HIV/AIDS

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have HIV/AIDS, or who would like information about it.

Human immunodeficiency virus (HIV) is a virus that can be passed from person to person by sexual contact, from mother to baby, and by blood-to-blood contact.

The HIV infection attacks the immune system, increasing the risk of infection, serious illnesses and some cancers.

AIDS (acquired immune deficiency syndrome) is a term used to describe the point at which the immune system has been weakened so much by HIV that it can't fight certain life-threatening infections and illnesses.

About HIV/AIDS

HIV is now a treatable condition and most people living with the virus can remain fit and well when on treatment.

Over 80,000 people were living with HIV in the UK at the end of 2008. Around three in every 10 people didn't know that they had an infection because they hadn't been tested.

The majority of infections are in heterosexuals; these are usually in people who have come to live in the UK from countries where HIV is widespread and have been diagnosed since living in the UK. Infections are also common among men who have sex with men.

AIDS is no longer a common term used by medical professionals, who now use the descriptions of advanced or late-stage HIV infection.

The immune system

When your immune system is healthy, it protects your body against infections caused by bacteria and viruses. White blood cells find and destroy germs that your body sees as 'foreign' and this stops you developing serious diseases.

HIV avoids being destroyed by your immune system by changing its outer 'coat' again and again. It multiplies (replicates) inside a type of white blood cell called a CD4 cell. This kind of cell is normally involved in helping other types of immune cell to attack and destroy bacteria and viruses.

As HIV multiplies, it destroys the CD4 cells in your body, so there are fewer of them. Having fewer CD4 cells means that your body's ability to fight other infections is weakened and your defences against certain cancers are reduced.

Symptoms of HIV/AIDS

The first few months after you become infected with HIV is called primary HIV infection, or acute HIV infection. You might also hear this called seroconversion. You may have symptoms of HIV infection but you may not pay attention to them, because they are like other infections such as flu. Early symptoms usually start about four weeks after the infection and can last for up to four weeks.

Symptoms of primary HIV include:

• fever
• swollen glands
• sore throat
• rash on your body or face
• painful muscles or joints
• headache
• feeling generally unwell
• ulcers in your mouth
• sweating at night
• brain infections such as meningitis (this is rare)

During this time, you're very infectious because the amount of the virus in your blood is high. This means that the risk of passing the infection on to someone else is high, for example, through unprotected sex.

After these early symptoms, HIV may remain hidden for years. Many people don't progress into advanced HIV infection, and deaths are now uncommon in people taking anti-HIV medicines.

If you're unaware of your HIV infection, your body's ability to fight infection becomes badly affected. When this happens, your immune system will become weak and won't be able to work properly. Eventually, you could be at risk of life-threatening illnesses. When this happens it's called advanced HIV infection (or AIDS).

Advanced HIV infection (AIDS)

Once your immune system has been seriously damaged, you may start to develop illnesses that usually require complex treatments in hospital. Illnesses associated with advanced HIV infection include:

• tuberculosis
• pneumonia
• certain cancers of the lymph glands (lymphoma)

These illnesses are uncommon in people who have been taking anti-HIV medicines.

Causes of HIV/AIDS

Most people with HIV are infected during unprotected vaginal or anal sex. Not everyone who is exposed to HIV becomes infected with the virus, although you're more likely to become infected if you have repeated sexual contact with someone who is infected. There is a small chance of infection through unprotected oral sex. It's estimated that around six in every 100 people with HIV get it through unprotected oral sex with someone who has HIV.

HIV can also be passed on through direct contact with infected blood. For example, by using infected needles for injections, piercings or tattoos or from accidental injury with a needle containing infected blood.

The virus can be passed from a mother to her baby if she has HIV during pregnancy, childbirth or when breastfeeding.

In the past, people have become infected with HIV through blood or organ donations. All donations in the UK are now screened for HIV, so the chances of this happening are extremely low.

HIV isn't found at high enough levels in the other fluids in your body, such as saliva, sweat, urine or on your skin, to cause an infection from this kind of contact.

HIV can't be passed on through normal day-to-day activities, such as sharing cutlery, sitting on toilet seats or by shaking hands. HIV can't be passed on through a mosquito bite or bites from other animals or insects.

Diagnosis of HIV/AIDS

It's important to have an HIV test if you think you have been at risk of HIV infection.

There are effective treatments available that slow the growth of the virus. Being diagnosed soon after you are infected can help you get the best out of the treatments.

The test for HIV is a blood test. You may have a finger prick test which is checked in a clinic within a few minutes, or blood taken from your arm that is sent to a laboratory. Your blood sample will be tested for HIV antibodies; these are produced by your body in response to infection. It can take up to three months for HIV infection to show in your blood, so tests done before this time may not be accurate.

You can get a test at a sexual health clinic, where sexually transmitted infections are diagnosed and treated. You can also ask your GP for a test or go to a private clinic. Some clinics offer same day HIV testing.

Counselling can be arranged if you have particular anxieties about your results. You can also talk about the test results with your GP.

Treatment of HIV/AIDS

There is no cure for HIV infection. However, treatment with anti-HIV medicines can reduce the amount of the virus in your body, slow down the effects of the virus and reduce your chances of developing a later, life-threatening infection. When used appropriately and taken properly, anti-HIV medicines can help you to stay well and live a full life.

HIV treatment is managed at specialist out-patient clinics and it's important to attend all your appointments. Your health professional will check how well your immune system is working and ask you about your general health at these appointments.

Usually, once the number of CD4 white blood cells has fallen to a low level, or if you become pregnant, your doctor will recommend starting treatment with medicines. You may also start treatment if you develop a serious infection or a condition linked to advanced HIV infection.

Medicines

Medicines used to treat HIV work in a number of different ways. For this reason, you will be asked to take a combination of different medicines together.

These medicines prevent the virus from reproducing in your body, which reduces the amount of virus in your blood. This allows your immune system to recover. Medicines also stop the virus from changing (mutating) when it reproduces. The aim of treatment is to reduce the amount of virus in your blood to very low levels.

You will probably take three medicines together, which are often combined into one or two pills taken once or twice daily. This is known as antiretroviral therapy, combination therapy, or HAART (highly active antiretroviral therapy). Taking your medicines on time, every time is very important with medicines used to treat HIV infection. This is the best way of slowing down the virus and helping you to stay well.

There are several types of medicine. Combination therapies usually contain medicines from at least two different classes of drugs. Your doctor will work with you to choose the medicines that suit you best.

Always ask your doctor or specialist nurse for advice and read the patient information leaflet that comes with your medicine.

Side-effects

Side-effects are the unwanted effects of taking a medicine. If you have side-effects it's important to talk to your doctor, or the healthcare professional who prescribed your medicine, before you stop taking it.

You may develop side-effects in the first few months after you start your treatment. These usually get better after a few weeks. You may:

• feel sick or be sick
• have diarrhoea or wind (flatulence)
• feel tired and have aching muscles
• have a rash
• have trouble sleeping or bad dreams
• feel dizzy

These side-effects at the start of therapy may be very mild, and usually improve as your body gets used to the medicine.

Medicines can increase the amount of fat in your blood, which can increase your risk of heart disease. Certain medicines affect the kidneys or liver in some people.

If you have any side-effects during your treatment, your doctor or nurse will discuss the options for treatment or change to a new combination of HIV medicines.

Prevention of HIV/AIDS

The risk of getting, or passing on, the HIV infection is dramatically reduced by using a condom during sex. Wearing a condom can't completely eliminate the risk of HIV infection. Reducing the number of partners you have does reduce your overall risk of infection. You may wish to get regular checks for sexually transmitted infections.

There are also emergency drug treatments for partners when a condom breaks. These drugs reduce their risk of being infected.

If you take intravenous drugs or inject medicines, don't share injection equipment and always use a fresh needle.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.