HIV - Everything You need to know

Once in the body, HIV attacks the immune system and if not treated properly, can lead to AIDS, which is acquired immunodeficiency syndrome, being the result of a severely damaged immune system in the body that causes the person more likely to develop other infections or diseases such as certain types cancer, etc.[1] [2]

Read: What is HIV?

How do you get HIV?

HIV is transmitted only through the specific contact or exchange of body fluids from a person infected with the virus, including blood, breast milk, semen, and vaginal secretions.

The infection can be passed during sexual acts, needles or injecting equipment sharing, breastfeeding, or contaminated blood transfusions. However, the risk of receiving a contaminated blood transfusion is extremely low thanks to regular testing of blood donations. Additionally, HIV can be transmitted from mother to baby during pregnancy via the placenta or during delivery due to blood and vaginal secretions. Different strategies can be used to prevent transmission of HIV from mother to baby during delivery, including scheduled C-sections. [3]

Besides saliva does not contain HIV, it is important to state that HIV can be transmitted also through contact with broken skin, wounds, or mucous membranes in the mouth, as can be the case with oral sex, deep open mouth kissing if both partners have sores or bleeding gums or eating food that has been pre-chewed and happens to contain blood by a person infected with HIV. [4]

HIV Risk Factors

A risk factor makes the chances of getting a disease or condition higher, in the case of HIV, there are several factors which can make the probability of transmission higher, including, but not limited to:

• Being infected with another sexually transmitted disease such as herpes, chlamydia, gonorrhea, syphilis, bacterial vaginosis (testing supports prevention of this risk factor).
• Being a man and performing sexual activities with another men.
• Being sexually active and having sex with multiple partners, being defined as any sexual activity with +1 person during lifetime.
• Having sexual activities with someone who has sexual had multiple sexual partners during lifetime.
• Having sexual activities with someone who has had previous sexual contact and has not received a negative result for HIV at least 6 months after the last sexual act. (testing supports prevention of this risk factor).
• Sharing contaminated needles, syringes, and other injecting equipment with others. This usually happens due to illegal drug abuse. If you have a drug addiction and are reading this, please know there is people who loves you and support you, and please seek help.
• Exposing regularly to blood or bodily fluids of HIV infected people as can be the case of people working closely with the direct care and attention of HIV populations.
• Accidental needle stick injuries, mostly among health workers.[5]
• Unsafe injections, tissue transplantation or blood transfusions, mostly outside the US.
• Medical or other procedures involving unsterile cutting or piercing.[6]

HIV symptoms

HIV symptoms will depend on the stage of the disease. As the infection progresses the person will experience more detrimental symptoms and consequences.

Stage I: Acute HIV Infection (2 weeks – 15 years)

It is important to highlight that most people infected with HIV experience no symptoms or symptoms which are like flu at the beginning stage of the disease.

This phase occurs 2-6 weeks after infection. In the case of influenza-like symptoms, these may include some of the following: raised temperature (fever), headache, body rash, sore throat, tiredness, joint pain, muscle pain, and swollen glands. It is estimated that 80% of people infected with HIV will experience some of the symptoms described above. [7]

As stated before, having these symptoms does not mean you have HIV as they can be due to flu or influenza, besides, if you experience these symptoms and you have exposed to sex activities and to the risk of HIV infection, you should get tested for HIV.

HIV Symptoms: Everything you need to know about HIV symptoms

Please take note these symptoms may disappear as in the case of a common flu.

This does not mean you have not been infected with HIV, it just means the symptoms have gone, as in this infection symptoms will disappear and may not appear again during many years, progressively damaging the immune system in a silent way.

Please we aware that when you are in the early stage of infection, you are at very high risk of transmitting HIV to others. Testing is always the best option for you and others.

Stage II: Clinical Latency (10-15 years)

Within this stage, the immune system has become severely damaged, and for this reason, the symptoms will differ from stage I and become more prominent. Among these symptoms we can find:

• Chronic diarrhea.
• Weight Loss.
• Serious life-threatening illnesses.
• Recurrent infections.
• Skin problems.
• Night sweats. [8]

HIV symptoms in men

• Fever
• .Fatigue and headache.
• Swollen lymph nodes, pain in the joints.
• Skin rash.
• Nausea, vomiting and diarrhea.
• Sore throat and dry cough.
• Night sweats. [9]

HIV symptoms in women

1 in 4 people with HIV in the US are women, with women experiencing different complications from HIV, including:

• Severe pelvic inflammatory disease (PID).
• Repeated vaginal yeast infections.
• A higher risk of cervical cancer.
• Menstrual cycle problems.
• Higher risk of osteoporosis.
• Entering menopause younger.
• Having more severe hot flashes.
• Risk of passing HIV to their baby while pregnant or during childbirth [10]

What are the stages of HIV?

Stage I: Acute HIV Infection

Stage 1 occurs after the initial infection has taken effect and can produce symptoms like flu for the infected person, besides, not every person will experience this. This first stage usually starts 2 weeks after infection and lasts a couple of weeks.

Stage II: Chronic HIV Infection or Clinical Latency

In the case of stage 2, the person infected can start to feel better and even may have no symptoms at all, with this asymptomatic stage lasting up to 10-15 years.

Stage III: Acquired Immunodeficiency Syndrome (AIDS)

During stage 3 the immune system of the infected person has been seriously damaged after years of an undetected and untreated infection, being no longer able to fight infections and illnesses by itself. [11]

Fortunately, in developed countries as the U.S., most people with HIV do not develop Stage III of the disease (AIDS) because proper access to HIV medicine which, as prescribed, stops the progression of the disease. [12]

For that matter, testing becomes a crucial part of treating the disease as studies have shown that early, if not immediate treatment increases health and life expectancy, also preventing serious illness including cancer, liver, and renal disease in more than 50% in comparison with those cases where treatment was delayed. [13]

HIV Transmission

HIV can only be transmitted by coming into direct contact with different body fluids of a person with HIV who has a detectable viral load, these fluids are the following:

• Semen (cum) and pre-seminal fluid.
• Rectal fluids.
• Vaginal fluids.
• Blood.
• Breast milk.

For transmission to take place, the virus present within these fluids must access the bloodstream of an HIV-negative person, a process which takes place through mucous membranes found in the rectum, vagina, mouth, or tip of the penis); also, it can access the bloodstream through open cut or sores; or by direct injection as in the case of HIV transmitted by infected syringes.[14]

How do I know if I have HIV?

To find if you have an HIV infection, a blood test will be required as a confirmatory test. For HIV, the gold standard test is the Western Blot, which separates the blood proteins and detects specific ones called HIV antibodies which indicate the HIV infection, this test is 99.9% accurate in confirming if you are positive of not for HIV. [15]

Additionally, for screening tests, HIV can be detected with rapid tests which provide same day results and greatly facilitate the diagnosis of HIV and its early treatment and care, being is always the best option.

Within this set of tests, home tests can provide a secure, private way of detecting HIV. In case of a positive result, home test services will also offer a free consultation with a medical professional who will guide you through the process while keeping your privacy. If you receive a positive result, it’s vital that you immediately seek medical assistance so the virus can be managed as early as possible.

In the case of most tests, antibody testing is performed detecting an immune response of the body to fight HIV, with 28 days being necessary after infection for the body to start this process at a level as high as to be detected.

Please take note this 28-day period is the standard recommended time to start testing for HIV after a possible infection. In case of questions, please consult your home test provider and they will facilitate you with the most appropriate period for testing depending on their type of test.

In the case of children less than 18 months of age, serological tests are not sufficient to detect HIV infection, for this matter, virological testing can and must be provided as early as birth or at 6 weeks age. [16]

What kinds of tests are available, and how do they work?

At this moment there are available 2 choices for home tests which collect different samples of oral fluids or blood. Depending on the type of test, your required sample will be different. Below there are some guidelines for both options:

• Oral test: For the oral test, HIV specific antibodies will be screened on your saliva. To have an accurate result, do not eat or drink for 15 minutes before you start the test, also do not use mouth cleaning products 30 minutes before you start the test.Please read instructions carefully and make sure you do not touch the flat pad for sample collection with your fingers, then, just follow instructions o swab around your mouth and wait for 40 minutes until you obtain the result.
• Blood test: For the blood test, a sample of blood will be collected after a little pick on your finger like the one needed for blood sugar measurements. After the blood sample is collected into a collection card, results will be sent to the lab and you will receive a confirmation 1-2 days after. In the case of a positive result, and if you select one of the providers mentioned below, you will be guided by a medical professional through all the process.

How soon after an exposure the test can detect the HIV Virus?

- Short answer: Between 28 and 45 days.

- Long answer: To know how much time we need to wait before confirming a disease with a test, we need to look at a concept called the window period. This period is the amount of time necessary for an infection to be detected by the test. Also is important to note, that even with the same disease, different tests possess different window periods.

In the case of fourth generation laboratory tests, which are recommended in accordance with US and UK guidelines, the median window period is 18 days (Which means there is a range of 13 to 24 days), besides, if you want to be assured, please take note that 99% of HIV-infected individuals would be detectable within 44 days of exposure[17], making this mark a more reliable time to wait for a test in most cases.

HIV Test 

HIV Mail-In self-test - LetsGetChecked, MyLAB Box, NURX, Health Testing Center, Everlywell

Now there are several alternatives for people to perform HIV self-testing in their homes. Within the following list we provide some of the options available for this as well as their characteristics:

• LetsGetChecked: Offers 2 types for test for HIV which include as well as other diseases. Among the options available are the Standard 5 which includes: HIV, Chlamydia, Gonorrhea, Trichomoniasis and Syphilis for just $149 and the Complete 8 , which for $249 includes all the mentioned diseases as well as others: Gardnerella, Mycoplasma, Ureaplasma, Herpes Simplex Virus I & II.
• MyLAB Box: MyLAB Box offers different tests which are useful to detect STDs, including HIV. Going from the less to the most expensive option they offer the HIV test for just $79, a ~100% sensitive and ~100% specific test delivered directly to your home. Additionally, as one STD also participate as a risk factor for other STDs, tests that include HIV as well as other related STDs are also a great option. In the case of MyLab Box, they offer the Safe Box, a $189 test which includes HIV (I & II), Chlamydia, Gonorrhea, and Trichomoniasis.

Read: How does a HIV test work? Here’s what you need to know about taking a HIV test

• NURX:  Offers different options for STD testing, with different ranges of prices and price discounts if you have health insurance. In the case of having insurance, you will pay just $75 for the test kit + shipping and $15 for the medical consultation fee. If not, and depending on the test you choose, you will pay $150 for the Basics Covered Kit, $190 for the Healthy Woman Kit, or $220 for the Full Control Kit.
• Health Testing Center: Offers a HIV test starting at $79, additionally they offer more comprehensive options as the 10 STD Panel at $198 which includes HIV, Herpes 1&2, Chlamydia, Gonorrhea, Syphilis, and Hepatitis (A,B&C).
• Everlywell: For just $49, Everlywell offers a test which can help you check for HIV from the privacy of your own home. This home test, as well as the other tests presented, contains all materials for sample collection as well as detailed directions to guide you in this process. It also includes pre-paid shipping both ways as well as results reviewed by a health professional.

HIV test near me - Priority STD, Health Testing Center

In the case you still want to perform test on a center or location near your home, both Priority STD and Health Testing Center are great options for you.

In the case of Priority STD, it offers 100% confidential testing which can be done on just 5 minutes and provide you results in just 1-2 days.

With over 4,000 testing centers nationwide, you have an option no matter in which state you are located. Health Testing Center is also another great option with affordable prices.

Either if you decide to test at home or choose a location, they offer both options. Most results are available within 1-2 business days and all test are HIPPA compliant.

Same day HIV test/Walk-in HIV Test

Rapid tests provide another option for those which want to obtain results not in 1-2 days, but 20-30 minutes.

In this case, rapid tests present as an option with rapid antibody screening test, rapid antigen/antibody test and oral fluid antibody self-test being an option for this scenario. [18]

Besides this, is important to state that the only Rapid Test approved by the FDA is the oral HIV test [19], so in case you select this option is good to ask your provider about this option.

HIV rapid test/HIV RNA Early Detection

All laboratory tests, including those for HIV detection has 2 values which measure its effectiveness, these valued are called sensitivity and specificity.

In the case of the HIV RNA test its sensitivity rate is 100% and specificity rate of 99.83%, making it one of the most recommendable options, with results within 2-4 business days.

If you consider this to be the best option for you, STDCheck offers the HIV RNA Early Detection test for $169 which utilizes the only FDA- approved HIV RNA test on the market.

When to get tested for HIV?

The CDC recommends that “everyone between the ages of 13 and 64 get tested for HIV at least once as part of routine healthcare”.

This is important to note because, even in a developed country as the US, 1 of 7 people with HIV do not know they have it.[20]

Read: How does a HIV test work? Here’s what you need to know about taking a HIV test

Additionally, there are other circumstances in which testing for HIV are recommended at least once as part of routine healthcare.

 If you answer yes to at least 1 of the following questions, then you should get tested for HIV:

• You are a man practising sexual activities with other men, please be aware you are at high risk of contracting HIV, for that matter, is extremely important that in case you continue with this behaviour, you get tested at least annually for HIV.[21]
• You are sexually active and has had sex with another person who you cannot assure was HIV negative. (You had sex with another person without confirming a negative result for HIV first.)
• You have injected drugs and shared needles or works (water, cotton, etc) with others.
• You have been involved in the situation of exchanging sex for drugs or money.
• You have been diagnosed with for another sexually transmitted disease.
• You have practised sexual activities with another person whose sexual history involves other people and have not tested negative for HIV, or you cannot assure is having sexual activities with you only.
• If unfortunately, you have been sexually assaulted or has had a high-risk exposure to HIV, it is very recommendable to take post-exposure prophylaxis (PEP) and receive an HIV antigen test which can detect infection in less time than standard antibody tests.[22]
• You are pregnant or looking to conceive, is highly advised that you get tested for HIV as well as other STDs as part of routine healthcare and prevent passing HIV or other STDs to your baby.

HIV in pregnant women

- If you are pregnant, testing for HIV has been advised by the CDC. In case you are infected, you will be able to receive treatment to improve your health and prevent passing the virus to your baby. [23]

Please take note that if you are pregnant and suffering from HIV, if it is detected and treated, the risk of transmitting HIV to your baby can be 1% or less, for that matter, testing is of extreme importance. [24]

How long does it take to get results? (for each test?)

For most home tests, you will be receiving the results of the test within 1-2 days.

Read: How does a HIV test work? Here’s what you need to know about taking a HIV test

In case you would like to obtain faster results, there is the option of walk-in/rapid HIV tests which can provide results as quickly as 30 min after testing.

Important things to remember about sample collection

As new technologies to help people test themselves are introduced, self-testing also requires proper instructions and follow up to guarantee that results are as accurate as possible and that samples are taken properly.

In the case of rapid tests, studies have shown that the rate of unproper usage is higher among users in comparison with mailed tests which are delivered back to the laboratory.

If you choose a home delivered test, please follow instructions properly and make sure to read all instructions at least once before proceeding with the sample collection.

If you consider it necessary, there are also explanatory videos you can find on the internet, which can help you have an idea of how testing works.

Careful instruction following is especially important for collection of blood samples into microtubes, as the chances of producing unacceptable samples is higher for this type of tests.

Most home tests include collection with cards which makes this process easier.

Finally, please take note that any HIV testing most follow the WHO 5Cs, being: Informed consent, confidentiality, counselling, correct test results and connection to care, treatment and other services. [25]

Understanding HIV test results

It is important to note that a negative result does not necessarily mean a person is not infected with HIV. It is crucial that for this result to be accurate, the test needs to be performed after the window period has passed.

If you are using a home test, normally you will obtain the information about the window period on the package of the test, normally, if you get an HIV test 3 months after the exposure, the best choice will be to re-take the test 3 months more to confirm the negative result. [26]

Read: HIV treatment | How do you treat HIV?

HIV Prevention/Risk Reduction

The only 100% accurate method to prevent yourself from acquiring an STD during sexual contact, including HIV is to not have vaginal, anal, or oral sex.

If sexual activities are performed, practicing it only inside a faithful, long-term, and mutually monogamous relationship such as marriage with a person who has not had any previous sexual contact during lifetime or tested negative for STDs, including HIV, is the closest method to 100% to prevent yourself from any STD including HIV.

For this reason, being responsible and testing yourself and others are 2 key steps to prevent yourself from HIV.

How often should you be checked for HIV?

The CDC suggests that every person between 13-64 years old to receive testing for HIV as part of routine healthcare.

The recommendation is for at least 1 test during lifetime. For those at higher risk, the CDC recommends getting tested at least once a year.

Additionally, if you are pregnant or looking to conceive, it is also medically advised to receive testing for HIV and other STDs as part of prenatal care.

Written by Tommy Gonzales on December 30, 2020. Updated and republished in June 2021. 

References

[1] HIV/AIDS. (2020, February 13). Retrieved December 10, 2020, from https://www.mayoclinic.org/diseases-conditions/hiv-aids/symptoms-causes/syc-20373524

[2] About HIV/AIDS. (2020, November 03). Retrieved December 10, 2020, from https://www.cdc.gov/hiv/basics/whatishiv.html

[3] HIV/AIDS. (n.d.). Retrieved December 10, 2020, from https://www.who.int/news-room/fact-sheets/detail/hiv-aids

[4] Content Source: HIV.govDate last updated: June 24, 2. (2019, June 24). How Is HIV Transmitted? Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/how-is-hiv-transmitted

[5] HIV/AIDS. (n.d.). Retrieved December 10, 2020, from https://www.who.int/news-room/fact-sheets/detail/hiv-aids

[6] Risk Factors for AIDS. (n.d.). Retrieved December 10, 2020, from https://www.winchesterhospital.org/health-library/article?id=19029

[7] (n.d.). Retrieved December 10, 2020, from https://www.nhs.uk/conditions/hiv-and-aids/symptoms/

[8] Content Source: HIV.govDate last updated: July 01, 2. (2020, July 01). Symptoms of HIV. Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv

[9] Wacher, M. (2019, October 01). 7 Early Stage Symptoms of HIV: Ending HIV NSW. Retrieved December 10, 2020, from https://endinghiv.org.au/blog/7-symptoms-of-hiv-early-stages/

[10] HIV/AIDS in Women | HIV Symptoms in Women | HIV Transmission. (2020, November 20). Retrieved December 10, 2020, from https://medlineplus.gov/hivaidsinwomen.html

[11] Symptoms and stages of HIV infection. (2020, July 03). Retrieved December 10, 2020, from https://www.avert.org/about-hiv-aids/symptoms-stages

[12] Content Source: HIV.govDate last updated: June 05, 2. (2020, June 18). What Are HIV and AIDS? Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/what-are-hiv-and-aids

[13] Treat HIV Early To Prevent Transmission. (n.d.). Retrieved December 10, 2020, from https://endinghiv.org.au/treat-early/

[14] Content Source: HIV.govDate last updated: June 24, 2. (2019, June 24). How Is HIV Transmitted? Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/how-is-hiv-transmitted

[15] Western blot test. (2017, September 12). Retrieved December 10, 2020, from https://stanfordhealthcare.org/medical-conditions/sexual-and-reproductive-health/hiv-aids/diagnosis/western-blot-test.html

[16] HIV/AIDS. (n.d.). Retrieved December 10, 2020, from https://www.who.int/news-room/fact-sheets/detail/hiv-aids

[17] Pebody, R. (2019, June 01). What is the window period for HIV testing? Retrieved December 10, 2020, from https://www.aidsmap.com/about-hiv/what-window-period-hiv-testing

[18] Types of HIV Tests. (2020, October 20). Retrieved December 10, 2020, from https://www.cdc.gov/hiv/basics/hiv-testing/test-types.html

[19] Oral HIV Testing at Home. (n.d.). Retrieved December 10, 2020, from https://oraquick.com/

[20] Content Source: CDC’s HIV BasicsDate last updated: June 05, 2. (2020, December 02). Who Should Get Tested? Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/hiv-testing/learn-about-hiv-testing/who-should-get-tested

[21] Recommendations for HIV Screening of Gay, Bisexual, and Other Men Who Have Sex with Men - United States, 2017. (2017, August 10). Retrieved December 10, 2020, from https://www.cdc.gov/mmwr/volumes/66/wr/mm6631a3.htm

[22] Content Source: CDC’s HIV BasicsDate last updated: June 05, 2. (2020, December 02). Who Should Get Tested? Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/hiv-testing/learn-about-hiv-testing/who-should-get-tested

[23] Opt-Out| Pregnant Women, Infants, and Children. (2019, November 12). Retrieved December 10, 2020, from https://www.cdc.gov/hiv/group/gender/pregnantwomen/opt-out.html

[24] Content Source: CDC’s HIV BasicsDate last updated: June 05, 2. (2020, December 02). Who Should Get Tested? Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/hiv-testing/learn-about-hiv-testing/who-should-get-tested

[25] HIV/AIDS. (n.d.). Retrieved December 10, 2020, from https://www.who.int/news-room/fact-sheets/detail/hiv-aids

[26] Content Source: CDC’s HIV BasicsDate last updated: May 14, 2. (2020, December 02). Understanding HIV Test Results. Retrieved December 10, 2020, from https://www.hiv.gov/hiv-basics/hiv-testing/learn-about-hiv-testing/understanding-hiv-test-results