HIV

What is it?

Human immunodeficiency virus (HIV) is a sexually transmitted infection (STI) and a blood borne virus. Approximately 100,000 people are infected with HIV in the UK. HIV infection results in progressive failure of the human immune system, a part of the body that fights infections and prevents cancers. Over time an infected person, without treatment will develop a range of progressively more serious and ultimately life-threatening infections and cancers. Without diagnosing HIV and treating it, the average survival time after infection is estimated to be around 10 years.

HIV is usually passed from person to person through the following:

  • Unprotected penetrative vaginal or anal sex. Less commonly: oral sex or sharing sex toys that have infectious body fluids on (eg semen, anal or vaginal secretions).
  • Injecting drugs and sharing injecting equipment (needles, syringes, spoons) that has been used by someone infected with HIV.
  • Receiving contaminated blood (transfusion) or blood products.
  • Transmission from a HIV infected mother to her child during pregnancy, labour or breast feeding

HIV positive individuals are highly infectious during the first few months after being infected, when they have very high levels of the virus (viral load) in their body fluids. Infected individuals become significantly less infectious after they start on HIV treatment, and their viral load becomes undetectable or fully suppressed - this usually takes up to six months. After 6 months with an undetectable viral load the chances of passing HIV on to someone else are very low.

How does it affect you?

Those infected with 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 of being infected, approximately 50% 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.

Afterwards many infected individuals do not experience any symptoms for sometimes many years but during this time they will remain infectious and their immune system will continue to be attacked and damaged by the virus. Eventually an HIV infected person will show signs of immune system impairment and they may develop a range of HIV symptoms such as thrush in their mouth, 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. Later they are victim to more serious and life threatening conditions such as PCP pneumonia, tuberculosis, brain infections, and cancers like lymphoma or Kaposi’s sarcoma. This collection of more serious illnesses and conditions is called AIDS (Acquired Immuno Deficiency Syndrome).

Diagnosis

A simple blood test can detect HIV. The test may not pick up infection from a recent risk/exposure but it is highly accurate if performed four weeks after your last risk and is almost 100% accurate if you test 8 weeks after your last risk. 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 4 - 8 week “window period.”

Treatment

These days treatment for HIV (antiretroviral therapy) is highly effective. Antiretroviral therapy is not a cure, but individuals diagnosed with HIV at an early stage and started on treatment when advised to by their doctor, 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 it does mean taking it for life.

If you are diagnosed with HIV you will be referred by the SHL Health adviser team to an HIV outpatient clinic of your choice to discuss the infection, perform a range of blood tests and be considered to start treatment.

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. In a HIV positive person this usually varies from a few hundred to several million copies/ml. In patients on 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 you developing AIDS but significantly reduces the transmission risk of passing the virus on to your partner(s).

Contacting partners

If you are diagnosed with HIV you need to inform all of your sexual partners dating back to the time of your last HIV negative test (or inform 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 are HIV positive and have had unprotected 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 HIV transmission 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. You should also avoid donation of semen, organs or blood if you are HIV positive.