This article was medically reviewed by Dr. Mohamed Hasham.
In this blog, ID Care infectious disease specialist, Dr. Mohamed Hasham, answers some of the many questions people have when it comes to HIV/AIDS, such as: What is HIV, What are the risk factors for HIV? How do you test for HIV? What happens when someone gets infected with HIV? What are likely signs and HIV symptoms? What is the distinction between HIV-1 and HIV-2, and HIV and AIDS? How does ID Care treat HIV?
What is HIV?
Dr. Hasham explains that HIV is an acronym that stands for human immunodeficiency virus. This is the virus that is known to cause AIDS which is also an acronym for acquired immune deficiency syndrome. The virus is transmitted from person to person via bodily fluids including semen, blood, vaginal fluid and breast milk, but not by saliva. A good overview of the history of HIV and AIDS can be found on Avert, a resource for global information and education on HIV and AIDS.
What are the Top Risk Factors for HIV?
Multiple leading medical resources state that the most common risk factors for HIV include:
- Unprotected sex, especially with multiple partners or anonymous partners.
- Injection drug use, primarily if they’re dirty needles or you share them with others. Even a small amount of blood with HIV can be passed on to you.
Dr. Hasham notes that there are also reports of HIV transmission through the placenta and pregnancy, so if a mother is infected, she can pass it on. Along with passing it on through breast milk.
How Do You Test for HIV?
According to Mayo Clinic, HIV is usually diagnosed by testing your blood or a sample of cells taken with a swab from inside your cheek for the presence of antibodies to the virus. HIV tests vary in how soon they are able to detect infection. The time between when you get the virus and when it can be detected is called the window period. It can take up to three to 12 weeks for your body to make enough antibodies for an antibody test to detect HIV infection. It usually takes a few days to a few weeks to get results of an HIV test, although rapid HIV tests can produce results in about 20 minutes. Regardless of the type of screening test used, if you have an initial positive result, you’ll need follow-up testing to establish an HIV diagnosis.
What Happens When Someone Gets Infected With HIV?
“When somebody gets infected with HIV,” states Dr. Hasham, “the virus gets into the bloodstream and attacks certain immune cells and for our purposes, let us call it the CD4 cell. What happens is that the virus attaches onto receptors that are on the top of these immune cells. It binds onto that cell and releases its genetic material into this cell which will then find its way to the powerhouse of the cell (the cell nucleus). This starts the process of integrating into the DNA and replicating the virus, eventually coming out of the nucleus, exiting the cell, and infecting another cell.
When it exits the cell to get back into the bloodstream in order to go and infect another cell, it bursts out of that CD4 cell and that cell is dead. And what happens is you get such a huge viral response in the early stage of the infection because these viruses are replicating very, very quickly, so cell numbers will drop. Over time, the immune system does start to kick in and it will try and kind of tame the situation, and you almost level off with the viral number.
During this time, the immune system is just trying to keep up, but eventually it will tire out and then the immune system will drop again. And that is when you risk your T cells (white blood cells also known as your CD4 cells) reaching a certain number, or on the lower end. Once you reach that point, then you are looking at having AIDS. There are other criteria for AIDS as well but lowering the number down to the point where it cannot quiet a lot of the infection is also criteria for the AIDS definition.”
What are the Likely Signs and HIV Symptoms? Are HIV Symptoms in Men and HIV Symptoms in Women the Same or Different?
Dr. Hasham notes that HIV symptoms do not necessarily differ between men and women, because we’re talking about the body’s immune system which makes no distinction between men and women. Symptoms can include a flu-like syndrome. You can feel fatigued, tired, can suffer from fever, chills, night sweats, muscle aches, and swollen lymph nodes.
According to HIV.gov, these symptoms can last anywhere from a few days to several weeks. But some people do not have any symptoms at all during this early stage of HIV. Important to note is that you should not assume you have HIV just because you have any of these symptoms as they can be similar to those caused by other illnesses.
What is the Distinction Between HIV-1 and HIV-2?
HIV-1 is the most common type of HIV and accounts for 95% of all infections, whereas HIV-2 is relatively uncommon and less infectious. HIV-2 is mainly concentrated in West Africa and the surrounding countries. HIV-2 is less fatal and progresses more slowly than HIV-1.
What is the Difference Between HIV and AIDS?
According to HIV.gov, AIDS is the late stage of HIV infection that occurs when the body’s immune system is badly damaged because of the virus. In the U.S., most people with HIV do not develop AIDS because taking HIV medicine every day as prescribed stops the progression of the disease.
A person with HIV is considered to have progressed to AIDS when:
- the number of their CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3). In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3. OR
- they develop one or more opportunistic infections regardless of their CD4 count.
Even if Someone Has Full-blown AIDS, Can AIDS be Reversed to HIV?
Dr. Hasham states that, “yes, this is possible if you are able to build up their immune system to where it was or close to where it was. This is a testament to the new medications that we have, which are amazing. We tell patients that you have to take HIV medication every day or take it how it is prescribed. This is the only way these medications work.”
What are the Latest Treatments for HIV?
“We go by the general recommendations from the Infectious Disease Society,” states Dr. Hasham. “And we base our HIV treatment on several things. One, ease of therapy; try and get one pill once a day. Those pills are typically a combination of two to three different drugs that each have a different role in how they combat the HIV virus, how they combat the replication of the virus and even how the virus enters the cell.
The treatment is also based on the virus itself that the person has. We do genetic testing to determine which of the medications the virus will respond to. Based on that, along with talking with the patient, we come up with their medication plan. The right plan requires a lot of interactive discussions back and forth with the patient.” Dr. Hasham reiterates that this takes a lot of skill. “You have to move along the relationship. Patients have to be able to trust you. All that goes into it when you are also deciding on which treatment to use because they may question it later.”
Dr. Hasham also notes that when talking with a patient, he is making sure that they are keeping up with their general health, including their blood pressure and cholesterol. “We advise them to make sure that they follow up with their primary care doctor to ensure that they have those things under control. Especially if we are concerned that one of the medications might be affecting, let us say, their cholesterol for example. We make sure that they are getting care for that. It is not just the HIV itself.”
How Often Do You Interface with Patients?
Dr. Hasham indicates that if he is starting somebody brand new on a new medication, he will bring them back in two weeks to test their blood work. And if everything is going in the right direction, then he will bring them back in three months and do it again. “Over time, that differs with different people, and can stretch out from every three months to every six months and in some situations, we have done yearly visits. But in that interim period, we would get blood work done to make sure everything is going okay.”
What Else Should People Know About HIV and Potentially AIDS in Today’s World?
Dr. Hasham wants people to know that “HIV, and HIV AIDS, is still here, even though it might no longer be the hot topic as it was in the late 80s and 90’s. It is still very real. When you have people that are engaging in risky behavior, you worry about transmission. So, I would want people to be safe and protect themselves when they are in any kind of sexual relationship, for example, but it is not only that. You can get it from needle sticks. You can get it from drug use. Those are the main things to consider, especially for preventive measures.”
Is There Any HIV Cure on the Horizon?
“I don’t know if there is the cure on the horizon,” states Dr. Hasham, “but there are some very interesting things going on with vaccine trials that are being looked at. Also, other treatments are being explored that are similar to what they use in cancer treatment.
I am hopeful and optimistic that a cure is definitely in our lifetime and hopefully, sooner rather than later with all the different research going on – especially all the new technologies that are coming out in research. There is a lot of interest in the scientific community about HIV, which is always good. You have more eyes on it, more research going into it. This is always a good thing.”
How Can ID Care’s Infectious Disease Experts Help You?
The expert infectious disease specialists at ID Care are here to address any concerns you may have about HIV, HIV AIDS, or if you believe you may be infected. As the largest independent infectious disease practice on the East Coast, ID Care is always up-to-date on the latest information concerning infectious diseases as well as mitigation strategies patients and healthcare organizations can use to stop the spread. To learn more, visit idcare.com or call 908-281-0610 to schedule a consultation with an ID Care expert.