HIV and AIDS

What are HIV and AIDS?

HIV
HIV stands for Human Immunodeficiency Virus.

HIV infects and gradually destroys a person's immune system. The immune system is the part of the body that protects and reduces infections and cancers.

Initially someone living with HIV may show no signs or symptoms of HIV infection as their immune system manages to control it. However, in most cases after time their immune system will need help from anti-HIV drugs to keep the HIV infection under control.

There is no cure for HIV – treatment can only help keep the HIV infection under control rather than rid an individual of it completely.

AIDS
AIDS stands for Acquired Immune Deficiency Syndrome.

AIDS is not a single disease or condition; instead, it is a term that describes the point when an individual starts to get one or more specific illnesses due to the damage to their immune system caused by HIV.

People do not die of AIDS; they die from the cancers, pneumonia or other conditions that may take hold when their immune system has been weakened by HIV.

How HIV is transmitted?

HIV is not passed on easily from one person to another. The HIV virus is in body fluids, for the HIV to be passed on, the body fluids of someone who is already infected have to get into an uninfected person’s body and then into their bloodstream.

The body fluids that contain enough HIV to infect someone are:

• Seminal fluid (cum, semen, and  precum)
• Vaginal Fluids, including menstrual fluids
• Breast milk
• Blood

Other body fluids, like saliva, sweat or urine, do not contain enough of the HIV virus to infect another person.

The main ways that HIV can be transmitted are:

• Through unprotected penetrative sex (such as anal or vaginal sex)
• From mother to baby
• From blood to blood

It is important to understand you cannot get infected with the HIV virus from a range of social contact such as touching, kissing, hugging and others.

If you think you may have been exposed to HIV within the last 72 hours, you may be able to get PEP (post-exposure prophylaxis); a four week course of anti-HIV treatment which may prevent HIV infection after the virus has entered your body. You can find more information on PEP here.

Signs and symptoms

If you are infected with HIV then there are usually no symptoms straight away with some people who don’t get any symptoms at all.

The first symptoms of HIV may appear within six weeks of infection but after a few weeks they usually disappear. After this many people have no symptoms.

The most common symptoms are:

• Fever (raised temperature)
• Sore throat
• Body rash

Other symptoms can include:

• Tiredness
• Joint pain
• Muscle pain
• Swollen glands

These symptoms, which can last up to four weeks, are a sign that your immune system is putting up a fight against the virus. These symptoms can all be caused by conditions other than HIV, and do not mean you have the virus.

However, if you have several of these symptoms, and you think you have been at risk of HIV infection, you should get an HIV test.

HIV affects the ability of your body's immune system to fight infection. If the HIV is left untreated, it will destroy a type of white blood cell called CD4 T-cells, which are important for your immune system to do its job.

The number of CD4 blood cells that you have in your body is called your ‘CD4 count’. The lower the CD4 count the more likely you are to show signs of illness. However, a low CD4 count is not an illness itself. Some people are well when their CD4 count is low, at least for a while. Other people with HIV may have symptoms before their CD4 count is lowered.

What to look out for:

Common symptoms of HIV infection, especially as your CD4 count gets lower, can be:

• Unintentional weight loss
• Chronic diarrhoea
• Skin rashes, on your face, genitals or anus
• Increase in herpes ulcers or thrush infections in your mouth and genitals
• Sweats, more often at night
• Unusual tiredness
• Nausea or loss of appetite
• Swelling of glands in the neck, groin or armpits

These symptoms can all be caused by other infections or conditions other than HIV, and do not mean you have AIDS. If you experience all or some of the symptoms above regularly, it may be a good idea to think about getting a HIV test, especially if you think you may have been at risk of HIV infection. Details of your nearest sexual health clinic (GU clinic) can be found here.

Testing for HIV

If you think you have been exposed to HIV, you will need to decide whether to have a HIV test. This is an important decision that you should make as soon as possible.

What is an HIV test?

You can find out if you have been infected with HIV by having a blood test. The test not only looks for the HIV virus (antigen) itself but also for antibodies to the virus. Antibodies are made in your blood when an infection has got into your body.

When should I get an HIV test done?

It could take up to 12 weeks (3 months) for HIV antibodies to show up in the blood tests. However HIV antigens (the HIV virus) may be present and detectable in your blood from as little as 4 weeks after infection. How quickly HIV antigens or antibodies can be detected in your blood varies from person to person, and therefore HIV may not be detected, even though the infection is there, before 12 weeks from when you might have been exposed to HIV. This is called the window period.

Results of the test
If you have a test 3 months after you've run the risk of getting HIV and no antibodies or antigens (the HIV virus itself) are found, the result will be negative; you are certain not to have HIV. This negative result does not mean you are immune to HIV. If you continue to take risks you could be infected with HIV and will need to consider taking another HIV test. Having a test does not protect you from getting HIV.

If HIV antigens or antibodies or to HIV are present in your blood stream, then you will have a positive result which means you have HIV. Having the virus means you are more likely to pass it on to other people through unprotected sex, giving blood or sharing needles if you inject drugs. If you engaged in any of the above during the time between getting HIV and having the test you may have passed on the virus to others. If this is the case you should tell those involved so that they can get a HIV test. This can be done anonymously through the GUM clinic.

To make sure no-one is given the incorrect result, a positive result is only given after the blood has been tested many times. A HIV test is very reliable.

Where can I get an HIV test?

HIV tests can be done at the following places:

• Kwik Prick Rapid HIV test at Trade
• Trade’s Gay Men’s Clinics
• Genitor-Urinary Medicine (GUM) clinic
• Family doctor (GP)
• Private clinic
• Other HIV organisations within Leicester, i.e. LASS

If you have concerns about going for a HIV test, and would like to talk about the good things and not so good things about testing; what to expect when you go for a test, or would like some reading resources, then contact Trade.

Trade is here to support you at any time during your choice around HIV testing, contact us on the phone or drop in to see us anytime during office hours.

HIV Treatment

There is no cure for HIV, however there are drugs that can stop HIV reproducing and can drive down the amount of the virus in your body to very low levels.

Combination therapy

A combination of three or more drugs can stop HIV from reproducing and allow your immune system to recover. Three or more drugs are needed to be effective.

The aim of the treatment is to reduce the quantity of the virus, although it won't completely disappear.

There are now a number of anti-HIV drugs for doctors to use in combination therapy.

Side effects
Many people experience short term side effects when they begin to take the drugs. This usually improves after a few weeks. Any long-term side effects will be monitored by your doctor or clinic and dealt with as soon as possible.

If you experience on-going side effects from taking anti-HIV drugs you should see your doctor immediately.

Treatment as Prevention

• Taking anti-HIV treatment and having an undetectable viral load can significantly reduce the risk of HIV transmission.
• Even if you have an undetectable viral load there is a small risk that HIV transmission may occur; and this is likely to be higher for anal sex than for vaginal or oral sex.
• The risks of transmission increase if anti-HIV treatment is not taken properly or if either partner is infected with other STIs.
• Risks can be reduced by using condoms and having regular sexual health check-ups.

Remember: a condom is visible to both you and your partner; any failures can usually be clearly seen by both of you. Whereas a viral load is invisible, may not be up-to-date, and results are only given directly to you or your partner, not both.

How common is HIV?

HIV in the UK
HIV can affect anybody, regardless of their race, gender, sexuality, disability, culture and background, but in the UK most people with HIV come from one of two groups:

• Men who have sex with men
• People of sub-Saharan African origin

Gay men are the group most affected by HIV in the UK. However, in recent years more people newly diagnosed with HIV in the UK became infected through heterosexual sex rather than gay sex. The majority of these became infected with HIV when they were abroad.

Although HIV levels in these groups are high, there are a variety of other ways that people can become infected with HIV. Every year people become infected through injecting drugs; children have HIV passed on from their mothers; and a small number of people are infected through blood transfusions and blood products.

The Health Protection Agency estimates about 30% of people in the UK living with HIV do not know that they have become infected.

HIV around the world
The joint United Nations Programme on HIV/AIDS (UNAIDS) has estimated that there are up to 40 million people living with HIV in the world. 70% of them live in sub-Saharan Africa.

Within the three most affected countries, Botswana, Swaziland and Lesotho - one in four people is living with the virus. There is no country outside Africa where more than one in 20 people are living with the virus.

HIV in Leicester
Leicester City has a rate of HIV higher than the national average with 3.38 people in every 1000 being infected with the virus, compared to the national average of 2 in every 1000.

The rates within the Leicestershire and Rutland, however, fall below the national average.

Living with HIV

It is possible to be HIV positive and have a good sex life without putting your partner at great risk or putting yourself at any further risk.

If you are living with HIV there are a number of issues that you need to think about when it comes to sex.

Treatments might affect your sex drive, or it might be affected by the pressures of coping with your diagnosis. It's all part of managing your sex life.

Consider / Decisions

These are some things you need to think about:

• Telling others about having HIV
• What to do if either you or your partner is living with HIV and the other is not
• Using condoms and femidoms
• Re-infection
• How your viral load affects your actions
• Having children
• Avoiding telling others about having HIV

Telling others about having HIV
Telling somebody about your HIV status or your partner's HIV status can be very difficult. There might be all kinds of things to consider and implications that worry you, before you rush into anything, it may be worth talking it through with us at Trade to get some advice and support.

Re-infection

Some couples assume that if they are both living with HIV then there is no need to practice safer sex. This isn't the case due to the risk of re-infection; research is now suggesting that there are different strains of the HIV virus. So if you have unprotected sex with another person who has HIV you could become infected with another strain of HIV; one that might be resistant to the medication you are taking or that will affect your immune system more dramatically. There is also the possibility of transmitting other STIs.

Viral Loads

If you have a high level of the HIV virus in your bloodstream (a high viral load) then your HIV is more likely to be transmitted to someone else if you don't practice safe sex than it is if you have a low viral load. But having an undetectable viral load does not mean that you can't transmit the virus. Undetectable means just that: it can't be detected by tests, but the virus is still there.

Pregnancy

If you have HIV it is still possible to have children without them having HIV.

If a man is living with HIV then his sperm can have the HIV virus removed from it in a process called sperm washing before being used in artificial insemination.

For women living with HIV the risk of transmission to the baby (known as vertical transmission) is greatest during birth. If the mother is taking combination therapy and gives birth by caesarean section then this risk is reduced. Breastfeeding can transmit the virus so bottle feeding is advised.