REACH - HIV Q&A

A. HIV is the virus that causes AIDS. This virus is passed from one person to another through blood-to-blood and sexual contact. In addition, infected pregnant women can pass HIV to their babies during pregnancy or delivery, as well as through breast-feeding. People with HIV have what is called HIV infection. Most of these people will develop AIDS as a result of their HIV infection. An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC defined AIDS indicator illnesses. An HIV-positive person who has not had any serious illnesses also can receive an AIDS diagnosis on the basis of certain blood tests (CD4+ counts). A positive HIV test result does not mean that a person has AIDS. A physician using certain clinical criteria makes a diagnosis of AIDS.

Q. Is there a connection between HIV and other sexually transmitted diseases?

A. Yes. Having a sexually transmitted disease (STD) can increase a person's risk of becoming infected with HIV, whether the STD causes open sores or breaks in the skin (e.g., syphilis, herpes, chancroid) or does not cause breaks in the skin (e.g., chlamydia, gonorrhea). If the STD infection causes irritation of the skin, breaks or sores may make it easier for HIV to enter the body during sexual contact. Even when the STD causes no breaks or open sores, the infection can stimulate an immune response in the genital area that can make HIV transmission more likely. In addition, if an HIV-infected person also is infected with another STD, that person is three to five times more likely than other HIV-infected persons to transmit HIV through sexual contact.

Not having (abstaining from) sexual intercourse is the most effective way to avoid STDs, including HIV. For those who choose to be sexually active, the following HIV prevention activities are highly effective:

Engaging in sex that does not involve vaginal, anal, or oral sex
Having intercourse with only one uninfected partner
Using latex condoms every time you have sex.

Q. How easily is the virus transmitted?

A. Having contact with infected fluids from an HIV-positive person doesn't always mean you will become infected yourself. Whether or not you get infected depends on three things:

1. The amount of HIV that gets in (it’s not just how much someone comes people have more virus in their semen, vaginal secretion, or blood at different times).

2. The concentration of HIV (Viral Load).

3. The ease with which the fluid can get into the bloodstream. The membranes of the rectum, for example, pass the virus into the bloodstream more easily than the membranes of the mouth.

Q. Are some people at greater risk of HIV infection than others?

A. HIV does not discriminate. It is not who you are, but what you do that determines whether you can become infected with HIV. Worldwide, sexual intercourse is by far the most common mode of HIV transmission, but in the U.S., as many as half of all new infections are now associated either directly or indirectly with injection drug use (i.e., using HIV-contaminated needles to inject drugs or having sexual contact with an HIV-infected drug user). Overall, HIV infection is spreading fastest in this country among young people, women, African-Americans, Hispanic-Americans, and Caribbean-Americans.

Q. Are women especially vulnerable?

A. In western countries, women are four times more likely to contract HIV through vaginal sex with infected men than men contracting HIV through vaginal sex with infected women. This biological vulnerability is made worse by social and cultural factors that often undermine women's ability to avoid sex with partners who are HIV-infected or to insist on condom use. In the U.S., the proportion of new AIDS cases among women more than tripled from 7% in 1985 to 23% in 1999. African-American and Hispanic women, who represent less than one-quarter of U.S. women, represent nearly 80% of AIDS cases reported among American women to date.

Q. Are young people at significant risk of HIV infection?

A. Nearly half of the roughly 40, 000 Americans newly infected with HIV each year are under the age of 25. Approximately two young Americans become infected with HIV every hour of every day, and about 25% of the people now living with HIV in this country became infected when they were teenagers. Statistics show that by the age of 19, at least half of females and 60% of males in this country have engaged in sexual intercourse, and one in six sexually experienced teens has contracted one or more STDs. Many young people also use drugs and alcohol, which can increase the likelihood that they will engage in high-risk sexual behavior.

Q. How effective are latex condoms in preventing HIV?

A. Studies have shown that latex condoms are highly effective in preventing HIV transmission when used correctly and used every time. These studies looked at uninfected people considered to be at very high risk of infection because they were involved in sexual relationships with HIV-infected people. The studies found that even with repeated sexual contact, 98%-100% of those people who used latex condoms correctly, every time they had sex, did not become infected.

Lambskin condoms will not protect you from infection or re-infection because they are made from lamb intestines and have pores that can let the virus through. It is important to experiment with different sizes, shapes, and brands of condoms to find out which ones you prefer. Condoms can be thicker or thinner, have studs, ribs, or colors, and are lubricated with a broad variety of lubricants. Latex condoms will tear when used with oil-based lubricants - use only water-based lubricants

Q. Does the spermicidal Nonoxynol-9 prevent HIV transmission?

A. It has been found that under some circumstances Nonoxynol-9 actually increases a person’s chance of becoming infected with HIV. The chemicals in the spermicidal gel may at times irritate the mucous membranes and cause lesions that make it easier to transmit HIV from an infected partner to a non-infected partner. Nonoxynol-9 helps prevent pregnancy, but it does not prevent HIV. Using a plain water-based lubricant with a condom every time you have sex is effective against HIV infection.

Q. Is there a vaccine to prevent HIV infection?

A. Despite continued intensive research, experts believe it will be at least a decade before we have a safe, effective, and affordable AIDS vaccine. And even after a vaccine is developed, it will take many years before the millions of people at risk of HIV infection worldwide can be immunized. Until then, it is essential that we use other HIV prevention methods, such as practicing safer sex and avoiding non-sterile needles and injection equipment.

Q. How does a person know if he/she is infected with HIV?

A. The only way to know your HIV status for sure is to be tested. Immediately after infection, some people may develop mild, temporary flu-like symptoms or persistent swollen glands, but even if you look and feel healthy, you may be infected. The only way to determine for sure whether you are infected is to be tested for HIV infection. You cannot rely on symptoms to know whether or not you are infected with HIV.

Q. Can you tell whether someone has HIV or AIDS?

A. You cannot tell by looking at someone whether he or she is infected with HIV or has AIDS. An infected person can appear completely healthy. But anyone infected with HIV can infect other people, even if no symptoms are present.

Q. How can a person get tested?

A. Several years ago, the only type of antibody test available was a blood test done through your doctor's office. Today, as technology has improved, there are now different types of antibody tests available. Antibody tests can now be done on blood, mouth swabs, and urine, all based on ELISA and Western Blot techniques. Many people who don’t like needles are glad to be able to choose the mouth swab or urine test.

The lab tests don’t look for HIV itself. They look for antibodies to the virus. The HIV antibody test, marketed under the brand name “OraSure,” actually looks for HIV antibodies in a fluid in the mouth called "oral mucosal transudate." But for simplicity sake it is sometimes referred to as the mouth swab test.

Q. What is “the window period” for testing?

A. When people are first infected with HIV, it can take up to 6 months, rarely, for their bodies to make enough HIV antibodies for an HIV test to show they have the disease (to have a “positive” test result). We call this “the window period.” To be certain that you don’t have HIV, you must get tested once, avoid all risky behaviors, and then have a second test at least 3 months after your first one. If the second test is also “negative” (no HIV antibodies found) and you continue to avoid all risks at all times, you will stay “HIV-free.”

Q. How quickly do people infected with HIV develop AIDS?

A. In some people, the T-cell decline and opportunistic infections that signal AIDS develop soon after they first become infected with HIV. But more often people remain without symptoms for 10 to 12 years, and a few people go even longer. As with most diseases, early medical care and living a healthy lifestyle can help prolong the life of a person with HIV disease.

Q. If a person’s test is HIV negative, does that mean that the person’s partner is HIV negative also?

A. No. The HIV test result reveals only the HIV status of the person tested. A negative test result does not tell you whether the person’s partner has HIV. Therefore, taking an HIV test should not be seen as a method to find out if your partner is infected. Testing should never take the place of protecting yourself from HIV infection. If certain behaviors are putting a person at risk for exposure to HIV, it is important to reduce the risks. Someone who does get tested should encourage his or her sex partner(s) to also get tested.

Q. What is the risk to each person of unprotected sex between two persons who are both HIV+?

A. Some research suggests that an HIV infected person can become "reinfected" with another strain of HIV. This is of particular concern, because getting reinfected with a strain of HIV that is resistant to certain medications may cause that person to fail on medications that previously worked for him. There are also some concerns that reinfection may accelerate an infected person's progression to AIDS. Viral load may also rise through reinfection, increasing the amount of HIV in the blood.

Super-infection is a complicated issue, which clearly needs more research. Your biggest concern is the transmission of a drug-resistant strain from one HIV positive partner to the other HIV positive partner. Again, no one could predict if there would be complications for either of you in that scenario. It's a difficult decision. Many experts suggest that positive partners use condoms until more information is available.

Q. What Is “viral load” and how is it measured?

A. Viral load is the quantity of HIV-RNA (HIV) in the blood. RNA is the genetic material of HIV that contains the information needed to make more virus. Viral load tests measure the amount of HIV-RNA in a small amount of blood (one milliliter, ml).

Q. Are there treatments for HIV/AIDS?

A. For many years, there were no effective treatments for AIDS. Today, people in the United States and other developed countries can use a number of drugs to treat HIV infection and AIDS. Some of these are designed to treat the opportunistic infections and illnesses that affect people with HIV/AIDS. In addition, several types of drugs seek to prevent HIV itself from reproducing and destroying the body's immune system:

Reverse transcriptase inhibitors attack an HIV enzyme called reverse transcriptase. They include abacavir, delavirdine, didanosine (ddI), efavirenz, lamivudine (3TC), nevirapine, stavudine (d4T), zalcitabine (ddC), and zidovudine (AZT). Protease inhibitors attack the HIV enzyme protease and include amprenavir, indinavir, nelfinavir, ritonavir, and saquinavir.

Many HIV patients are taking several of these drugs in combination -- a regimen known as highly active antiretroviral therapy (HAART). When successful, such combination or "cocktail" therapy can reduce the level of HIV in the bloodstream to very low, even undetectable, levels and sometimes enables the body's CD4 immune cells to rebound to normal levels. These therapies are costly and can have serious side effects, so preventing HIV is always our best choice.

Researchers are working to develop new drugs known as fusion inhibitors and entry inhibitors that can prevent HIV from attaching to and infecting human immune cells. Efforts are also underway to identify new targets for anti-HIV medications and to discover ways of restoring the ability of damaged immune systems to defend against HIV and the many illnesses that affect HIV-infected individuals. Ultimately, advances in rebuilding the immune systems of HIV patients may benefit people with other serious illnesses, including cancer, Alzheimer's disease, multiple sclerosis, and immune deficiencies associated with aging and premature birth.

Q. Is there a cure for AIDS?

A. There is still no cure for AIDS. And while new drugs are helping some people with HIV/AIDS live longer, healthier lives, there are many problems associated with them:

Existing treatments do not work for many people with HIV/AIDS.
Anti-HIV drugs are highly toxic and can cause serious side effects, including heart damage, kidney failure, and osteoporosis. Many (perhaps even most) patients cannot tolerate long-term treatment with HAART.
HIV mutates constantly. In as many as 40% of people on HAART, HIV mutates into new viral strains that have become highly resistant to current drugs, and as many as 10% of newly infected Americans are acquiring drug-resistant strains of the virus.
Because treatment regimens are unpleasant and complex, many patients occasionally miss doses of their medication. Failure to take anti-HIV drugs on schedule and in the prescribed dosage can encourage the development of new viral strains that are resistant to current HIV drugs.
Even among those who do respond well to treatment, HAART does not eradicate HIV. The virus continues to replicate at low levels and often remains hidden in "reservoirs" in the body, such as the lymph nodes and brain.

Importantly, roughly 95% of all people with HIV/AIDS live in the developing world, where there is virtually no access to antiretroviral treatments. In the U.S., HAART contributed to a significant decline in the annual number of AIDS-related deaths between 1996 and 1998. But the rate of this decline has now slowed markedly, and some communities have begun reporting an increase again in AIDS deaths.