Introduction

HIV (human immunodeficiency virus) is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease.

AIDS (acquired immune deficiency syndrome) is the name used to describe a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus.

While AIDS cannot be transmitted from 1 person to another, the HIV virus can.

There's currently no cure for HIV, but there are very effective drug treatments that enable most people with the virus to live a long and healthy life.

With an early diagnosis and effective treatments, most people with HIV will not develop any AIDS-related illnesses and will live a near-normal lifespan.

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Symptoms

Most people infected with HIV experience a short, flu-like illness that occurs 2-6 weeks after infection. After this, HIV may not cause any symptoms for several years.

It's estimated up to 80% of people who are infected with HIV experience this flu-like illness.

The most common symptoms are:

• raised temperature (fever)
• sore throat
• body rash

Other symptoms can include:

• tiredness
• joint pain
• muscle pain
• swollen glands

The symptoms usually last 1-2 weeks, but can be longer. They're a sign that your immune system is putting up a fight against the virus. But having these symptoms does not necessarily mean you have the HIV virus. Remember: they're commonly caused by conditions other than HIV. If you have several of these symptoms and think you've been at risk of HIV infection within the past few weeks, you should get an HIV test. After the initial symptoms disappear, HIV may not cause any further symptoms for many years.

During this time, the virus continues to be active and causes progressive damage to your immune system.

This process can vary from person to person, but may take up to 10 years, during which you'll feel and appear well. Once the immune system becomes severely damaged, symptoms can include:

• weight loss
• chronic diarrhoea
• night sweats
• skin problems
• recurrent infections
• serious life-threatening illnesses

Early diagnosis and treatment of HIV can prevent these problems.

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Causes 

Sexual contact

Most people diagnosed with HIV acquire the virus through unprotected vaginal or anal sex.

It may also be possible to catch HIV through unprotected oral sex, but the risk is much lower. The risk is higher if:

• the person giving oral sex has mouth ulcers, sores or bleeding gums
• the person receiving oral sex has recently been infected with HIV and has a lot of the virus in their body, or another sexually transmitted infection.

People who are at higher risk of becoming infected with HIV include:

• people with a current or previous partner with HIV
• people with a current or previous partner who is from an area with high HIV rates
• people who are from an area with high HIV rates
• people who engage in chem sex (using drugs to help or enhance sex)
• People with penises (PWP) who have unprotected sex with PWP
• People with vaginas (PWV) who have unprotected sex with PWP who have sex with PWP.
• people who inject drugs and share equipment
• people who have unprotected sex with somebody who has injected drugs and shared equipment
• people who share sex toys with someone infected with HIV
• people with a history of sexually transmitted infections, hepatitis B or hepatitis C
• people who have had multiple sexual partners
• people who have been raped
• people who have received a blood transfusion, transplant or other risk-prone procedures in countries that do not have strong screening for HIV
• healthcare workers who could accidentally prick themselves with an infected needle -- but this risk is extremely low
• babies born from a parent with untreated HIV

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Transmission

• HIV is not passed on easily from one person to another. The virus does not spread through the air like cold and flu viruses. HIV lives in the blood and in some body fluids. To get HIV, 1 of these fluids from someone with HIV has to get into your blood.
• The body fluids that contain enough HIV to infect someone are:
• semen
• vaginal fluids, including menstrual blood
• breast milk
• blood
• lining inside the anus
• Other body fluids, like saliva, sweat or urine, do not contain enough of the virus to infect another person.The main ways the virus enters the bloodstream are:
• by injecting into the bloodstream with needles or injecting equipment that's been shared with other people
• through the thin lining on or inside the anus, vagina and genitals
• through the thin lining of the mouth and eyes
• through cuts and sores in the skin
• HIV is not passed on through:
• spitting
• kissing
• being bitten
• contact with unbroken, healthy skin
• being sneezed on
• sharing baths, towels or cutlery
• using the same toilets or swimming pools
• mouth-to-mouth resuscitation
• contact with animals or insects like mosquitoes
• HIV infects the immune system, causing progressive damage and eventually making it unable to fight off infections. The virus attaches itself to immune system cells called CD4 lymphocyte cells, which protect the body against various bacteria, viruses and other germs.

Once attached, it enters the CD4 cells and uses it to make thousands of copies of itself. These copies then leave the CD4 cells, killing them in the process.This process continues until eventually the number of CD4 cells, also called your CD4 count, drops so low that your immune system stops working. This process may take up to 10 years, during which time you'll feel and appear well.

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Testing

Seek medical advice immediately if you think there's a chance you could have HIV. The earlier it's diagnosed, the earlier you can start treatment and avoid becoming seriously ill. Some HIV tests may need to be repeated 1-3 months after exposure to HIV infection, but you should not wait this long to seek help. A GP or a sexual health professional can talk to you about having a test and discuss whether you should take emergency HIV medicine. Anti-HIV medicine called post-exposure prophylaxis (PEP) may stop you from becoming infected if taken within 72 hours of being exposed to the virus.

You should be able to get PEP from:

• sexual health clinics or genitourinary medicine (GUM) clinics
• hospitals -- usually accident and emergency (A&E) departments

If you already have HIV, try your HIV clinic if the PEP is for someone you've had sex with.

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If you're positive:

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If you're diagnosed with HIV, you'll have regular blood tests to monitor the progress of the HIV infection before starting treatment.

2 important blood tests are:

• HIV viral load test -- a blood test that monitors the amount of HIV virus in your blood
• CD4 lymphocyte cell count -- which measures how the HIV has affected your immune system

Treatment can be started at any point following your diagnosis, depending on your circumstances and in consultation with your HIV doctor. HIV is treated with antiretroviral medicines, which work by stopping the virus replicating in the body. This allows the immune system to repair itself and prevent further damage. A combination of HIV drugs is used because HIV can quickly adapt and become resistant. Some HIV treatments have been combined into a single pill, known as a fixed dose combination, although these often cost more to prescribe. Usually, people who have just been diagnosed with HIV take between 1 and 4 pills a day.Different combinations of HIV medicines work for different people, so the medicine you take will be individual to you.

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Prevention

Condoms

Both male condoms and female condoms are available. They come in a variety of colours, textures, materials and flavours. A condom is the most effective form of protection against HIV and other STIs. It can be used for vaginal and anal sex, and for oral sex performed on PWP. HIV can be passed on before ejaculation through pre-cum and vaginal secretions, and from the anus. It's very important condoms are put on before any sexual contact occurs between the penis, vagina, mouth or anus. Lastly, if you are participating in group sex you must wear a different condom for each different person you sleep with/hole.

Lubricant

Lubricant, or lube, is often used to enhance sexual pleasure and safety by adding moisture to either the vagina or anus during sex.Lubricant can make sex safer by reducing the risk of vaginal or anal tears caused by dryness or friction, and can also prevent a condom tearing.Only water-based lubricant (such as K-Y Jelly) rather than an oil-based lubricant (such as Vaseline or massage and baby oil) should be used with condoms. Oil-based lubricants weaken the latex in condoms and can cause them to break or tear.

Sharing needles and injecting equipment

If you inject drugs, this could expose you to HIV and other viruses found in blood, such as hepatitis C. It's important not to share needles, syringes, injecting equipment such as spoons and swabs, or the actual drugs or liquids used to dilute them. Many local authorities and pharmacies offer needle exchange programmes, where used needles can be exchanged for clean ones. If you're a heroin user, consider enrolling in a methadone programme. Methadone can be taken as a liquid, so it reduces your risk of getting HIV. A GP or drug counsellor should be able to advise you about both needle exchange programmes and methadone programmes.If you're having a tattoo or piercing, it's important that a clean, sterilised needle is always used.

HIV prevention medicine

If you're HIV negative, you may be able to take pre-exposure prophylaxis (PrEP) medicine to reduce your risk of getting the virus.

PrEP is available for some people who are at high risk of HIV infection -- for example, those whose partner is HIV positive.

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