Signs and symptoms

The symptoms of HIV and AIDS vary, depending on the phase of infection. When first infected with HIV, you may have no symptoms at all, although it's more common to develop a brief flu-like illness 2 to 6 weeks after becoming infected. But because the symptoms of an initial infection — which may include fever, headache, sore throat, swollen lymph glands and rash — are similar to those of other diseases, you might not realize you've been infected with HIV.

Even if you don't have symptoms, you're still able to transmit the virus to others. Once the virus enters your body, your own immune system also comes under attack. The virus multiplies in your lymph nodes and slowly begins to destroy your helper T cells (CD4 lymphocytes) — the white blood cells that coordinate your entire immune system.

You may remain symptom-free for 8 or 9 years. But the virus continues to multiply and destroy immune cells. Tests are likely to show a sharp decline in the number of these cells in your blood. Eventually, you may develop mild infections or chronic symptoms such as:

• Swollen lymph nodes — often one of the first signs of HIV infection
  
  
• Diarrhea
  
  
• Weight loss
  
  
• Fever
  
  
• Cough and shortness of breath

During the last phase of HIV — which occurs approximately 10 to 11 years after the initial infection — more serious symptoms may begin to appear, and the infection may then meet the official definition of AIDS. In 1993 the Centers for Disease Control and Prevention (CDC) redefined AIDS to mean the presence of HIV infection as shown by a positive HIV-antibody test plus at least one of the following:

• The development of an opportunistic infection — an infection that occurs when your immune system is impaired — such as Pneumocystis carinii pneumonia (PCP)
  
  
• A CD4 lymphocyte count of 200 or less — a normal count ranges from 600 to 1,000

By the time AIDS develops, your immune system has been severely damaged, making you susceptible to opportunistic infections. The signs and symptoms of some of these infections may include:

• Soaking night sweats
  
  
• Shaking chills or fever higher than 100 F for several weeks
  
  
• Dry cough and shortness of breath
  
  
• Chronic diarrhea
  
  
• Persistent white spots or unusual lesions on your tongue or in your mouth
  
  
• Headaches
  
  
• Blurred and distorted vision
  
  
• Weight loss

You may also begin to experience signs and symptoms of later-stage HIV infection itself, such as:

• Persistent, unexplained fatigue
  
  
• Soaking night sweats
  
  
• Shaking chills or fever higher than 100 F for several weeks
  
  
• Swelling of lymph nodes for more than 3 months
  
  
• Chronic diarrhea
  
  
• Persistent headaches
  
  

If you're infected with HIV, you're also more likely to develop certain cancers, especially Kaposi's sarcoma, cervical cancer and lymphoma.

Symptoms of HIV in children
Children who are HIV-positive often fail to gain weight or grow normally. As the disease progresses, they may have difficulty walking or delayed mental development and may develop cerebral palsy. Children are also susceptible to the same opportunistic infections adults are and may have severe forms of common childhood illnesses such as ear infections (otitis media), pneumonia and tonsillitis.

Fever Diarrhea Cerebral palsy Middle ear infection Children's middle ear infections: A Health Decision Guide Tonsillitis Children's Health Center

Causes

Normally, white blood cells and antibodies attack and destroy foreign organisms that enter your body. This response is coordinated by white blood cells known as CD4 lymphocytes. Unfortunately, CD4 lymphocytes are also the main targets of HIV, which attaches to the cells and then enters them. Once inside, the virus inserts its own genetic material into the CD4 lymphocytes and uses them to make copies of itself.

When the new copies of the virus break out of the host cells and enter your bloodstream, they search for other cells to attack. In the meantime, the old host cells die. The cycle repeats itself again and again. In the process, more than 10 billion new HIV particles are produced every day. To counter this huge virus production, your immune system turns out as many as 2 billion new CD4 cells daily.

Eventually, the virus wins this race. The number of CD4 cells in your body progressively decreases, and you develop severe immune deficiency, which means your body can't effectively fight off viruses and bacteria that cause disease.

How HIV is transmitted
You can become infected with HIV in several ways, including:

• Sexual transmission. 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. You can also become infected from shared sexual devices if they're not washed or covered with a condom. The virus is present in the semen or vaginal secretions of someone who's infected and enters your body through small tears that can develop in your rectum or vagina during sexual activity. If you already have another sexually transmitted disease, you're at much greater risk of contracting HIV. Contrary to what researchers once believed, women who use the spermicide nonoxynol-9 also may be at increased risk. This spermicide irritates the lining of the vagina and may cause tears that allow the virus into your body.
  
  
• Transmission through infected blood. In some cases the virus may be transmitted through blood and blood products — including whole blood, packed red cells, fresh-frozen plasma and platelets — you receive in blood transfusions. In 1985 American hospitals and blood banks began screening the blood supply for HIV antibodies. This blood testing, along with improvements in donor screening and recruitment practices, has substantially reduced the risk of acquiring HIV through a transfusion. Currently, the chance of transfusion-associated transmission in the United States is about 1 in every 450,000 to 1 in every 600,000 transfusions.
  
  
• Transmission through needle sharing. HIV is easily transmitted through needles and syringes contaminated with infected blood. That's why sharing intravenous drug paraphernalia puts you at high risk of HIV and of other infectious diseases such as hepatitis. Your risk is increased if you inject drugs frequently or also engage in high-risk sexual behavior. Although avoiding the use of injected drugs is the most reliable way to prevent infection, this may not be an option for you. If so, one way to reduce your risk is to use household bleach to sterilize injection paraphernalia. Another option is to participate in a needle exchange program in your community. These programs allow you to exchange used needles and syringes for sterile equipment. Finally, consider seeking counseling or treatment for your drug use.
  
  
• Transmission through accidental needle sticks. Transmission of the virus between HIV-infected patients and health care workers through needle sticks is low. The average risk is approximately 3 in 1,000.
  
  
• Transmission from mother to child. Between one-quarter and one-third of untreated pregnant women infected with HIV pass the infection to their babies. But if women receive treatment for their HIV infection during pregnancy, the risk to their babies decreases as much as two-thirds. When treatment is combined with Caesarean section, the infection rate may drop even further.
  
  
• Other methods of transmission. In rare cases the virus may be transmitted through organ or tissue transplants or unsterilized dental or surgical equipment.

STD quiz: Are you taking proper, preventive steps?

Ways HIV is not transmitted
To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. You can't become infected through ordinary contact — hugging, dancing or shaking hands — with someone who has HIV or AIDS. You also can't be infected in any of the following ways:

• Coming into contact with the sweat or tears of someone with HIV or AIDS.
  
  
• Sharing food, utensils, towels or bedding, a swimming pool, telephone or toilet seat with someone who has the virus.
  
  
• Being bitten by bedbugs or mosquitoes.
  
  
• Kissing someone who is HIV-positive or who has AIDS. There's no evidence that the virus is transmitted through kissing. Although HIV is sometimes found in the saliva of people with the virus, it occurs in low concentrations. In addition, natural inhibitory substances in saliva help prevent transmission of the virus.
  
  
• Donating blood.

Risk factors

HIV crosses all cultures, national borders and religions. Anyone, of any age, race, sex or sexual orientation can be infected, but you're at greatest risk of HIV/AIDS if you:

• Have unprotected sex with multiple partners. You're at risk whether you're heterosexual, homosexual or bisexual. Unprotected sex means having sex without using a new latex or polyurethane condom every time.
  
  
• Have unprotected sex with someone who is HIV-positive.
  
  
• Have another sexually transmitted disease, such as syphilis, herpes, chlamydia, gonorrhea or bacterial vaginosis.
  
  
• Share needles during intravenous drug use.
  
  
• Are a person with hemophilia who received blood products between 1977 and April 1985 — the date standard testing for HIV began.
  
  
• Received a blood transfusion or blood products before 1985.

Newborns or nursing infants whose mothers have tested positive for HIV also are at high risk.

Syphilis Genital herpes Gonorrhea Chlamydia Vaginitis

When to seek medical advice

If you think you may have been infected with HIV or are at risk of contracting the virus, seek medical counseling as soon as possible. Tests are available that can determine your status. Thinking about being tested for HIV infection is frightening for most people. But remember that testing itself doesn't make you HIV-positive or HIV-negative. Testing is important both for your own health and to prevent transmission of the virus to others.

You can be tested by your doctor, or at a hospital, the public health department, a Planned Parenthood clinic or other public clinics. Many clinics don't charge for HIV tests. Be sure to choose a place in which you feel comfortable and that offers counseling before and after testing. Don't let concern about what people may think stop you from being tested. For a referral, or to make an appointment for an HIV test at a Planned Parenthood clinic near you, call 800-230-PLAN (800-230-7526). You can also contact your local or state health department.

Keep in mind that HIV/AIDS tests may be either anonymous or confidential. A confidential test means that if your test is positive, the results will likely be reported to your state health department, but won't be released to anyone else without your permission. In an anonymous test, your name isn't recorded and no one but you can ever learn the test result. Not all states have anonymous testing, but most provide some type of confidential testing. Contact the National AIDS Hotline (800-342-AIDS, or 800-342-2437) or your state health department to find out more about the laws governing HIV reporting in your state.

If you're pregnant, you may want to get tested even if you think you're not at risk. If you are HIV-positive, treatment with antiretroviral drugs during your pregnancy can greatly reduce the chances you'll pass the infection to your baby.

If you engage in a high-risk behavior such as unprotected sex or sharing needles during intravenous drug use, get tested for HIV every 3 to 6 months.

Screening and diagnosis

HIV is diagnosed by testing your blood for the presence of antibodies to the virus. Unfortunately, HIV tests aren't accurate immediately after infection because it takes time for your body to develop these antibodies — usually from 6 to 12 weeks. In rare cases it can take up to 6 months for an HIV test to become positive.

Most often, you'll have a simple blood test known as an enzyme-linked immunosorbent assay (ELISA) screening test. If this test is positive — meaning you have antibodies to HIV in your blood — the same test will be repeated. If the repeat test is also positive for HIV antibodies, you'll have another confirming blood test called the Western blot test. This test looks for the presence of HIV proteins in your blood. The Western blot test is important because you may have non-HIV antibodies that cause a false-positive result on the ELISA test. Combining the two types of tests helps ensure that your results are accurate. You'll receive a diagnosis of HIV only if all three tests are positive.

If you test positive for an HIV infection, tell your sexual partner or partners right away so they can be screened and take steps to protect themselves.

If you receive a diagnosis of HIV/AIDS, your doctor will use a test to help predict the probable progression of your disease. This test measures the amount of virus in your blood (viral load). Studies have shown that people with higher viral loads generally fare more poorly than those with a lower viral load. Viral load tests are also used to decide when to start and when to change your treatment.

Complications

HIV infection weakens your immune system, making you highly susceptible to a large number of bacterial, viral, fungal and parasitic infections. You may also be vulnerable to certain types of cancers. But treatment with antiretroviral drugs has markedly decreased the number of many opportunistic infections and cancers affecting people with HIV. It's now more likely these infections will occur in people who have not had treatment.

Bacterial infections

• Mycobacterium avium complex (MAC). This infection is caused by a group of bacteria referred to by a single name — MAC. The bacteria normally cause an infection of the respiratory tract. But if you have advanced HIV infection and your CD4 lymphocyte count is less than 50, you're more likely to develop a systemic infection that can affect almost any internal organ, including your bone marrow, liver or spleen. MAC causes nonspecific symptoms such as fever, night sweats, weight loss, stomach pain and diarrhea.
  
  
• Tuberculosis (TB). Worldwide, TB is the most common opportunistic infection associated with HIV, accounting for 15 percent of all AIDS-related deaths. As many as 1 billion people are likely to become infected with TB in the next 20 years. Of these, 35 million may die as a result of their disease.
  
  Everyone who is HIV-positive should have a simple skin test for TB early in their medical care. If the test is positive, you'll also need a chest X-ray and other appropriate tests to make sure you don't have an active infection. If your TB isn't active, there are treatments to prevent it from becoming active in the future. TB is more worrisome than many other opportunistic infections because it spreads easily from one person to another, including those with healthy immune systems.
  
  You can get TB when someone with the disease coughs or sneezes near you. The bacteria then spread through your blood and lymph nodes to the rest of your body. TB most often affects the lungs, but people with HIV are more likely to have infection at other sites. Furthermore, TB can strike people with HIV regardless of their CD4 lymphocyte levels. This means TB often can occur years before other problems associated with HIV develop. Multidrug-resistant tuberculosis (MDR-TB), in which the disease resists treatment with traditional antibiotics, is of particular concern to people with HIV/AIDS. Ultimately, however, TB is of concern to everyone because it can affect even people with healthy immune systems.
  
  
• Salmonellosis. You contract this bacterial infection from contaminated food or water. Symptoms include severe diarrhea, fever, chills, abdominal pain and, occasionally, vomiting. Although anyone exposed to salmonella bacteria can become sick, salmonellosis is 20 times more common in people who are HIV-positive. You can reduce your risk by washing your hands carefully after handling food and animals and by cooking meat and eggs thoroughly.
  
  
• Bacillary angiomatosis. Rarely seen in people not infected with HIV, this infection first appears as purplish to bright red patches on your skin. It often resembles Kaposi's sarcoma. But it can also cause disease in other parts of your body, including your liver and spleen.

Tuberculosis

Viral infections

• Cytomegalovirus (CMV). This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and breast milk. At least half the adult population has been infected. But 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. Most commonly, CMV causes infection and inflammation of your retina (CMV retinitis). If not treated, CMV retinitis can lead to blindness.
  
  
• Viral hepatitis. Viral hepatitis is a viral infection of the liver. Symptoms include yellowing of your skin and the whites of your eyes (jaundice), fatigue, nausea, abdominal pain, loss of appetite and diarrhea. There are several types of hepatitis, but the most common are hepatitis A, B and C. Hepatitis B and C can lead to persistent or chronic infection and put you at risk of long-term complications such as cirrhosis or liver cancer. If you're HIV-positive and also have hepatitis, your HIV disease may progress more rapidly, and you may be more likely to develop liver toxicity from your medications.
  
  You contract hepatitis A from contaminated food and water and through poor hygiene. Those at greatest risk include intravenous drug users, gay men, people who live or have sex with someone who's already infected, international travelers or those who travel to or live on American Indian reservations or in Alaska's native villages. You can help protect yourself from this type of hepatitis by avoiding, as much as possible, suspect food and water and by practicing good hygiene. A highly effective vaccine also is available that can help prevent hepatitis A in HIV-positive and high-risk people.
  
  Sexually active heterosexuals, gay men and intravenous drug users have an especially high risk of acquiring hepatitis B. Infants born to mothers infected with hepatitis B, health care workers and patients on hemodialysis also are vulnerable to the disease. If you're at risk, you should be screened for hepatitis B. If you're not infected, there is a vaccine that can help protect you.
  
  Those who are at risk of hepatitis B are also at risk of hepatitis C, which has a high likelihood — an 85 percent chance or more — of progressing to chronic infection. Unfortunately, there's no vaccine against hepatitis C.
  
  
• Herpes simplex virus (HSV). HSV, which usually causes genital herpes, may be transmitted during unprotected anal or vaginal sex. Initial symptoms include pain or irritated skin in the genital area. Later, sores that ooze and bleed erupt on the genitals, buttocks and anus. Although these sores eventually heal, the virus periodically reappears, causing the same symptoms. If you have HIV, your skin infection is likely to be more severe than would occur in people who don't have HIV, and the sores may take longer to heal. Systemic symptoms may also be more severe. Although the herpes virus isn't life-threatening in adults, it may cause brain damage, blindness or death in infants infected during delivery.
  
  
• Human papillomavirus (HPV). This is one of the most common causes of sexually transmitted disease. Some types of this virus cause common warts; others cause warts on the genitals. If you're HIV-positive, you're especially susceptible to infection with HPV and more prone to recurrent infections. HPV infection is especially serious because it puts women at risk of cervical cancer and puts both men and women at risk of anal cancer. Infection with both HPV and HIV increases a woman's risk even further, because cervical cancer seems to occur more often and more aggressively in women who are HIV-positive. About half of all women with HPV have no symptoms. Women who are HIV-positive or have unprotected sex with more than one partner should have a Pap test — a test that examines cells taken from the cervix — every year to check for cervical cancer, HPV and other sexually transmitted diseases. Anyone who engages in anal sex should be tested for anal cancer.
  
  
• Progressive multifocal leukoencephalopathy (PML). PML is an extremely serious brain infection. Symptoms vary and may include speech problems, weakness on one side of the body, loss of vision in one eye or numbness in one arm or leg. PML usually occurs only when your immune system has been severely damaged.

Hepatitis A Hepatitis B Hepatitis C Pap test: Simple, lifesaving test Genital warts Cervical cancer Women's Health Center

Fungal infections

• Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick white coating on the mucous membranes of your mouth, tongue (thrush), esophagus (Candida esophagitis) or vagina. Children may have especially severe symptoms in the mouth or esophagus, which can make eating painful and difficult.
  
  
• Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and spinal cord (meninges). Cryptococcal meningitis, the most common central nervous system infection associated with HIV, is caused by a fungus that is present in soil. Symptoms include headache, a high fever, stiff neck and sensitivity to light. Cryptococcal meningitis can be successfully treated with antifungal medications, but early treatment is essential. Meningitis is a serious disease that can cause severe complications or prove fatal in a short period of time. Once you've had cryptococcal meningitis, you'll need to be on long-term medication to prevent a recurrence.

Oral thrush

Parasitic infections

• Pneumocystis carinii pneumonia (PCP). This is the most common opportunistic infection that occurs with AIDS in the United States. PCP attacks your lungs, making it difficult for you to breathe. Symptoms include a cough that doesn't go away, fever and trouble breathing. PCP is the leading cause of death in children with HIV. Fortunately, in recent years antiretroviral medications that boost the immune system have helped reduce the number of cases of this serious disease.
  
  
• Toxoplasmosis. Toxoplasmosis is the most common cause of brain lesions in people with advanced HIV disease. It's caused by Toxoplasma gondii, a parasite spread primarily by cats. Infected cats pass the parasites in their stools, and these may then spread to other animals. Humans generally contract toxoplasmosis by touching their mouths with their hands after changing cat litter or by eating raw or undercooked meat, especially pork, lamb and venison. If you become infected with the parasites while pregnant, you may pass the infection to your baby. Once you're infected, the parasites can spread to every organ in your body, including your heart, eyes and lungs. For many people with AIDS, toxoplasmosis leads to encephalitis, an infection of the brain. Symptoms may include disorientation, seizures and difficulty walking or speaking.
  
  
• Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly found in animals. You contract cryptosporidiosis when you ingest contaminated food or water. The parasite grows in your intestines and bile ducts, and causes severe, chronic diarrhea in people with AIDS.

Cancers

• Kaposi's sarcoma. Kaposi's sarcoma is a tumor of the blood vessel walls. It's the most common cancer found in HIV-positive people, especially gay and bisexual men, but is extremely rare in people not infected with HIV. It usually appears as pink, red or purple lesions on your skin and in your mouth. In people with darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect your internal organs, including your digestive tract and lungs. Smaller skin lesions may be treated with liquid nitrogen, low-dose radiation or chemotherapy applied directly to the lesion. If the cancer is more severe or has spread to your internal organs, you may be treated with systemic chemotherapy.
  
  
• Non-Hodgkin's lymphoma. This cancer originates in lymphocytes, a type of white blood cell. Lymphocytes are concentrated in your bone marrow, lymph nodes, spleen, digestive tract and skin. Although lymphomas can start in other organs, they usually begin in your lymph nodes. The most common early symptom is painless swelling of the lymph nodes in your neck, armpit or groin.

Understanding cancer Non-Hodgkin's lymphoma

Other complications
Researchers identified wasting syndrome as a complication of AIDS in the 1980s. Although current aggressive treatment regimens have reduced the number of cases, wasting syndrome still affects many people with AIDS. It is defined as a loss of at least 10 percent of your body weight and is often accompanied by diarrhea, chronic weakness and fever.

Treatment

When HIV was first identified in the early 1980s, there were no drugs to treat the virus and few treatments for the opportunistic infections associated with it. Since then, a number of medications have been developed to treat both HIV/AIDS and opportunistic infections. For many people, including children, newer treatments have both extended and improved the quality of life. But none of these drugs can cure HIV/AIDS, many have side effects that can be quite severe, and treatment is often expensive.

Treatment guidelines
A panel of leading AIDS specialists has developed recommendations for the use of antiretroviral medications in people with HIV. These recommendations are based on the best information available at the time they were developed. The HIV/AIDS Treatment Information Service has a program in place to regularly refine and update the recommendations as knowledge about HIV infection evolves. According to current guidelines, treatment should focus on achieving the maximum suppression of symptoms for as long as possible. This aggressive approach is known as highly active antiretroviral therapy (HAART). The aim of HAART is to reduce the amount of virus in your blood to very low, or even nondetectable, levels, although this doesn't mean the virus is gone. This is usually accomplished with a combination of three or more drugs.

But the treatment guidelines also emphasize the importance of quality of life. Thus the goal of AIDS treatment is to find the strongest possible regimen that is also simple and has the fewest side effects. If you have HIV/AIDS, it's important that you take an active role in every treatment decision. You and your doctor should discuss the risks and benefits of all therapies so that you can make an informed decision about what will likely be a complex and long-term treatment.

Antiretroviral drugs
Antiretroviral drugs inhibit the growth and replication of HIV at various stages of its life cycle. Three classes of these drugs are available:

• Nucleoside analogue reverse transcriptase inhibitors (NRTIs). NRTIs were the first antiretroviral drugs to be developed. They inhibit the replication of an HIV enzyme called reverse transcriptase. They include zidovudine (Retrovir, AZT), lamivudine, didanosine (Videx), zalcitabine (Hivid), stavudine (Zerit) and abacavir (Ziagen). The major side effect of zidovudine is bone marrow suppression, which causes a decrease in the number of red and white blood cells. Approximately 5 percent of people treated with abacavir experience hypersensitivity reactions such as a rash along with fever, fatigue, nausea, vomiting, diarrhea and abdominal pain. Hypersensitivity reactions can also occur without a rash. In either case, symptoms usually appear within the first 6 weeks of treatment and generally disappear when the drug is discontinued. If you've had a hypersensitivity reaction to abacavir, avoid taking the drug again.
  
  
• Protease inhibitors (PIs). PIs interrupt HIV replication at a later stage in its life cycle by interfering with an enzyme known as HIV protease. This causes HIV particles in your body to become structurally disorganized and noninfectious. Among these drugs are saquinavir (Fortovase), ritonavir (Norvir), indinavir (Crixivan), nelfinavir (Viracept), amprenavir (Agenerase) and lopinavir (Kaletra).
  
  The most common side effects of protease inhibitors include nausea, diarrhea and other digestive tract problems. PIs can also cause a significant number of side effects when they interact with certain other medications you may be taking. That's because all PIs, to one degree or another, affect an enzyme system in your liver that is responsible for metabolizing a large number of drugs. Newer side effects have also appeared with the continuing and widespread use of protease inhibitors. These include elevated triglyceride levels and problems with sugar metabolism that may sometimes progress to diabetes.
  
  There may also be abnormalities in the way fat is metabolized and deposited in your body. Some people lose much of their total body fat; others gain excess fat on the back between their shoulders (buffalo hump) or in the stomach (protease paunch). No one knows exactly why these abnormalities occur. In fact it's not even certain whether these problems are a direct result of treatment with protease inhibitors or due to some other cause that has yet to be identified. Similar metabolic abnormalities have occurred in people on antiretroviral therapy that doesn't include PIs. Although these body changes can be distressing, the possibility they may occur should not stop you from obtaining treatment for HIV/AIDS.
  
  
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs). These drugs bind directly to the enzyme, reverse transcriptase. Three NNRTIs are approved for clinical use: nevirapine (Viramune), delavirdine (Rescriptor) and efavirenz (Sustiva). A major side effect of all NNRTIs is a rash. In addition, people taking efavirenz may have side effects such as abnormal dreams, sleeplessness, dizziness and difficulty concentrating.

Fusion inhibitors
One of the most alarming developments in the AIDS epidemic is the emergence of drug-resistant strains of HIV. Worldwide, a majority of people receiving treatment for HIV are resistant to at least one drug, and many don't respond to a typical three-drug combination. But a drug called T-20 or enfuvirtide (Fuzeon), the first in a new class of drugs called fusion inhibitors, appears to suppress even the most resistant strains of HIV. Fusion inhibitors stop the virus from replicating by preventing its membrane from fusing with the membrane surrounding healthy cells. In March 2003, the Food and Drug Administration approved Fuzeon for use in combination with other HIV drugs and for adults and children older than 6 who have advanced infection and who have developed resistance to other drugs. Doctors administer Fuzeon by injection.

Your response to any treatment is measured by the levels of HIV in your blood (viral load). These levels should be tested at the start of treatment and then every 3 to 4 months while you're on therapy. In some cases you may be tested even more often.

Peripheral neuropathy Pancreatitis Diabetes

New treatments
More than a dozen HIV vaccines are currently being tested, and many new drugs for HIV- or AIDS-related infections are in development. Although these drugs are not yet licensed, some may be available by compassionate exception to people who need them.

For more information on new therapies, call the AIDS Clinical Trials Information Service at 800-TRIALS-A (800-874-2572). If you'd like to find out more about federally approved treatment guidelines, contact the HIV/AIDS Treatment Information Service at 800-HIV-0440 (800-448-0440).

The National Library of Medicine's Health Services/Technology Assessment Text Database also provides access to the full text of documents that may help you make treatment decisions.

National Library of Medicine: HSTAT (Health Services/Technology Assessment Text): http://lhncbc.nlm.nih.gov/csb/CSBPages/HSTATproject.html

Prevention

There's no vaccine to prevent HIV infection and no cure for AIDS. But it's possible to protect yourself and others from infection. That means educating yourself about HIV and avoiding any behavior that allows HIV-infected fluids — blood, semen, vaginal secretions and breast milk — into your body.

If you're HIV-negative
The following measures can help keep you from being infected with HIV:

• Educate yourself and others. Make sure you understand what HIV is and how the virus is transmitted. Just as important, teach your children about HIV.
  
  
• Know the HIV status of any sexual partner. Don't engage in unprotected sex unless you're absolutely certain your partner isn't infected with HIV.
  
  
• Use a new latex or polyurethane condom every time you have sex. If you don't know the HIV status of your partner, use a new latex condom every time you have anal or vaginal sex. If you're allergic to latex, use a plastic (polyurethane) condom. Avoid lambskin condoms — they do not protect you from HIV. If you don't have a male condom, use a female condom. Use only water-based lubricants, not petroleum jelly, cold cream or oils. Oil-based lubricants can weaken condoms and cause them to break. During oral sex use a condom, dental dam — a piece of medical-grade latex —or plastic wrap. Remember that although condoms can reduce your risk of contracting HIV, they don't eliminate the risk entirely. Condoms can break or develop small tears, and they may not always be used properly.
  
  
• 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.
  
  
• Be cautious about blood products in certain countries. Although the blood supply in the United States is now well screened, this isn't always the case in other countries. If an emergency requires that you receive blood or blood products in another country, get tested for HIV as soon as you return home.
  
  
• Get regular screening tests. If you're a woman, have a yearly Pap test. Men and women who engage in anal sex should also have regular tests for anal cancer.
  
  
• Don't become complacent. Because potent antiretroviral medications have reduced the number of AIDS deaths in the United States, you may think that HIV infection is no longer a problem. But HIV/AIDS is still a terminal illness for which there is no vaccine and no cure. Right now, the only way to stay healthy is to protect yourself and others from infection.

Condoms: The right form of birth control for you? Latex allergies

If you're HIV-positive
If you've received a diagnosis of HIV/AIDS, the following guidelines can help protect others:

• Follow safer sex practices. The only foolproof way to protect your sexual partner or partners from HIV infection is to avoid practices that expose them to blood, semen or vaginal secretions. Barring that, carefully follow guidelines for safer sex, including using a new latex condom every time you have vaginal or anal sex and using a dental dam, condom or piece of plastic wrap during oral sex. If you use sexual devices, don't share them.
  
  
• Tell your sexual partner(s) you have HIV. It's important to tell anyone with whom you've had sex that you're HIV-positive. Your partners need to be tested and to receive medical care if they have the virus. They also need to know their HIV status so they don't infect others.
  
  
• If your partner is pregnant, tell her you have HIV. Even if you're not the father, be sure to tell any pregnant woman with whom you've had sex that you're HIV-positive. She needs to receive treatment to protect her own health and that of her baby.
  
  
• Tell others who need to know. Although only you can decide whether to tell friends and family about your illness, you do need to inform your health care providers of your HIV status. This is not just to protect them, but also to ensure that you get the best possible medical care.
  
  
• Don't share needles or syringes. If you use intravenous drugs, never share your needles and syringes with anyone else.
  
  
• Don't donate blood or organs. The virus will spread to other people.
  
  
• Don't share razor blades or toothbrushes. These items may carry traces of HIV-infected blood.
  
  
• 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 by as much as two-thirds. Having your baby by Caesarean section cuts the risk even further.

Pregnancy Center

Self-care

Although it's important to receive medical treatment for HIV/AIDS, it's also essential to take an active role in your own care. The following suggestions may help you stay healthy longer:

• Make sure your doctor knows how to treat HIV. Find someone who understands all the ramifications of the disease. You'll also want a doctor who is willing to work with you and who makes you feel comfortable and respected.
  
  
• Follow your doctor's instructions. Keep all of your appointments, and take your medications exactly as directed. This is often challenging because you may have to take a number of medications throughout the day. But it's essential to follow your schedule as closely as possible. If you get sick from your medication, call your doctor. Don't stop taking your medication or change the dosage on your own.
  
  
• Get immunizations. These may prevent infections such as pneumonia and the flu.
  
  
• Don't smoke or use illegal drugs. These weaken your body even more.
  
  
• Eat the healthiest diet you can. Emphasize fresh fruits and vegetables, whole grains and lean protein. Healthy foods help keep you strong, give you more energy and support your immune system. Unfortunately, you may not always feel like eating when you have HIV. But good nutrition is tremendously important. A registered dietitian can be especially helpful if you have diarrhea, weight loss or trouble eating. Also, because your nutritional needs are extremely high and you may not digest food well, talk to your doctor about vitamin and mineral supplements.
  
  
• Avoid foods that may put you at risk of infection. These include unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi. Cook meat until it's well-done or until there's no trace of pink color.
  
  
• Drink pure water. The Department of Health and Human Services recommends that you boil tap water or use bottled or filtered water for drinking. If you buy a water filter, look for one that uses reverse osmosis as part of the purification process.
  
  
• Get regular exercise. Exercise helps increase your strength and energy levels and can help battle the depression that's often a part of dealing with HIV/AIDS.
  
  
• Get enough sleep. Rest when you need to.
  
  
• Take care with companion animals. Some animals may carry parasites that can cause infections in people who are HIV-positive. But that doesn't mean you should give up your companion animal. Animals are a great source of comfort. You can protect yourself by having someone else clean your cat's litter box or pick up after your dog. If you must do these chores yourself, wear latex gloves and wash your hands immediately afterward. Don't feed your pets raw meat, and make sure they have all of their shots. Always wash your hands thoroughly with soap and water after petting or playing with your animals.
  
  
• Find ways to relax. This might mean anything from yoga or meditation to walking, reading, playing chess or computer games, or listening to music.
  
  
• Keep your hands clean. Wash your hands thoroughly with soap and water after using the restroom, before eating or preparing food and after spending time in public places. You might find it helpful to carry a waterless alcohol gel with you for times when it's not convenient to use soap and water.

Immunizations for people with weakened immune systems Stop Smoking Program Aerobic exercise: Why and how Relaxation techniques Hand washing: The simplest way to avoid infection

Coping skills

Receiving a diagnosis of any life-threatening illness is devastating. But 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.

Fortunately, a wide range of services and resources are available to people with HIV. Most HIV/AIDS clinics have social workers, counselors or nurses who can help you with problems directly or put you in touch with people who can. All have experience with HIV and are there to help you with the large part of your life that lies beyond medicine. They can arrange for transportation to and from doctor appointments, help with housing and child care, deal with employment and legal issues and see you through financial emergencies.

Treatment for HIV presents its own problems. The regimens are complex and side effects can be severe. Furthermore, the physical effects of treatment can create difficulties in other areas of your life. You may have a hard time explaining to your employer why you're sick so often or have so many doctor visits, for example. You also may not be able to participate in life as fully as you would like.

Some of the following suggestions may help you deal with the emotional toll of living with HIV/AIDS:

• Learn all you can about HIV/ AIDS. Find out how the disease progresses, your prognosis and your treatment options, including both experimental and standard treatments and their side effects. The more you know, the more active you can be in your own care. One valuable resource is the National AIDS Hotline. The people there can answer questions about many different aspects of living with HIV/AIDS. You can reach them 24 hours a day, 7 days a week at 800-342-AIDS (800-342-2437).
  
  
• Be proactive. Although you may often feel tired and discouraged, don't let others — including your family or your doctor — make important decisions for you. It's vital that you take an active role in your treatment.
  
  
• Maintain a strong support system. Strong relationships are crucial in dealing with life-threatening illnesses. Although friends and family can be your best allies, in some cases they may have trouble dealing with your illness. If so, the concern and understanding of an HIV counselor, other people who are HIV-positive, or a formal support group can be especially helpful.
  
  
• Take time to make important decisions. One intense struggle you'll likely face is how much to reveal about your illness. When your disease is first diagnosed, you may not want anyone to know. But HIV/AIDS is a terrible burden to carry alone. Like many people, you may eventually decide that it's important for your emotional well-being to confide in someone you trust. The choice is up to you. You need to tell your current and former sexual partners and your health care providers. Beyond that there is no legal obligation for you to reveal your HIV status, even to your employer. In fact, the law guarantees your right to privacy.
  
  
• Come to terms with your illness. Coming to terms with your illness may be the hardest thing you've ever done. For some people, having a strong faith or a sense of something greater than themselves makes this process easier. Others seek counseling from someone who understands HIV/AIDS. Still others make a conscious decision to experience their lives as fully and intensely as they can or to help other people who have the disease. No matter how you choose to deal with the difficulties of HIV/AIDS, remember that you're not alone. There is a tremendous support network available for people with HIV infection. Call the National AIDS Hotline at 800-342-AIDS (800-342-2437) for more information.

Complementary and alternative medicine

Be sure to discuss any alternative treatments you may be using with your doctor. Some may interfere or interact with other medications you're taking. The herb St. John's wort, for instance, can interfere with the effectiveness of antiretroviral medications. If you're interested in finding out more about alternative and complementary treatments, many resources are available both on and off the Internet.

Herb and drug interactions: 'Natural' products not always safe

— March 17, 2003 —