HIV (AIDS)

Symptoms of HIV can vary from person to person and may not always be noticeable in the early stages of the infection. Often people develop a flu-like illness which can be caused by many different viruses including HIV.

Symptoms of HIV include:

• Fever
• Fatigue
• Swollen glands
• Sore throat
• Headache
• Muscle aches
• Joint pain
• Skin rash
• Night sweats and/or drenching sweats
• Weight loss
• Diarrhoea

Most patients who have been exposed to HIV will experience flu-like symptoms within 2-6 weeks after infection occurs. After this, HIV may not cause any noticeable symptoms for many years. It is essential to get tested as soon as possible if you have been exposed to HIV.

Most individuals may experience a short, flu-like, illness within 2 to 6 weeks after acquiring a HIV infection. This is often referred to as ‘primary HIV infection’ or ‘seroconversion illness’. Many patients do not experience any symptoms or signs of HIV but can still pass on the infection to their partners.

After these initial symptoms have passed, it is possible for HIV to remain without symptoms even though the virus will continue to damage and weaken your immune system.

It is essential to get tested if you are concerned about having HIV or you think you have been exposed to it.

HIV can be transmitted through infected body fluids such as semen, vaginal fluid, rectal fluid, blood, and breast milk. HIV can occur If these fluids come into contact with:

• The penis, vagina, mouth and rectum.
• Damaged tissue that has been cut or scraped.
• The blood stream.

HIV cannot be transmitted through non-sexual contact such as hugging, kissing, holding hands, sharing household items such as bedding, towels, plates or utensils.

Your risk for HIV can be increased by:

• Having unprotected anal sex (highest risk) or vaginal sex (second highest risk) with someone who is living with HIV and is not on appropriate treatment, or has a high-viral load. The risk of contracting HIV from unprotected oral sex is low, however, it can be increased if the person performing oral sex has mouth ulcers, sores, or bleeding gums.
• Having unprotected sex with a current or previous partner who has HIV and is not on medication.
• Not using condoms when having sex with new partners who have not been recently tested for HIV.
• Engaging in chem-sex.
• Using intravenous drugs or sharing needles.
• Having other STIs such as Syphilis, Herpes, Chlamydia, Gonorrhoea, and Bacterial vaginosis.
• Receiving unsterile body piercings.
• Receiving a blood transfusion which is infected with HIV but has not been properly screened before use.
• Sharps or needle-stick injury.

Condoms are very effective in preventing HIV transmission if they are used correctly. However, condoms can sometimes split or come off during sex. The risk of condoms splitting is increased when using certain creams or vaginal pessaries, such as thrush treatment.

If your HIV-positive partner is not on effective treatment, it is highly possible that they will pass HIV onto you.

Your partner cannot pass HIV onto you if they have an undetectable HIV viral load and are on effective treatment. It is important that your partner strictly follows their treatment plan as laid out by their clinician in order for their HIV viral load to remain undetectable. If your partner does not follow their treatment plan, it is possible for their virus level to become detectable again and put you at risk of getting HIV.

HIV can be prevented by:

• Wearing a condom during anal, vaginal, and oral sex with all new partners.
• Using a water-based lubricant can help to prevent condom splitting. Condoms are up to 98% effective if they are used correctly. However, some creams and vaginal pessaries, such as thrush treatment can make condoms less effective.
• Taking PrEP (pre-exposure prophylaxis) to prevent HIV transmission from injectable drugs or sex.
• Taking PEP (post-exposure prophylaxis) to prevent HIV infection after possible exposure. PEP should be taken as soon as possible after exposure but certainly within 72 hours after being exposed to be effective.
• Not sharing or using shared equipment when injecting or taking drugs.

HIV is an easily manageable condition. While there is no current cure for HIV, HIV-positive individuals are able to live a full and healthy life.

There have been a few reports of HIV having been cured in HIV-positive patients. However, these are patients who have had a serious form of blood cancer. These patients had their existing immune system removed, and a bone-marrow transplant from someone else who was HIV-negative, providing a new immune system. Interfering with the immune system in this manner is very aggressive, invasive and risky, and depends on a wide range of factors.

The treatment for HIV is called antiretroviral therapy (ART) and involves taking a combination of HIV medicines every day.

ART does not cure HIV, but works by preventing HIV from making copies of itself, which lowers the amount of HIV in your body (known as the viral load). A low viral load allows your immune system to get stronger and produce more CD4 cells. With a stronger immune system, your body can fight off infections and some HIV-related cancers.

Reducing the amount of HIV in your body also lowers the risk of passing HIV to others. The main goal with HIV treatment is to get a patient's viral load to an undetectable level so that it cannot be detected on a blood test.

An undetectable viral load means the level of HIV virus within the body is so low that HIV cannot be transmitted to other people through sex. Therefore, ART not only helps you stay healthy but also protects those you care about and allows you to live a full, and normal, life.

A wide range of treatment options are now available to suit the needs of individual patients.

The aim of successful treatment is to achieve complete suppression of the virus in the blood. This is confirmed by an ‘undetectable’ viral load.

Achieving an ‘undetectable’ viral load has a 3-fold benefit:

• Improvement in symptoms caused by the HIV virus
• Improvement in the immune system
• Prevention of onward transmission

Over 95% of people diagnosed with HIV in the UK are on effective treatment and undetectable, and therefore are not infectious (U=U).

Viral load is a measurement of the amount of HIV virus in the blood. This amount can vary from 0 to millions of copies of virus per ml of blood. The higher the viral load, the more infectious the patient is and greater the adverse effect of the HIV virus on the immune system.

Tests commonly used in the UK to measure viral load have a lower limit of detection set at 20 copies/ml. You will be classed as Undetectable = Untransmittable (U=U) once your viral load has fallen below the limit of detection.

You should begin taking HIV treatment as soon as possible. Most individuals on HIV treatment are able to achieve an undetectable viral load within 6 months or less.

Common side effects include:

• Headaches
• Nausea or vomiting
• Diarrhoea
• Tiredness
• Rash

Your clinician will be able to select a combination of drugs that is best suited to you in order to reduce the possible side-effects.

HIV drug resistance can occur in patients who do not take their medications regularly. When resistance develops, it allows the virus to become detectable in the blood and weaken the immune system once more.

Clinicians who specialise in HIV treatment stress the importance of sticking to your medication schedule.

To prevent drug resistance from occurring:

1. A HIV Genotype Resistance test is performed before starting treatment to choose the most effective medications for you.
2. Patients should take their HIV medications as prescribed.
3. Patients on HIV therapy should have their HIV viral load tested every 3–6 months. Regular testing helps us catch any issues with your treatment early and take the right steps to prevent problems.

Patients who become resistant to their HIV medication will be switched to a new combination of drugs.

You can access free and confidential HIV treatment in the UK from specialist HIV and sexual health clinics.

Your partner will only need HIV treatment if they also test positive for HIV.

Maintaining an undetectable viral load, provided consistent and proper medication adherence, eliminates the risk of transmitting the HIV virus to your partner.

If your partner desires additional preventive measures against HIV, they may explore PrEP. For a more comprehensive discussion tailored to your specific situation, it is advisable to consult your clinician.

We recommend only having unprotected sex when your HIV treatment is working successfully, as to eliminate the risk of passing the infection to a sexual partner. This will be when the level of the HIV virus is undetectable in your blood. Undetectable = Untransmittable (U=U).

If you do not maintain your Undetectable status, you will be able to transmit HIV to your partners.

In the meantime, you should use a condom.

With access to a new generation of HIV drugs and proper medical care, patients with HIV can live a normal life in terms of both quality of life and life span.

There are a few restrictions that HIV-positive individuals currently face, such as not being accepted for blood and organ donation.

Aside from this, patients with HIV can virtually do anything they wish to, including marrying and having children and grandchildren.

If left untreated, HIV can lead to several health complications, including the development of AIDS (Acquired Immunodeficiency Syndrome) which is the most severe stage of HIV.

Individuals with HIV may experience other health issues, such as wasting and diarrhoea, which may be a result of an advanced HIV infection or an opportunistic infection. There is also an increased risk of developing bone disease, such as osteoporosis, and cardiovascular disease.

Neurological problems such as HIV-associated dementia may occur as a direct result of HIV or as a side effect of taking antiretroviral therapy (ART). Mental health problems, such as depression and anxiety, are also common among individuals with HIV.

Although HIV can lead to several health complications, with early diagnosis and appropriate treatment many people living with HIV can manage their infection and prevent these complications from occurring.

While a cure for HIV is currently unavailable, significant progress has been made in managing the virus.

Effective treatment options allow individuals living with HIV to lead fulfilling and vibrant lives without having to worry about their HIV infection.

Occasionally you may have come across news reports of HIV infection being cured. These are the cases where patients had certain types of blood cancers, and their treatment required wiping out and replacing their native immune system using the immune system from other individuals who had a built-in resistance to HIV.

Such treatment to treat blood cancer is very specialised and risky, and eradication of HIV in these patients is an additional benefit rather than main reason for the treatment.

5-10% of the population has a mutation called Delta 32 mutation. People with single Delta 32 mutation get partial protection against HIV whilst those with double Delta 32 mutation get almost complete protection from HIV. The test to identify one's Delta 32 mutation is currently not available in the UK.

There is a risk of passing HIV onto your children but there are effective ways to lower this risk.

It is essential to speak to your clinician if you are planning to become pregnant as you can pass HIV onto your baby through the placenta, during birth, and through breastfeeding if you are not on an effective HIV treatment.

The risk of mother to child transmission of HIV in the absence of medical care is 30-50%. In the early years of the HIV epidemic, a caesarean section was routinely undertaken. This reduced the risk of transmission to 1-2%.

With the availability of effective HIV drugs, an undetectable HIV viral load can dramatically reduce the risk of transmission of HIV to the newborn baby, thus making the option of being able to give birth to their baby by vaginal delivery possible for HIV positive mothers.

If you acquire HIV after all your children have been born and breastfed, you will not pass on HIV to them.

Unfortunately, you will no longer be able to donate blood if you have HIV.

If you are a former or current partner of someone living with HIV you may not be able to donate blood until 3 months have passed since the last sexual contact and you have tested negative for HIV.

We recommend only having unprotected sex when your HIV treatment is working successfully and your viral load is undetectable. An undetectable viral load means you will not be able to transmit HIV to your partners. Undetectable = Untransmittable (U=U).

In the meantime, you should use a condom.