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HIV/AIDS

HIV infection; Infection - HIV; Human immunodeficiency virus; Acquired immune deficiency syndrome: HIV-1

Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). When a person becomes infected with HIV, the virus attacks and weakens the immune system. As the immune system weakens, the person is at risk for getting life-threatening infections and cancers. When that happens, the illness is called AIDS. Once a person has the virus, it stays inside the body for life.

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STDs and ecological niches
HIV
Primary HIV infection
Canker sore (aphthous ulcer)
Mycobacterium marinum infection on the hand
Dermatitis - seborrheic on the face
AIDS
Kaposi sarcoma - close-up
Histoplasmosis, disseminated in HIV patient
Molluscum on the chest
Kaposi sarcoma on the back
Kaposi sarcoma on the thigh
Molluscum contagiosum on the face
Antibodies
Tuberculosis in the lung
Kaposi sarcoma - lesion on the foot
Kaposi sarcoma - perianal
Herpes zoster (shingles) disseminated
Dermatitis seborrheic - close-up

Causes

The virus is spread (transmitted) person-to-person through certain body fluids:

HIV can be spread if these fluids come in contact with:

HIV cannot be spread through sweat, saliva, or urine.

In the United States, HIV is mainly spread:

Less often, HIV is spread:

The virus is NOT spread by:

HIV and blood or organ donation:

Risk factors for getting HIV include:

Symptoms

Symptoms related to acute HIV infection (when a person is first infected) can be similar to the flu or other viral illnesses. They include:

Many people have no symptoms when they are first infected with HIV.

Acute HIV infection (Stage 1) progresses over a few weeks to months to become chronic or asymptomatic HIV infection (Stage 2) (no symptoms). This stage can last 10 years or longer. During this period, the person might have no reason to suspect they have HIV, but they can spread the virus to others.

If they are not treated, almost all people infected with HIV will develop AIDS (Stage 3). Some people develop AIDS within a few years of infection. Others remain completely healthy after 10 or even 20 years (called long-term nonprogressors).

People with AIDS have had their immune system damaged by HIV. They are at very high risk of getting infections that are uncommon in people with a healthy immune system. These infections are called opportunistic infections and can affect any part of the body. These can be caused by:

People with AIDS are also at higher risk for certain cancers, especially lymphomas and a skin cancer called Kaposi sarcoma.

Symptoms depend on the particular infection and which part of the body is infected.

Lung infections are common in AIDS and often cause cough, fever, and shortness of breath.

Intestinal infections are also common and can cause:

Other common symptoms in people with HIV infection and AIDS include:

Exams and Tests

There are tests that are done to check if you've been infected with HIV.

DIAGNOSTIC TESTS

In general, testing is a 2-step process:

Home tests are available to test for HIV. If you plan to use one, check to make sure it is approved by the FDA. Follow instructions on the packaging to ensure the results are as accurate as possible.

The Centers for Disease Control and Prevention (CDC) recommends that everyone ages 15 to 65 have a screening test for HIV. People with risky behaviors should be tested regularly. Pregnant women should also have a screening test.

TESTS AFTER BEING DIAGNOSED WITH HIV

People with AIDS should have regular blood tests to check their CD4 cell count:

Other tests include:

Treatment

HIV/AIDS is treated with medicines that stop the virus from multiplying. This treatment is called antiretroviral therapy (ART).

In the past, people with HIV infection would start antiretroviral treatment after their CD4 count dropped or they developed HIV complications. Today, HIV treatment is recommended for all people with HIV infection, even if their CD4 count is still normal.

There are two types or treatment:

Regular blood tests are needed to make sure the virus level in the blood (viral load) is kept low or suppressed. The goal of treatment is to lower the HIV virus in the blood to a level that is so low that the test can't detect it. This is called an undetectable viral load.

If the CD4 count already dropped before treatment was started, it will usually slowly go up. HIV complications often disappear as the immune system recovers.

Support Groups

Joining a support group where members share common experiences and problems can often help lower the emotional stress of having a long-term illness.

Outlook (Prognosis)

With treatment, most people with HIV/AIDS can live a healthy and normal life.

Current treatments do not cure the infection. The medicines only work as long as they are taken every day. If the medicines are stopped, the viral load will go up and the CD4 count will drop. If the medicines are not taken regularly, the virus can become resistant to one or more of the medicines, and the treatment will stop working.

People who are on treatment need to see their health care providers regularly. This is to make sure the medicines are working and to check for side effects of the medicines.

When to Contact a Medical Professional

Contact your provider for an appointment if you have any risk factors for HIV infection. Also contact your provider if you develop symptoms of AIDS. By law, the results of HIV testing must be kept confidential (private). Your provider will review your test results with you.

Prevention

Preventing HIV/AIDS:

Safer sex practices, such as using latex condoms, are effective in preventing the spread of HIV. But there is still a risk of getting the infection, even with the use of condoms (for example, condoms can tear).

In people who aren't infected with the virus, but are at high risk of getting it, certain medicines can help prevent infection.

This treatment is known as pre-exposure prophylaxis, or PrEP. Talk to your provider if you think PrEP might be right for you.

HIV-positive people who are taking antiretroviral medicines and have no detectible virus in their blood do not transmit the virus.

The US blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood.

If you believe you have been exposed to HIV, seek medical attention right away. Do not delay. Starting antiviral medicines right after the exposure (up to 3 days after) can reduce the chance that you will be infected. This is called post-exposure prophylaxis (PEP). It has been used to prevent transmission in health care workers injured by needlesticks.

Related Information

Asymptomatic HIV infection
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Gastrostomy feeding tube - bolus
Jejunostomy feeding tube
Oral mucositis - self-care

References

Centers for Disease Control and Prevention website. About HIV. www.cdc.gov/hiv/basics/whatishiv.html. Reviewed June 30, 2022. Accessed June 2, 2023.

Centers for Disease Control and Prevention website. PrEP (pre-exposure prophylaxis). www.cdc.gov/hiv/basics/prep.html. Reviewed June 3, 2022. Accessed June 2, 2023.

DiNenno EA, Prejean J, Irwin K, et al. Recommendations for HIV screening of gay, bisexual, and other men who have sex with men - United States, 2017. MMWR Morb Mortal Wkly Rep. 2017;66(31):830-832. www.cdc.gov/mmwr/volumes/66/wr/mm6631a3.htm.

Reitz MS, Gallo RC. Human immunodeficiency viruses. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 169.

Simonetti F, Dewar R, Maldarelli F. Diagnosis of human immunodeficiency virus infection. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 120.

Tsibris AMN, Hirsch MS. Antiretroviral therapy for human immunodeficiency virus infection. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 128.

US Department of Health and Human Services, Clinical Info.gov website. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new?view=full. Updated March 23, 2023. Accessed June 2, 2023.

US Preventive Services Task Force, Owens DK, Davidson KW, Krist AH, et al. Screening for HIV Infection: US Preventive Services Task Force Recommendation Statement. JAMA. 2019;321(23):2326-2336. PMID: 31184701 pubmed.ncbi.nlm.nih.gov/31184701/.

Verma A, Berger JR. Neurological manifestations of human immunodeficiency virus infection in adults. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 77.

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Review Date: 5/19/2023  

Reviewed By: Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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