HIV Testing

• Unprotected anal or vaginal sex with someone who has HIV. Unprotected means sex without a condom. In the context of HIV, it also means the person with HIV is not taking HIV medications. Anal sex is the riskiest type of sex for transmitting and getting HIV. Gay, bisexual, and other men who have sex with men are the group most affected by HIV.2
• Using the same drug injection needles, syringes, materials, or equipment as someone who has HIV

• From mother to child during pregnancy, childbirth, or breastfeeding
• Getting stuck with a needle or other sharp object contaminated with HIV

• Oral sex
• Receiving a blood transfusion or organ transplant in the US. The blood supply and donated organs in the US are tested for HIV.
• Contact with HIV-contaminated blood through broken skin, wounds, or mucous membranes
• Being bitten by someone who has HIV. If the bite doesn’t break the skin, there is no risk of getting HIV.
• Eating food that has been chewed by someone who has HIV
• Deep, open-mouth kissing with someone with HIV if the HIV-contaminated blood gets into the bloodstream
• Getting a tattoo or body piercing if the equipment has traces of HIV-contaminated blood

• Touching, shaking hands, hugging, or closed-mouth or “social” kissing with someone who has HIV
• Contact with saliva, sweat, or tears of someone who has HIV, as long as those bodily fluids do not contain blood
• Sharing bathrooms, dishes, or eating utensils with someone who has HIV

• Everybody aged 15 to 65 years
• People younger than 15 or older than 65 if they are at increased risk for HIV
• Pregnant women

• Everybody aged 13 to 64 years
• People with one or more of the following HIV risk factors:
  • Men who have sex with men
  • Had anal or vaginal sex with someone who has HIV
  • Had more than one sex partner since your last HIV test
  • Injected drugs and shared needles, syringes, or drug injection materials or equipment with other people
  • Exchanged sex for drugs or money
  • Had any other sexually transmitted infection
  • Had viral hepatitis
  • Had tuberculosis
  • Had sex with someone with any of the above risk factors
  • Had sex with someone whose sexual history you don’t know

• Help you stay healthy
• Lower the risk of transmitting the infection to sex partners
• Lower the risk of transmitting the infection to your baby if you’re pregnant or breastfeeding

Many people with gonorrhea, especially women, have no symptoms. But even people without symptoms can still spread the infection to others through sex.

A person with acute, or new, HIV infection has a large concentration of virus in the bloodstream and they can easily spread the infection to others. As many as 60% of people with acute HIV don’t have symptoms.⁴ When present, symptoms start 2 to 4 weeks after infection with HIV and generally include:^3,4

• Fever
• Swollen, painful lymph nodes in the neck
• Sore throat
• Rash
• Muscle or joint pain
• Diarrhea
• Headache

The next stage is chronic HIV, during which the virus reproduces at a slower rate compared to the acute infection. People with chronic HIV may not have any symptoms or may have mild degrees of fatigue, night sweats, weight loss, and enlarged lymph nodes. As the HIV virus attacks the immune system, the level of CD4 cells continues to decline, leaving the body more susceptible to other infections. Symptoms from these other infections include:^3,4

• White patches in the mouth due to infection with fungus or Epstein-Barr virus
• Itchy fungal infection of the vagina
• Bacterial infection of the hair follicles
• Painful blisters from herpes zoster, or shingles

The chronic stage of HIV generally lasts about 8 to 10 years but some people progress more quickly and others more slowly.^3,4 People who take the recommended HIV medications can stay in this stage for decades. If chronic HIV continues without treatment, the CD4 count will eventually drop below 200 cells/microliter, at which point AIDS is diagnosed.

AIDS and advanced HIV are discussed in the next section.

If you may have been exposed to HIV in the last 72 hours, go to the emergency room or see a health care provider immediately to discuss the option of taking HIV medications to lower your risk of becoming infected. This is called post-exposure prophylaxis (PEP). It is only effective if you start taking it within 72 hours of exposure and continue every day for 28 days.⁷

The last, most severe stage of HIV is AIDS. There are two criteria for AIDS.

AIDS is diagnosed when the CD4 count is less than 200 cells/microliter.^3,4 This signifies a significant weakening of the immune system.

AIDS is also diagnosed if the person has developed an AIDS-defining condition, regardless of the CD4 level. These are illnesses that develop due to the weakened immune system. Many of the illnesses are infections with fungi, viruses, parasites, and bacteria. Other AIDS-defining conditions are cancers.

Examples of AIDS-defining conditions include:^3,4,8

• Pneumonia caused by the Pneumocystis jirovecii fungus
• Infection of the airways, lungs, or esophagus with the Candida fungi
• Infection of the eye (retinitis) with cytomegalovirus
• Chronic ulcers or infection of the airways, lungs, or esophagus with the herpes virus
• Widespread infection with histoplasmosis, cryptococcus, coccidioides fungi
• Chronic intestinal infection with isospora or cryptosporidium parasite
• Brain infection with the toxoplasma parasite
• Tuberculosis or infection with similar mycobacterium organisms
• Cancer, such as lymphoma, Kaposi sarcoma, and invasive cervical cancer
• Dementia or other brain damage caused by HIV
• Wasting syndrome (weight loss, fever, diarrhea) caused by HIV

Other than the symptoms caused by AIDS-defining conditions, people with AIDS may also weight loss, weakness, fever, chills, seats, and swollen lymph nodes.³

• Blood test to look for HIV antibodies and antigens. The body makes antibodies in response to HIV infection. Antigens are pieces of the HIV virus itself. Most HIV screening tests in health care settings use this method. A rapid test using blood from a finger prick also uses this method.
• lood test or oral swab to look for HIV antibodies only. This method is used in rapid tests that use blood from a finger prick or oral swab.
• Blood test to measure the amount of nucleic acid, or genetic material, of the HIV virus in the blood (also known as the viral load)

Before starting treatment for HIV your health care provider may ask about the following:

• Symptoms
• Risk factors for HIV such as sexual activity or injection drug use
• History of sexually transmitted infection in the past
• Other medical conditions
• Current medications
• Allergies to medications
• Possibility of being pregnant. (You may be asked to take a pregnancy test.)

Lab tests required before treating HIV include:⁹

• Viral load, or concentration of virus in your blood
• CD4 count, or concentration of CD4 cells in your blood
• Genotype testing to identify the specific strain of HIV virus and to check if the virus is resistant to certain HIV medications
• Tests for other sexually transmitted infections

HIV is treated with a group of medications called antiretroviral therapy (ART). While presently there is no permanent cure for HIV, taking the appropriate HIV medications as prescribed can accomplish many benefits:¹⁰

• Lower the viral load, even to the point that the virus is not detectable on blood tests
• Lower the risk of transmitting HIV to others
• Maintain high CD4 cell count, an important sign of a functioning immune system
• Prevent AIDS
• Prolong survival: With treatment, the life expectancy of people with HIV can approach that of people without HIV

There are several combinations of HIV medications recommended for initial treatment. Options include:⁹

• Bictegravir/tenofovir alafenamide/emtricitabine
• Dolutegravir/abacavir/lamivudine
• Dolutegravir plus (emtricitabine or lamivudine) plus (tenofovir alafenamide or tenofovir disoproxil fumarate)
• Raltegravir plus (emtricitabine or lamivudine) plus (tenofovir alafenamide or tenofovir disoproxil fumarate)
• Dolutegravir/lamivudine

US guidelines recommend starting HIV medications immediately after the diagnosis of HIV is confirmed.⁹ If you’re taking HIV medications, it’s important to take them consistently as prescribed even if you feel well and your viral load is undetectable.

During treatment, blood tests are required to monitor viral load and CD4 levels at regular intervals.

The only certain way to avoid getting HIV through sex is to avoid anal, vaginal, and oral sex.¹¹

If you are sexually active, consider these measures to lower your risk of getting or
transmitting HIV:

• Stay in a mutually monogamous relationship with a partner who doesn’t have HIV. Mutually monogamous means that you and your partner have sex only with each other and not with other people
• Use a latex condom at all times

When one partner in a sexual relationship or encounter is HIV-positive and the other partner is HIV-negative, the following measures can lower the risk of transmitting HIV to the negative partner:^7,9,11,12

• The HIV-positive partner takes HIV medications and achieves a HIV viral load that is consistently less than 200 copies/mL
• The HIV-negative partner takes pre-exposure prophylaxis (PrEP), which is daily HIV medication to lower the risk of getting HIV
• The HIV-negative partner, if not on PrEP, takes post-exposure prophylaxis (PEP) within 72 hours of exposure to HIV and continues every day for 28 days

If both partners are HIV-positive, safe sex is still advised so that one partner doesn’t transmit a drug-resistant strain of HIV to the other partner.

Note that treatment of HIV does not prevent getting or transmitting other sexually transmitted infections.

HIV is also spread by using the same drug injection needles, syringes, materials, or equipment as someone who has HIV. The best way to lower your risk of getting HIV from drug use is to stop using drugs completely.

If you continue using drugs, consider these measures to lower your risk of getting or transmitting HIV:¹¹

• Use new, sterile needles, syringes, and water every time you inject drugs
• Never share needles, syringes, materials, or drug preparation equipment
• If you use a needle that has been used by somebody else, clean the needle with bleach. Bleaching a needle may lower the risk of getting HIV but it is not guaranteed.
• Clean your skin with alcohol before you inject

There is no vaccine available to prevent getting HIV.

Researchers are developing and testing an HIV vaccine

IMPORTANT:

Question: What’s the difference between HIV-1 and HIV-2?

Answer: HIV-1 and HIV-2 are the main types of HIV virus. HIV-1 is much more common than HIV-2.