What is HIV?
Human immunodeficiency virus (HIV) is a sexually transmitted infection and a blood borne virus. There are approximately 100,000 people living with HIV in the UK. HIV infection results in the progressive failure of the human immune system, a part of the body that fights infections and prevents cancers. This means without treatment a person living with HIV will eventually develop a range of progressively more serious and ultimately life-threatening infections and cancers.
HIV is usually transmitted through the following routes:
- Condomless penetrative vaginal or anal sex. Less commonly: oral sex or sharing sex toys that have body fluids on, such as semen or anal or vaginal secretions.
- Injecting drugs and sharing injecting equipment (needles, syringes, spoons)
- Receiving blood (transfusion) or blood products from a person living with HIV
- Transmission from a mother living with HIV to her child during pregnancy, labour or breast feeding
People living with HIV are significantly more likely to transmit the virus to others in the first few months after acquiring the infection, when they have very high levels of the virus (viral load) in their body fluids. They become significantly less likely to transmit after they start taking HIV treatment, and their viral load becomes undetectable or fully suppressed - this usually takes up to six months. Once a person achieves and sustains an undetectable viral load on treatment the chance of transmitting HIV on to a sexual partner is zero.
How does it affect you?
People who have acquired HIV often display no or minimal symptoms for the first few years. In those who do have symptoms, they can be variable and overlap with many other common conditions. This can partly explain why the diagnosis of HIV can be missed or delayed as symptoms are put down to other reasons.
Within six weeks transmission, approximately 50% of people will suffer a short flu like illness (lasting around two weeks) called a seroconversion illness, with features such as a general body rash, sore throat, fever, tiredness, diarrhoea, joint and muscle pains and swollen lymph glands in the armpits, neck or groin.
After this time people may not experience any symptoms, sometimes for many years, but they can still transmit the virus?and their immune system will continue to be attacked and damaged by the virus. Without treatment, signs of immune system impairment will eventually start to show and symptoms such as oral thrush, cold sores/ulcers on their mouth or genitals, general tiredness, night sweats, weight loss, warts on their skin, mouth or genitals, shingles, recurrent gut infections may become evident. Later they may face more serious and life-threatening conditions such as PCP pneumonia, tuberculosis, brain infections, and cancers like lymphoma. This collection of more serious illnesses and conditions is called AIDS (Acquired Immuno Deficiency Syndrome).
HIV Diagnosis
A simple blood test can detect HIV infection. The test is highly accurate if performed 45 days after your last risk or exposure (eg last condomless sex). This means, depending on the level of recent risk, and if your initial test was negative for HIV, it may be advisable to repeat the HIV test again after this “window period.”
To interpret your blood test results visit our support page https://www.shl.uk/about/about-your-results. If your test result is reactive this indicates possible HIV infection, and you will be referred by the SHL.UK health adviser team to a sexual health clinic of your choice to receive further (confirmatory) HIV blood tests. If your result confirms HIV infection the clinic will discuss the infection in more detail and ensure you are linked to an outpatient HIV clinic for treatment and ongoing management.
Outpatient management and treatment
These days treatment for HIV (antiretroviral therapy) is highly effective. Antiretroviral therapy is not a cure, but people diagnosed with HIV who start treatment as soon as possible can expect to live long and healthy lives. The treatment is usually simple to take, has few side effects and is very robust in controlling/suppressing HIV, but at the moment, it does mean taking it for life.
The following tests are commonly performed in the HIV outpatient setting.? The CD4 blood test, refers to your CD4 cell (or T cell) count, and is a rough measure of your immune system. The CD4 helper T-lymphocyte is the predominant immune cell that the HIV virus infects and destroys. Over time the body can’t effectively replace these lost CD4 cells and the size and function of this cell population declines and as it does so, the ability of your immune system to fight infection will also deteriorate. The lower the CD4 count the less able your immune system is to fight infection and the more serious and extensive the range of infections you become susceptible to.
The HIV viral load is a measure of how much replicating HIV is found in the circulating blood. This usually varies from a few hundred to several million copies/ml. In people taking HIV treatment, the viral load is an accurate measure of how effective treatment is and the treatment aim is for the viral load to reach an "undetectable" level. Treatment not only prevents the development of AIDS but significantly reduces the transmission risk of passing the virus on to your sexual partner(s).
Contacting partners
If you receive a confirmed diagnosis of HIV you need to inform all of your sexual partners dating back to the time of your last HIV negative test (and sometimes informing all partners in your life if you have never tested for HIV before). If you feel unable to inform previous sexual partners one of our health advisers will be able to support you and notify them on your behalf.
If you test HIV positive and have had condomless sex with a partner in the last 3 days, they may be eligible for post exposure prophylaxis (PEP). Please see the relevant section (PEP) about this.
Maintaining good sexual health
To prevent yourself from acquiring HIV, and other STIs use condoms for penetrative sex, do not share injecting equipment and have regular STI check-ups. Encourage your partner to have regular STI check-ups also.
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