The Top 10 Questions About HIV, Answered
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Although people are more educated about the human immunodeficiency virus (HIV) today, there are still misconceptions about the virus. False assumptions can increase the risk of infection and the odds of transmitting the virus to someone else. Here are some myth-busting answers to the most commonly asked questions about HIV.
1. Are HIV and AIDS the Same Thing?
HIV and AIDs are not the same thing. HIV is a virus, while AIDS is a stage of advanced infection. Specifically, HIV, or the human immunodeficiency virus, is an infectious virus that gradually breaks down a person’s immune system, leaving the body less able to defend itself against viruses, bacteria, fungi, and parasites. These infections, which are called “opportunistic,” tend to be mild in the early stages and can become progressively worse as they deplete your immune system.
AIDS, or acquired immunodeficiency syndrome, is the stage of the disease when the immune system is weakened by the loss of CD4 T cells (also called helper T cells). These are white blood cells that help fend off harmful pathogens in the body. Without these defenses, a person will be at high risk for serious illnesses that a healthy person would be able to fight off.
AIDS is diagnosed when a person has a CD4 count of less than 200 (meaning less than 200 cells per cubic millimeter of blood) or has at least one of 27 AIDS-defining conditions outlined by the Centers for Disease Control and Prevention (CDC), such as recurrent pneumonia and some lymphomas.
2. Can HIV Live Outside the Body?
HIV does not live outside the body for very long. Compared with other types of viruses, such as flu or chickenpox, HIV is relatively fragile: It does not thrive at room temperature (68 degrees F), when exposed to ultraviolet (UV) radiation from the sun, or at pH levels that are dissimilar to that of blood.
Even if a small amount of virus does manage to survive for a short period of time, the odds that it will infect you are next to zero. There have been no confirmed cases of HIV caused by a blood-tainted needle in a public place to date. Even in a healthcare setting, the risk of infection from a needlestick injury is less than 1 percent, per the CDC.
3. Which Activities Are Most Likely to Transmit HIV?
The three main routes of HIV infection in the United States are anal sex, vaginal sex, and shared needles. Of these, unprotected anal sex poses the highest risk. Here is the estimated probability of acquiring HIV from an infected source, through drug use and different sex acts, according to the CDC:
- Receptive anal sex: 1 in 72
- Shared injection drug use: 1 in 160
- Insertive anal sex: 1 in 909
- Receptive penile-vaginal sex: 1 in 1,250
- Insertive penile-vaginal sex: 1 in 2,500
The more you engage in these activities, the more likely you are to contract the virus, although it is still possible to get infected after a single exposure.
If you’re worried about your risk of contracting HIV, talk to your healthcare provider about PrEP (pre-exposure prophylaxis), a highly effective oral or injectable medication for HIV prevention. According to the CDC, it can reduce the risk of HIV infection through sex by 99 percent when taken correctly.
RELATED: 7 Things You Can Do to Protect Against HIV
4. Can You Get HIV From Oral Sex?
While there is a possible risk of getting HIV from oral sex, the documented risk remains extremely low. The CDC says that the risk is hard to quantify, because a lot of people who have oral sex have anal or vaginal sex, too.
Still, there are certain factors that may increase the potential for infection. These include coexisting sexually transmitted diseases (STDs) and bleeding gums. Even then, it’s unlikely that a person will be infected by having oral sex. Using a condom or dental dam can further reduce the already low risk, as can taking medicine to prevent or treat HIV.
5. How Common Are False Negatives and False Positives?
Thanks to the use of next-generation technologies, the accuracy of HIV testing in healthcare settings has never been better. Still, false positives and false negatives have been known to occur, albeit infrequently.
Today, the false negative rate for antibody-only tests is only around 0.3 percent (or roughly 3 out of every 1,000 tests), according to i-BASE. False positive rates are even lower — between 0.0004 percent and 0.0007 percent, according to StatPearls — due in large part to the practice of confirming a positive result with a secondary test.
If a false negative does occur, it is often the result of premature testing during the so-called window period. This is the period of time following infection when the body has not yet produced enough protective proteins (called antibodies) to register an accurate result. If this happens, a person may believe that they haven’t been infected.
Newer antigen/antibody lab tests have significantly reduced this window period, according to the CDC. However, you still need to wait about three to five weeks after being exposed to the virus to get a reliable result.
That said, if you think you’ve been exposed to HIV in the last 72 hours, the CDC says to contact a health provider, hospital, or urgent care center right away about getting post-exposure prophylaxis (PEP).
6. How Accurate Are In-Home HIV Tests?
Currently there is only one in-home HIV test available in the United States, OraQuick, promoted as a means to ensure privacy for those who might otherwise avoid getting tested. It is easy to use, requiring only a simple saliva swab, and can return a result in as little as 20 minutes.
Because antibody levels in saliva are lower than they are in blood, this test can fall short in its ability to detect infection. According to the U.S. Food and Drug Administration (FDA), 1 in 12 OraQuick tests will deliver a false negative, meaning that roughly 1 out of every 12 tests will deliver an incorrect all-clear sign.
7. Can a Pap Smear Detect HIV?
A Pap smear is valuable for many things, but HIV detection isn’t one of them. The aim of a Pap smear is to identify cell changes that may indicate cervical cancer, not to check for the presence of HIV, which can be identified only with a blood- or saliva-based HIV test.
That said, Pap smears are especially important for women who have HIV; these women are at least 5 times more likely to develop invasive cervical cancer than women who don’t have HIV. The test can also be used to screen for anal cancer and the human papillomavirus (HPV).
8. How Long Does It Take for HIV Symptoms to Appear?
Up to 80 percent of newly infected people experience symptoms during the early (acute) stage of HIV infection. These generally develop within two to four weeks of exposure and resemble symptoms of the flu, such as fever, sore throat, body rash, headache, and muscle and joint pain, according to the National Health Service (NHS).
One of the more telling signs of acute infection is lymphadenopathy, the sometimes painful swelling of the lymph nodes, specifically on the neck, behind the ears, under the armpits, and in the upper groin. While flu-like symptoms can last anywhere from a few days to several weeks, lymphadenopathy can persist for months and even years and may improve only after the start of HIV treatment.
After the acute stage of HIV infection, symptoms may not reappear for several years, but the virus is still active and causing damage if left untreated, per the NHS. That is why it’s important to see a healthcare provider as soon as possible if you suspect you have HIV.
9. Do HIV Symptoms Differ in Women and Men?
The HIV symptoms in men and women don’t differ very much. However, women with HIV can be susceptible to other infections that may cause symptoms in the genital tract, including bacterial vaginosis and candidiasis, a common fungal infection that can manifest as a vaginal yeast infection. (Oral thrush, a fungal infection, can appear in both women and men.)
Women with HIV also have an increased risk for recurrent and hard-to-treat pelvic inflammatory disease (PID) and can experience irregular periods, cramping, and unusual discharge.
In the later stages of HIV, women who also have HPV are more likely to have an increased risk of cervical cancer; gay and bisexual men with HPV are more likely to develop anal cancer.
But beyond these differences, the disease varies more by the individual than by sex. Other factors, like genetics, age, treatment history, and lifestyle habits such as smoking, diet, and exercise also play a role.
10. How Long Can I Wait Before Starting Treatment?
Ideally, you shouldn’t wait to start treatment. In the past, doctors would delay treatment until a person’s CD4 count fell below 500 — largely because of concerns about the long-term effects of HIV treatment and the premature development of a drug-resistant virus — but that’s no longer the case.
“Today, things are different,” says Linda-Gail Bekker, PhD, an infectious disease specialist and deputy director of the Desmond Tutu HIV Centre at the University of Cape Town in South Africa. “Newer-generation drugs have overcome many of these concerns. Moreover, if [treated] properly, a person with HIV can now expect to enjoy near-normal life expectancy.”
The focus, therefore, is no longer just on life extension; it’s on preserving quality of life. Research funded by the National Institutes of Health confirmed that early HIV treatment (started at CD4 counts above 500) reduced the risk of serious illness by 53 percent compared with delayed treatment.
That is why the U.S. Department of Health and Human Services now recommends that HIV treatment begin at the time of diagnosis.
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