How Can I tell if I am affected with HIV?

The only way to determine whether you are infected is to be tested for HIV infection. You can't rely on symptoms to know whether or not you are infected with HIV. Many people who are infected with HIV don't have any symptoms at all for many years.

Similarly, you can't rely on symptoms to establish that a person has AIDS. The symptoms associated with AIDS are similar to the symptoms of many other diseases. AIDS is a diagnosis made by a doctor based on specific criteria established by the Centers for Disease Control and Prevention (CDC).

Oppurtunistic Infections

In our bodies, we carry many germs - bacteria, protozoa, fungi, and viruses. When our immune system is working, it controls these germs. But when the immune system is weakened by HIV disease or by some medications, these germs can get out of control and cause health problems.

Infections that take advantage of weakness in the immune defenses are called "opportunistic". The phrase "opportunistic infection" is often shortened to "OI".

TESTING FOR OIs

You can be infected with an OI, and "test positive" for it, even though you don't have the disease. For example, almost everyone with HIV tests positive for Cytomegalovirus (CMV). But it is very rare for CMV disease to develop unless the CD4 cell count drops below 50, a sign of serious damage to the immune system.

To see if you're infected with an OI, your blood might be tested for antigens (pieces of the germ that causes the OI) or for antibodies (proteins made by the immune system to fight the germs). If the antigens are found, it means you're infected. If the antibodies are found, you've been exposed to the infection. You may have been immunized against the infection, or your immune system may have cleared the infection, or you may be infected. If you are infected with a germ that causes an OI, and if your CD4 cells are low enough to allow that OI to develop, your health care provider will look for signs of active disease. These are different for the different OIs.

OIs AND AIDS

People who aren't HIV-infected can develop OIs if their immune systems are damaged. For example, many drugs used to treat cancer suppress the immune system. Some people who get cancer treatments can develop OIs.

HIV weakens the immune system so that opportunistic infections can develop. If you are HIV-infected and develop opportunistic infections, you might have AIDS.

In the US, the Center for Disease Control (CDC) is responsible for deciding who has AIDS. The CDC has developed a list of about 24 opportunistic infections. If you have HIV and one or more of these "official" OIs, then you have AIDS. The list is available at http://www.aidsmeds.com/lessons/StartHere8.htm.

WHAT ARE THE MOST COMMON OIs?

In the early years of the AIDS epidemic, OIs caused a lot of sickness and deaths. Once people started taking strong antiretroviral therapy (ART), however, a lot fewer people got OIs. It's not clear how many people with HIV will get a specific OI.

In women, health problems in the vaginal area may be early signs of HIV. These can include pelvic inflammatory disease and bacterial vaginosis, among others.

The most common OIs are listed here, along with the disease they usually cause, and the CD4 cell count when the disease becomes active:

• Candidiasis (Thrush) is a fungal infection of the mouth, throat, or vagina. CD4 cell range: can occur even with fairly high CD4 cells.
• Cytomegalovirus (CMV) is a viral infection that causes eye disease that can lead to blindness.CD4 cell range: under 50.
• Herpes simplex viruses can cause oral herpes (cold sores) or genital herpes. These are fairly common infections, but if you have HIV, the outbreaks can be much more frequent and more severe. They can occur at any CD4 cell count.
• Malaria is common in the developing world. It is more common and more severe in people with HIV infection.
• Mycobacterium avium complex (MAC or MAI) is a bacterial infection that can cause recurring fevers, general sick feelings, problems with digestion, and serious weight loss. CD4 cell range: under 75.
• Pneumocystis pneumonia (PCP) is a fungal infection that can cause a fatal pneumonia. CD4 cell range: under 200. Unfortunately this is still a fairly common OI in people who have not been tested or treated for HIV.
• Toxoplasmosis (Toxo) is a protozoal infection of the brain. T-cell range: under 100.
• Tuberculosis (TB) is a bacterial infection that attacks the lungs, and can cause meningitis. CD4 cell range: Everyone with HIV who tests positive for exposure to TB should be treated.

PREVENTING OIs

Most of the germs that cause OIs are quite common, and you may already be carrying several of these infections. You can reduce the risk of new infections by keeping clean and avoiding known sources of the germs that cause OIs.

Even if you're infected with some OIs, you can take medications that will prevent the development of active disease. This is called prophylaxis. The best way to prevent OIs is to take strong ART.

TREATING OIs

For each OI, there are specific drugs, or combinations of drugs, that seem to work best. Refer to the Fact Sheets for each OI to learn more about how they are treated.

Strong antiretroviral drugs can allow a damaged immune system to recover and do a better job of fighting OIs.

Wha is AIDS?

WHAT DOES "AIDS" MEAN?

AIDS stands for Acquired Immune Deficiency Syndrome:

* Acquired means you can get infected with it;
* Immune Deficiency means a weakness in the body's system that fights diseases.
* Syndrome means a group of health problems that make up a disease.

AIDS is caused by a virus called HIV, the Human Immunodeficiency Virus. If you get infected with HIV, your body will try to fight the infection. It will make "antibodies," special molecules to fight HIV.

A blood test for HIV looks for these antibodies. If you have them in your blood, it means that you have HIV infection. People who have the HIV antibodies are called "HIV-Positive."

Being HIV-positive, or having HIV disease, is not the same as having AIDS. Many people are HIV-positive but don't get sick for many years. As HIV disease continues, it slowly wears down the immune system. Viruses, parasites, fungi and bacteria that usually don't cause any problems can make you very sick if your immune system is damaged. These are called "oppurtuniatic infections".

HOW DO YOU GET AIDS?

You don't actually "get" AIDS. You might get infected with HIV, and later you might develop AIDS. You can get infected with HIV from anyone who's infected, even if they don't look sick and even if they haven't tested HIV-positive yet. The blood, vaginal fluid, semen, and breast milk of people infected with HIV has enough of the virus in it to infect other people. Most people get the HIV virus by:

• having sex with an infected person
• sharing a needle (shooting drugs) with someone who's infected
• being born when their mother is infected, or drinking the breast milk of an infected woman

Getting a transfusion of infected blood used to be a way people got AIDS, but now the blood supply is screened very carefully and the risk is extremely low.

There are no documented cases of HIV being transmitted by tears or saliva, but it is possible to be infected with HIV through oral sex or in rare cases through deep kissing, especially if you have open sores in your mouth or bleeding gums.

WHAT HAPPENS IF I'M HIV POSITIVE?

You might not know if you get infected by HIV. Some people get fever, headache, sore muscles and joints, stomach ache, swollen lymph glands, or a skin rash for one or two weeks. Most people think it's the flu. Some people have no symptoms.

The virus will multiply in your body for a few weeks or even months before your immune system responds. During this time, you won't test positive for HIV, but you can infect other people.

When your immune system responds, it starts to make antibodies. When this happens, you will test positive for HIV.

After the first flu-like symptoms, some people with HIV stay healthy for ten years or longer. But during this time, HIV is damaging your immune system.

One way to measure the damage to your immune system is to count yourCD4 cells you have. These cells, also called "T-helper" cells, are an important part of the immune system. Healthy people have between 500 and 1,500 CD4 cells in a milliliter of blood.

Without treatment, your CD4 cell count will most likely go down. You might start having signs of HIV disease like fevers, night sweats, diarrhea, or swollen lymph nodes. If you have HIV disease, these problems will last more than a few days, and probably continue for several weeks.

HOW DO I KNOW IF I HAVE AIDS?

HIV disease becomes AIDS when your immune system is seriously damaged. If you have less than 200 CD4 cells or if your CD4 percentage is less than 14%, you have AIDS. If you get an opportunistic infection, you have AIDS. There is an "official" list of these opportunistic infections put out by the Centers for Disease Control (CDC). The most common ones are:

• PCP (Pneumocystis pneumonia), a lung infection;
• KS (Kaposi's sarcoma), a skin cancer;
• CMV (Cytomegalovirus), an infection that usually affects the eyes
• Candida, a fungal infection that can cause thrush (a white film in your mouth) or infections in your throat or vagina

AIDS-related diseases also includes serious weight loss, brain tumors, and other health problems. Without treatment, these opportunistic infections can kill you.

The official (technical) CDC definition of AIDS is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm AIDS is different in every infected person. Some people die a few months after getting infected, while others live fairly normal lives for many years, even after they "officially" have AIDS. A few HIV-positive people stay healthy for many years even without taking antiretroviral medications (ARVs).

IS THERE A CURE FOR AIDS?

There is no cure for AIDS. There are drugs that can slow down the HIV virus, and slow down the damage to your immune system. There is no way to "clear" the HIV out of your body.

Other drugs can prevent or treat opportunistic infections (OIs). In most cases, these drugs work very well. The newer, stronger ARVs have also helped reduce the rates of most OIs. A few OIs, however, are still very difficult to treat.

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