HIV and AIDS

HIV is a virus that damages the immune system and can be transmitted through sexual contact or the shared use of medical equipment such as needles and syringes. HIV progresses in phases and gradually debilitates the immune system.

After years of damage to the immune system, HIV can evolve into AIDS. People with AIDS are more likely to get other diseases, called opportunistic infections, as their immune system is severely damaged.

With HIV it’s very important to know your status and to know what may put you at risk of infection. Read all about the evolution, diagnosis, prevention, and treatment options in this article.

HIV stands for human immunodeficiency virus. Categorized as an sexually transmitted disease (STD), HIV can be passed on through sexual contact. The virus attacks the immune system or, more specifically, CD4 cells. HIV gradually increases in the blood which, in turn, causes a decrease in the amount of CD4 cells. As the immune system protects us from viruses and bacteria, over time, people with HIV will become more likely to get an array of conditions. 1 2

HIV occurs in three phases. The first phase takes place right after the moment of infection. In this phase, the virus multiplies rapidly and destroys CD4 cells. Because of the speed at which the virus multiplies, a lot of HIV is present in the blood of people with an acute HIV infection. This makes it more likely for them to transmit the virus to another person. Getting diagnosed and starting treatment in this phase is very beneficial for the outlook of the condition. 1

Once acute infection is over, HIV evolves into a chronic infection in the second phase. Other terms that refer to this phase are asymptomatic HIV infection or clinical latency. In this stage, the virus is still present in the blood and is still multiplying, but at a slower rate. While the condition progresses, the CD4 count lowers and the immune system progressively gets weaker.

People with chronic HIV usually stay in this phase for years to decades. Most of the time, people don’t show any symptoms during this period. To slow down the progression of this condition, there’s a HIV therapy called ART which stands for antiretroviral therapy. This is a combination of medications which people take daily in order to keep their viral load down to an undetectable level. This means that the amount of HIV in the blood is that low that it can’t be detected by a viral load test.

Taking your antiretroviral medications correctly is also a possible way to protect your partner, as HIV can't be transmitted if your viral load is undetectable. This means that there is not enough HIV in your bodily fluids to pass on the infection. Current guidelines recommend that all who have been infected with HIV must start ART as soon as possible, regardless of the CD4 count. 3

Without treatment, people can stay in the chronic phase for about a decade before developing AIDS. Correct and consistent treatment can postpone the evolution from chronic HIV to AIDS for decades. Some patients even never develop AIDS. 2 4 5

People that do develop AIDS are in the third phase of their HIV infection. In this phase, people can get serious symptoms and opportunistic infections as the immune system will already be very damaged.

Opportunistic infections are infections such as candidiasis, pneumonia and tuberculosis, that people with a healthy immune system would normally not get. People with AIDS do get these infections easily and get severe symptoms. As people with AIDS have a higher viral load than people with chronic HIV, they become very infectious again. 4 5

The signs of HIV are different according to the phase someone is in. People with an acute HIV infection often show no symptoms of the infection. Others do show symptoms, but they are general symptoms which may easily be taken for another condition such as the flu, mononucleosis or a common cold. The most common first signs of an acute HIV infection are:

• HIV mouth sores
• HIV rash
• Fever

Other HIV symptoms may also be present such as: 6 7

• HIV tongue: contains white fuzzy patches that can’t be scraped off
• Aching muscles
• Joint pains
• Unintentional weight loss
• Loss of coordination
• Tiredness
• Headache
• Swollen lymph nodes
• Sore throat
• Diarrhea
• Depression and anxiety
• Skin rash

After this phase, the infection becomes chronic and people may not show any symptoms for years or decades.

When the immune system is severely damaged and the viral load goes up again, people with HIV transition into the third stage, where they develop AIDS. AIDS makes people susceptible to opportunistic infections and causes a number of severe AIDS symptoms such as:

• Weight loss
• Night sweats
• Chronic diarrhea
• Recurrent infections
• Extreme fatigue
• Skin sores
• Life-threatening illnesses

HIV symptoms in men are mostly the same as HIV symptoms in women. In later stages where HIV has already progressed, women can be prone to opportunistic infections such as lower belly infections and vaginal yeast infections. 6 7

HIV can be transmitted from a person with a detectable viral load onto another person. There are certain bodily fluids that can contain the virus, such as:

• Blood
• Semen and pre-seminal fluid
• Rectal fluids
• Vaginal fluids
• Breast milk

To infect someone, these fluids need to enter the bloodstream of that person. This can happen through intercourse, open wounds or injections. A mother can also transmit HIV to her baby during pregnancy, birth or breastfeeding. 8

There is no cure for HIV or AIDS, but people that have HIV can still live a normal life if they correctly adhere to their therapy. In general, the earlier the diagnosis and treatment, the better the outlook of the condition. Many people can even prevent HIV from evolving into AIDS by keeping their viral load low with their medications.

On top of that, there are a number of things you can do to prevent getting HIV. These include:

• Practising abstinence or safe sex with the correct use of a condom
• Safe use of needles
• The use of PreP (pre-exposure prophylaxis), which is a drug taken before a possible exposure to HIV that prevents infection with the virus
• The use of PeP (post-exposure prophylaxis), which can prevent users from contracting HIV if it’s taken within 72 hours after a possible exposure to HIV. 9

If you think that you might be at risk for HIV, you should get an HIV test as soon as possible. There are various possibilities when it comes to HIV testing: 10 11 12

• You can get tested at a clinic, by your healthcare provider or with a convenient test kit send to your home. Your doctor will draw some blood and will perform an antigen/antibody test or a nucleic acid test (NAT). Both tests can detect HIV or the antibodies that fight HIV in the blood, but depending on when you think you might have contracted it, one or the other may be more appropriate. You can read more about these tests on our specific page about acute HIV-infections by clicking the link.
• An HIV antibody test, which also searches for HIV antibodies in the blood or oral fluid. This can be an at home HIV test or a rapid HIV test, and can detect HIV 23 to 90 days after infection. An HIV test kit that you use at home is accurate and reliable, although the window period between infection and HIV being visible in the blood must be taken into account.

If you did contract HIV, you should discuss the treatment with your doctor. There is no HIV cure or an AIDS cure available at the moment, but the disease can be managed by following guidelines and being consistent with your HIV medications. ART (antiretroviral therapy) can keep your viral load low enough so that you stay healthy and you don’t put others at risk. 10 11 12

HIV vaccines are constantly being researched, and although none of them are approved by governmental healthcare services yet, there are promising trials being conducted. 13 14 15

As people with HIV often have underlying health conditions, they may be at higher risk of severe illness due to COVID-19.

Learn more about the link between HIV, AIDS, and COVID-19 and the interactions between COVID-19 treatments and HIV medicine here.

Q: Can you get HIV from kissing?
A: Getting HIV from kissing is very unlikely. The virus doesn’t spread through air or saliva. The only way to get HIV from kissing is when both partners have an open wound in the mouth so that there can be an exchange of contaminated blood.

Q: What does AIDS stand for?
A: AIDS stands for acquired immunodeficiency syndrome.

Q: How long does it take to show symptoms of HIV?
A: Usually it takes 2 to 6 weeks after the infection for symptoms to appear. However, some people may not experience symptoms of an acute HIV infection at all.

Q: What does “non-reactive HIV test” mean?
A: A non-reactive HIV test means that there were no HIV antibodies or antigens found in the blood sample that was collected.

Q: How long can you live with HIV?
A: People who consistently take their HIV medications and who started treatment early can live long and healthy lives.