HIV is present in a variety of body fluids and secretions of which genital secretions, blood and breast milk are the most significant for the spread of HIV. The virus can be spread in a variety of ways. The most common way being through sexual contact with an HIV infected partner. HIV can enter the body through the lining of the vagina, penis, mouth, rectum or vulva during sex.
HIV can also be spread through contact with infected blood. HIV is frequently transmitted among injection drug users who share needles or syringes contaminated with small quantities of blood of someone infected with HIV.
Prior to the screening of blood products for evidence of HIV and prior to the introduction of certain techniques to destroy HIV in blood products in 1985, HIV was transmitted through transfusions of HIV contaminated blood or blood products. Today, due to the advances in technology in treating blood products, risk of acquiring HIV from blood and blood products is an extremely rare event.
HIV infection can also be transmitted by women to their fetuses transplacentally during pregnancy, at the time of deliver, or, shortly thereafter through breastfeeding. One quarter to one third of all untreated pregnant women infected with HIV will transmit the virus to their baby.
In 1998, the Department of Health announced the results of a study which found that partial Zidovudine (ZDV) prophylactic regimens begun during delivery or within 48 hours after birth may have substantial benefit in reducing the risk of perinatal HIV transmission (NEJM 1998;339:1409-1414). HIV infected mothers who began ZDV prophylaxis therapy during labor and delivery had almost the same reduced rate of HIV transmission (5.3%) as HIV infected mothers who began prophylaxis during the prenatal period (5.0%). HIV exposed newborns whose mothers had never taken ZDV, but began therapy in the first 48 hours of life, experienced significantly reduced HIV transmission (9.5%) as compared to infants whose therapy was initiated after 48 hours of life (25%) and infants receiving no therapy (31.6%).
It is important to remember that HIV can be transmitted to and infect anyone who practices risky behaviors such as:
When a person first becomes infected with HIV (primary HIV infection), he or she may or may not develop any symptoms. In fact, primary HIV infection may go unnoticed in as much as 50% of cases. Some people, however, will experience symptoms upon HIV infection. Symptoms can occur within days or weeks of the initial exposure to the virus, and may be smaller in nature to the symptoms of other infections that are transmitted sexually, for example mononucleosis and hepatitis.
Upon primary HIV infection, many people report a flu-like or mononucleosis-like illness, with a variety of symptoms, the most common being rashes of the skin, fever, swollen lymph nodes, pharyngitis, oral or genital ulcers, pain in the joints or muscles, diarrhea, headache, nausea, vomiting, and malaise usually within 2 to 6 weeks after exposure to the virus. At this time, the lymph nodes (organs of the immune system) can become swollen and tender (swollen glands), and easily felt in either the neck, under the armpits or groin area. Regardless of the type of symptoms, most of the symptoms resolve in 14-21 days. These symptoms are often mistaken for those of another viral infection. During this stage of primary HIV infection, people are very infectious due to the fact that HIV is present in large quantities in genital secretions.
In HIV infected individuals, more severe and persistent symptoms may not surface for 10 years or possibly longer after HIV first enters the adult body. This asymptomatic infection period is highly variable from person to person. Some people can have symptoms within a few months, whereas others will not have any symptoms for 10 years or more. During this asymptomatic period of HIV infection, however, the virus is actively reproducing itself and infecting and destroying cells of the immune system (cells that help fight infection and disease and in the process help keep you healthy).
As the infection process progresses and the immune system deteriorates, many complications begin to arise. One of the first such symptoms in HIV infected individuals is the enlargement of the lymph nodes, or more commonly referred to as swollen glands, which can persist for more than 3 months.
Many of the symptoms of advancing HIV disease (AIDS) are similar to other health problems not related to HIV. The following symptoms should prompt a medical visit to determine the cause and appropriate treatment.
It is important to note that symptoms are never a reliable way to diagnose HIV infection! Testing for HIV antibodies is the best way to find out if you have been infected with the virus. We recommend testing if you think you may have been exposed to the virus, or practice risky behaviors that may expose you to HIV.
Due to the fact that early HIV infection often causes no symptoms, the only true way of knowing whether you are infected or not is through testing. There are a variety of laboratory testing methods available to screen blood and diagnose infection.
HIV is primarily detected by testing a person's blood for the presence of antibodies to HIV. Antibodies are proteins that your body creates to fight infection or foreign invaders. The antibodies that your body creates are very specific to the particular infection that your body is trying to fight (i.e. HIV infection). These antibodies that are created by your body to fight HIV can be detected using what's called the HIV antibody test. Two different types of HIV antibody test exist - the ELISA and Western Blot. Both tests are used to diagnose HIV infection. The ELISA, which stands for Enzyme Linked Immunosorbent Assay, is the most commonly used test to screen for HIV antibody because of its relatively simple methodology, high sensitivity and suitability for testing large numbers of samples. If an individual tests positive for HIV antibody using the ELISA, a second confirmatory test (usually a Western Blot) is performed. The Western Blot is perhaps the most widely accepted/used confirmatory assay for detection of antibody to HIV, and is considered the gold standard for validation of HIV antibody testing results. An individual who takes the HIV antibody test and tests positive for antibody for HIV, will be diagnosed with HIV infection.
HIV antibodies generally do not reach detectable levels until 1 to 3 months following initial infection, and may rarely take up to 6 months to be generated in quantities large enough to show up in standard blood tests for HIV antibody. This time period between becoming initially infected with HIV and the time it takes for your body to develop antibodies is called the window period. The window period of seroconversion can be anywhere from 2 weeks to 6 months after exposure to HIV. It is a very rare event that individuals will seroconvert after 6 months. If you think that you may have been exposed to HIV, you may want to get tested after the window period is over. We generally recommend that individuals get tested at least 3 months after your last risk of exposure. Waiting out the window period will ensure a more accurate test and help avoid the need to retest. Approximately 99% of HIV infected individuals will seroconvert within this 3 month window period.
Early testing (once sufficient antibody is detectable - usually after the window period), enables HIV infected individuals to receive the appropriate treatments at the time when they are most able (healthy) to fight HIV and prevent emergence of certain opportunistic infections. Another benefit of early testing is that it allows HIV infected individuals to avoid high-risk behaviors that could spread HIV to other individuals.
For more information about HIV testing in your state or HIV/AIDS in general, we encourage you to call the following:
Centers for Disease Control National AIDS Hotline: 800 342-2437
TTY/TDD 800 243-7889
Spanish Hotline: 800 344-7432
International: 301 217-0023
New York State residents: 800 541-2437
In HIV infected individuals, more severe and persistent symptoms may not surface for 10 years or possibly longer after HIV first enters the adult body. This asymptomatic infection period is highly variable from person to person. Some people can have symptoms within a few months, whereas others will not have any symptoms for 10 years or more. During this asymptomatic period of HIV infection the virus is actively reproducing itself and infecting and destroying cells of the immune system (cells that help fight infection and disease).
HIV antibodies generally do not reach detectable levels until 1 to 3 months following initial infection and may, on rare occasions, take up to 6 months to be generated in quantities large enough to show up in standard blood tests for HIV antibodies. This time period between becoming initially infected with HIV and the time it takes for your body to develop antibodies is called the window period. The window period of seroconversion can be anywhere from 2 weeks to 6 months after exposure to HIV. It is a very rare event that an individual will seroconvert after 6 months.
Oral sex can be broken down into two situations:
There are risks associated with both situations.
The best thing to do if you choose to perform or receive oral sex is to protect yourself by using a latex condom or latex barrier such as a dental dam. A latex condom that has been cut open can be used as an effective barrier instead of a dental dam. Although not totally risk free, proper use of a latex condom can significantly reduce the transmission of HIV. If your partner is allergic to latex, try using a plastic or polyurethane condom. Plastic food wrap (not microwavable plastic wrap) when placed over the female genitals can be used as an effective barrier as well. Using one of these types of barriers can help reduce the risk of blood entering any of the aforementioned areas that are susceptible to HIV infection.
If you have a Sexually Transmitted Disease (STD) it is easier for you to get HIV. Having an STD changes the cells lining the vagina, penis, rectum or mouth. This makes it easier for HIV to enter your body. If you already have an STD, you are more likely to get infected with HIV if you have sex with someone who has HIV and you do not use a condom.
You are more likely to get HIV if your partner has HIV and an STD. People with both HIV and an STD have more HIV in their semen (cum) or vaginal fluid. This makes it easier for a person with an STD or HIV to give the virus to others when having sex without a condom.