to HIV treatments; it helps to decrease the amount of HIV in the blood. Recent research has suggested that those who achieve and maintain an undetectable viral load have virtually no risk of transmitting the virus to an HIV-negative partner. Therefore, the risk of HIV transmission to an HIV-negative partner can be reduced when an HIV-positive partner is on ART and taking their medications as prescribed.^23-25

Condoms also reduce the risk of transmission of HIV and other sexually transmitted infections (STIs). PrEP and PEP are treatment regimens that can also lower an individual's risk of acquiring HIV. People who inject drugs or share needles are at an increased risk of HIV transmission. There are several methods to help reduce the chances of HIV transmission including, but not limited to, participating in a needle exchange program or using bleach to clean used needles.^26,27

How can I get tested for HIV?

There are a variety of locations and services an individual can use to get tested for HIV. A good first step is to visit your regular doctor or primary care provider. They can provide HIV testing, including proper interpretation of test results, and access to treatment if need be.

Many individuals may feel uncomfortable seeing their primary care provider, and some may not have a regular provider at all. If this is the case, HIV testing is still available. Many community health centers or clinics offer testing, as well as local health departments, family planning clinics, substance abuse programs or treatment centers, VA health centers, and Planned Parenthood clinics.

If you are unsure of where to start when it comes to HIV testing, you can also use national resources created by the CDC (Centers for Disease Control and Prevention) to find options near you. These include:

• Visiting gettested.cdc.gov
• Texting your zip code to 566948 (KNOW IT)
• Calling 1-800-CDC-INFO (1-800-232-4636)²²

How long can a person live with HIV?

Life expectancy with HIV has increased significantly with the use of ART medicines (antiretroviral therapy). Some recent studies have suggested that for an individual with HIV who takes ART as directed, life expectancy is approaching, or even the same as, that of the general population.^18-21

How is HIV treated?

Currently, there isn't a cure for HIV. However, because HIV is a chronic condition, there are medications available to treat and suppress the virus. The main goal of HIV treatment is to lower the viral load or the amount of HIV in the blood. HIV treatment is commonly treated with combination therapies (a combination of various drug classes into one tablet or pill). The main drug classes for HIV treatment are designed to work in different parts of the HIV life cycle. These include CCR5 antagonists, post-attachment inhibitors, fusion inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), integrase inhibitors, protease inhibitors, pharmacokinetic enhancers.¹⁸

Is there medication available to lower the chances of acquiring HIV?

There are currently medication regimens available that can reduce an individual's risk of getting HIV. These methods are commonly known as prophylaxis or prophylactic treatment. PrEP (pre-exposure prophylaxis) is a medication regimen only for individuals who are currently HIV-negative, but who may be at an increased risk of getting the virus. PEP (post-exposure prophylaxis) is used immediately after a potential exposure to HIV has occurred. If an individual has been potentially exposed to HIV during a transmission event, PEP is used to prevent HIV. PEP must be taken within 72-hours of potential exposure.

What is currently being studied in HIV research and is there a cure?

It is a busy and exciting time in HIV research. Current efforts are focused on achieving HIV remission without the use of daily antiretroviral therapy (ART) through long-acting therapy. Other areas of research include HIV vaccines and immune system boosting therapies, treatments aimed at eliminating latent HIV, as well as stem cell transplants and gene therapy.

How does HIV impact aging?

Since the first cases of HIV were reported in the early 1980s, our understanding of HIV and its treatment has come a long way. Specifically, advancements in HIV treatment has allowed people with HIV to live longer lives. Because life expectancy has improved, this brings to light the impact of HIV on aging. Older individuals who are HIV positive are at risk for developing the following:

• Cardiovascular disease: Coronary artery disease, congestive heart failure, ischemic stroke
• Certain cancers: Non-AIDS defining cancers like lung, anal, breast, colorectal, and prostate cancers, and Hodgkin’s lymphoma
• Kidney issues and diabetes
• HIV-associated neurocognitive disorders: Issues with memory, language, attention, motor skills, or problems walking
• Liver disease: Liver issues may occur of treatment, as some ART drugs have the potential to affect the liver.
• Osteoporosis or osteopenia
• Geriatric syndromes: Individuals with HIV may be at a higher risk of having other geriatric-related issues (older age-related issues) such as hearing or vision loss, falls, difficulties with daily activities, slow movements, and urinary incontinence.^11-17

What are complications and comorbidities of HIV?

HIV is a chronic condition that impacts the functioning of the immune system. As a result, this increases the risk of developing immune-related complications or conditions. This includes opportunistic infections, rashes, certain cancers, and kidney disease. In addition, because HIV shares methods of transmission with other conditions, there is an increased risk of acquiring other conditions. Common comorbidities of HIV include hepatitis C and other STIs.