The human immunodeficiency
virus (HIV) is the virus that potentially causes AIDS (acquired immune
deficiency syndrome). HIV primarily attacks the immune defense system, making
the patient extremely vulnerable to opportunistic infections, which are infections
that occur in people who have weakened immune systems.
HIV primarily infects and
destroys immune cells with the CD4 receptor protein on their cell surfaces
(also called CD4-positive or CD4+ T-cells). Healthy individuals have a CD4 cell
count between 600 and 1,200 cells per microliter of blood. HIV patients have
less than 600 CD4 cells per microliter of blood.
Patients progress to AIDS
when/if their CD4 cell counts drop to lower than 200 cells per microliter
(one-one millionth of a liter) of blood. This may happen if a person does not
receive adequate treatment or if he/she develops a serious infection or
illness. Individuals with a CD4 cell counts lower than 200 have the greatest
risk of developing potentially fatal opportunistic infections, such as Mycobacterium
avium complex (MAC) infections, because their immune systems are very weak.
HIV is transmitted from
person to person via bodily fluids, including blood, semen, vaginal secretions,
and breast milk. Therefore, it can be transmitted through sexual contact with
an infected person, by sharing needles/syringes with someone who is infected,
through breastfeeding, during vaginal birth, or, less commonly, through
transfusions with infected blood. However, in countries where blood is screened
for HIV antibodies, HIV infection is rarely transmitted through blood
transfusions. Very low amounts of HIV have been found in saliva and tears in
some AIDS patients. However, contact with saliva, tears, or sweat has not been
shown to result in HIV transmission.
The most common type of HIV
worldwide is called HIV-1. It is easily transmitted and is the cause of most
HIV/AIDS infections around the world. HIV-1 has several subtypes (A through H
and O), which are more common in certain parts of the world but produce AIDS similarly.
The second type, called HIV-2, is much less common and less virulent or
Since 1981, when the first
case of AIDS was reported in the United States, the disease has become a global
pandemic, causing an estimated 65 million infections and 25 million deaths
During the mid-to-late
1990s, advances in HIV treatment slowed the progression of HIV infection to
AIDS. This consequently led to decreases in AIDS-related deaths. According to
the U.S. Centers for Disease Control and Prevention (CDC), the number of
AIDS-related deaths continues to decline, with an eight percent decrease from
2000 through 2004. However, the number of AIDS diagnoses increased eight
percent during that period as well.
From 2000 to 2004, the
estimated number of people living with AIDS increased from 320,177 to 415,193,
according to the CDC. This 30% increase can partially be attributed to advanced
treatments that have helped HIV/AIDS patients to live longer lives, as well as
increased access to testing and information about the disease.
According to the CDC, an
estimated 2.8 million patients died from AIDS, 4.1 million people became
infected with HIV, and 38.6 million were living with HIV worldwide in 2005.
According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and World
Health Organization (WHO) 2006 AIDS Epidemic Update, an estimated 39.5 million
people are currently living with HIV worldwide. It is also estimated that 4.3
million people became newly infected in 2006, with 2.8 million (65%) of these cases
occurring in Sub-Saharan Africa. In 2006, 2.9 million people died from
Certain geographic regions,
such as Sub-Saharan Africa and the Caribbean, have much higher rates of
infection than others. Certain populations, such as Sub-Saharan women, men who
have sex with men (MSM), prostitutes, and injection-drug users, are also at
increased risk for HIV infection.
Currently, there is no cure
for HIV/AIDS. However, treatment with anti-HIV drugs, called antiretrovirals,
may suppress the virus, which subsequently helps boost the immune system.
Although these drugs may help patients live longer lives, they do not reduce
the risk of transmitting the disease to someone else.
General: HIV is transmitted from person to person via bodily
fluids including blood, semen, vaginal secretions, and breast milk. Individuals
who have other sexually transmitted diseases are more susceptible to the virus.
This is because some STDs, such as syphilis, cause breaks in the skin or sores
that make it easy for HIV to enter the body.
HIV is particularly difficult to treat because it reproduces
very quickly and has a high mutation rate. When HIV reproduces, different
strains (types) of the virus emerge. Mutations (changes in genetic information)
occur almost every time a new copy of the virus is produced. Therefore, many
types of HIV can be produced in a single person in one day. For this reason,
HIV patients receive different combinations of antiretrovirals to suppress the
HIV primary targets immune cells called CD4 T-cells. The CD4
T-cells are white blood cells that help coordinate the immune system's response
to infection and disease. These cells have a molecule called CD4 on their
surfaces, which allows the cells to detect foreign substances, including
viruses that enter the body. This process then triggers the immune system to
destroy the foreign substance. When HIV enters the body, the virus recognizes
this protein, binds to the receptors on the CD4 cell wall, and enters the cell.
Once inside the cell, HIV replicates and eventually kills the cell.
Primary, or acute, infection: Patients can transmit the
virus to others during all stages of infection. The first stage of HIV, known
as the primary or acute infection, is the most infectious stage of the disease,
and it typically lasts several weeks. During this phase, the virus replicates
rapidly, which leads to an abundance of the virus in the bloodstream and a
drastic decline in the number of CD4 T-cells. The CD8 T-cells, which kill
abnormal or infected body cells, are then activated to destroy HIV-infected
body cells and antibodies are produced.
Clinical latency: The next stage, called clinical latency,
may last anywhere from two weeks to 20 years. During this phase, HIV is not
considered dormant. Instead, it is active in the lymph nodes where large
amounts of the virus become trapped. The surrounding tissues, which contain
high levels of CD4 T-cells, may also become infected. The virus accumulates in
infected cells and in the blood as free virus. Patients generally do not
experience symptoms during this stage until the CD4 cell count drops to 600
microliters of blood or lower.
Symptomatic stage: As the virus continues to weaken the
immune system, patients eventually become more susceptible to infections. The
next stage is the symptomatic stage, in which the person experiences symptoms
associated with a weakened immune system.
AIDS: The term AIDS (acquired immune deficiency syndrome)
refers to the most advanced stage of HIV infection. This stage happens when HIV
multiplies rapidly and severely affects the immune system. Individuals have
AIDS when they have fewer than 200 CD4 T-cells per microliter of blood. This
low CD4 T-cell count makes them extremely vulnerable to potentially fatal
opportunistic infections such as pneumonia or tuberculosis.
Several infections, including Pneumocystis jiroveci
pneumonia (formerly called Pneumocystis carinii pneumonia, PCP) and Kaposi's
sarcoma (KS), are considered AIDS-defining illnesses. This means that once a
patient develops one of these infections, their condition has progressed to
General: Race and ethnicity by themselves do not increase or
decrease a person's risk of acquiring HIV infection. However, certain people
are more likely to face challenges associated with the risk for HIV infection,
such as lack of awareness of HIV status, substance abuse, or socioeconomic
African Americans: In 2004, African Americans accounted for
20,965 (49%) of the 42,514 estimated AIDS cases (not HIV) diagnosed in the
United States. The rate of AIDS diagnoses among African American adults and adolescents
was 10 times higher than the rate of Caucasians and almost three times higher
than the rate of Latinos. In addition, 23 times more African American women
were diagnosed with AIDS than Caucasian women. Eight times more African
American men were diagnosed with AIDS than Caucasian men, according to the CDC.
Latinos: In 2004, Latinos accounted for 20% (8,672) of the
42,514 new diagnoses in the United States, according to the CDC. The top causes
of infection in most Latino men were infections after HIV exposure through
sexual contact with other men, injection drug use, and heterosexual contact.
The top causes of infection in Latino women were HIV exposure through
heterosexual contact and injection drug use. Latinos were shown to get tested
for HIV more often than any other race or ethnicity except African Americans.
According to the CDC, in 2004, about 50% of Hispanics between the ages of 15
and 44 were tested, and 18% had been tested during the past year.
Women: After the initial outbreak of HIV, few women were
diagnosed with the virus. Today, women account for more than 25% of all new
HIV/AIDS diagnoses in the United States. In 2004, an estimated 93,566 women
were living with AIDS, making up 23% of the estimated 415,193 people living
with AIDS in the United States.
Youth (13-24 years old): In the United States, it is
estimated that 50% of the 40,000 new HIV infections each year occur in people
younger than age 25 and 25% of infections occur in people younger than 21.
HIV/AIDS ranks as the sixth-leading cause of death among individuals ages 15-24
in the United States, with the number of AIDS cases reported each year in that
age group increasing by 417% from 1981 through 1994.
Injection-drug users: Since the AIDS epidemic began,
injection drug use (IDU) with illegal drugs has directly and indirectly (drug
use clouds judgment, leading people to engage in high-risk behaviors) accounted
for more than one-third of AIDS cases in the United States. In the year 2000,
out of the 42,156 new cases of AIDS reported, 11,635 were linked to IDU.
Injection drug use is more common among racial and ethnic
minorities in the United States, which makes them more likely to acquire HIV
through IDU. In 2000, IDU accounted for 26% of all AIDS cases among African
American adults and 31% among Hispanic adults and adolescents, compared to 19%
of all cases among Caucasian adults and adolescents.
Homosexuals: Men who have sex with men (MSM) accounted for
70% of all estimated HIV infections among male adults and adolescents in 2004
in the United States, according to the CDC. Although the number of HIV
diagnoses for MSM decreased during the 1980s and 1990s, the number increased by
eight percent from 2003 through 2004. According to the CDC, it is unknown
whether this increase is because more people are getting tested for HIV or
because more patients are becoming infected with HIV.
Healthcare workers: Although healthcare workers are exposed
to the virus at work, it is unlikely that they will acquire the virus from a
patient, especially if they follow universal precautions, which should be taken
with all patients.
For healthcare workers, HIV transmission is most likely to
occur through accidental injuries from needles or other sharp medical
instruments that may be contaminated with the virus. However, this risk is
small. Researchers estimate that about 0.3-1% of healthcare workers exposed to
the virus by an accidental needle stick or puncture develop HIV.
Since December 2001, there have been 57 documented reports
of healthcare workers acquiring HIV from a patient. To prevent transmission of
HIV to healthcare personnel in the workplace, the U.S. Centers for Disease
Control and Prevention (CDC) offers precautionary guidelines.
Bodily fluids: HIV is transmitted from person to person via bodily
fluids because the virus is present in varying concentrations in the blood,
semen, vaginal fluid, and breast milk. It can be spread by sexual contact with
an infected person, by sharing needles/syringes with someone who is infected,
or, less commonly, through transfusions with infected blood. HIV infection
through blood transfusion is extremely rare in countries where blood is
screened for HIV antibodies.
Environment: HIV does not survive well in the environment
outside of the body. According to studies performed by the U.S. Centers for
Disease Control and Prevention (CDC), drying HIV reduces the amount of viral
particles by 90-99% within several hours. The virus also cannot reproduce when
it is outside of the body. Therefore, it is highly unlikely that the disease
can be transmitted through contact with the environment, such as public toilet
Kissing: Casual contact through closed-mouth or
"social" kissing does not put an individual at risk for HIV. However,
there is the potential for blood contact with open-mouth kissing. The risk for
acquiring the virus from open-mouth kissing is low, and the CDC has only
investigated one case in which HIV transmission may have been caused by blood
contact during open-mouth kissing. The CDC recommends that individuals avoid
open-mouth kissing with an infected person.
Biting: There have been medical reports that found that HIV
transmission resulted after a human bite. Severe trauma and extensive tissue
tearing were reported in each of these cases. However, biting is not a common
way of transmitting the disease.
Saliva, tears, and sweat: Very low amounts of HIV have been
found in the saliva and tears of some AIDS patients. However, a small amount of
HIV in body fluid does not necessarily mean that the fluid can transmit the
virus. Contact with saliva, tears, or sweat has not been shown to result in
transmission of HIV.
Insects: According to numerous studies, there is no evidence
to suggest that HIV has been transmitted through insects, even in areas such as
Africa, that have high numbers of AIDS patients and mosquito populations. HIV
can only live for a short time inside an insect and does not reproduce inside
Effectiveness of condoms: If a condom is used properly
during sexual intercourse, an individual may reduce the risk of acquiring or
transmitting STDs, including HIV. Several studies show that using condoms
correctly and consistently may reduce the breakage rates of latex condoms to
less than two percent.
There are many types and brands of condoms, but only latex
or polyurethane condoms have been shown to effectively prevent HIV transmission
when used appropriately. According to the CDC, natural membrane condoms, such
as those made with lambskin, have natural pores that can possibly transmit
diseases. Therefore, lambskin condoms are not considered to be effective in
preventing HIV transmission.
Recent evidence has suggested that condom use by high-risk
populations increases, rather than decreases the infection rate. According to
the latest studies, condom promotion is only effective in lowering the rate of
AIDS in concentrated, high-risk groups; condoms have never been shown to reduce
HIV infection rates and AIDS deaths in general-population epidemics like those
in sub-Saharan Africa. In on study, researchers asserted that of the three
interventions scientifically shown to prevent AIDS - abstinence, being
faithful, and using condoms - they argue that the use of condoms clearly comes
last and should be promoted as a first-line defense only to those in extremely
high-risk groups, such as commercial sex workers.
One prospective study showed that for 'receptive' men during
anal sex, it made little or no difference whether their partners used a condom
or not. Researchers suggested that condoms are less effective in anal sex than
in vaginal sex.
SIGNS AND SYMPTOMS
Early symptoms: Many patients are asymptomatic (experience
no symptoms) when they first become infected with HIV. After one or two months,
an estimated 80-90% of HIV patients develops flu-like symptoms, including,
headache, fever, fatigue, and enlarged lymph nodes. These symptoms usually last
about one week to one month and are often mistaken for another viral infection,
such as the flu. Despite having minimal or no symptoms during this stage,
individuals are very infectious because the virus is present in large
quantities in bodily fluids.
The most obvious sign of HIV infection is a decrease in the
number of CD4 cells in the blood. These cells help fight against infection. HIV
slowly kills these cells without causing symptoms. Even when the infected
individual is asymptomatic, the virus is multiplying, infecting, and destroying
cells in the immune system.
Clinical latency symptoms: After the initial infection with
HIV, more serious symptoms develop. This next stage of infection is called
clinical latency. Once infected with HIV, it may take 10 or more years for more
severe symptoms to appear in adults or up to two years in children who are born
with HIV infection. The length of this asymptomatic period varies among
individuals. Some people may start to experience more serious symptoms within a
few weeks, while others may have no symptoms for several years. The virus can
also hide within infected cells. Patients can transmit the virus to others
during all stages of the disease.
As the immune system continues to weaken, many symptoms
appear, including inflamed lymph nodes (swollen glands) that may be enlarged
for longer than three months. Other symptoms may include fatigue, weight loss,
frequent fevers and sweats, persistent or frequent yeast infections (oral or
vaginal), persistent skin rashes or flaky skin, pelvic inflammatory disease
(PID) in women that does not respond well to treatment, and short-term memory
In addition, some individuals develop a painful nerve
disease called shingles or frequent and severe herpes infections that cause sores
to develop on the mouth, genitals, or anus. Infected children may be sick often
or grow slowly (failure to thrive) because their immune systems are still
AIDS symptoms: Once the patient's CD4 T-cell count is less
than 200 cells per microliter of blood, their condition has progressed to AIDS,
the final stage of the disease. The first symptoms often include moderate and
unexplained weight loss, frequent lung infections, and oral ulcerations
Patients are vulnerable to opportunistic infections and
tumors. Opportunistic infections and tumors may include tuberculosis, thrush,
herpes viruses, shingles, Epstein-Barr virus, pneumonia, and a type of cancer
called Kaposi's sarcoma (KS). In the last stages of AIDS, it is common for
individuals to have cytomegalovirus or Mycobacterium avium complex (MAC)
General: Opportunistic infections are conditions that occur
in individuals who have weakened immune systems. The organisms (bacteria,
fungi, or viruses) that cause these infections do not cause illnesses in
patients who have healthy immune systems because they are able to fight off the
infection. The most common opportunistic infections associated with HIV and
AIDS are Pneumocystis jiroveci pneumonia, Mycobacterium avium complex (MAC),
toxoplasmosis, and tuberculosis. Patients at risk of developing these
infections typically receive medication to prevent infections.
Pneumocystis jiroveci pneumonia: Pneumocystis jiroveci
pneumonia (formerly called Pneumocystis carinii or PCP) is the most common
opportunistic infection among HIV patients. Before antiretroviral therapy and
preventative treatment was available, about 70-80% of people with HIV developed
PCP. However, this number has been declining significantly over the years.
Originally, researchers thought a one-cell organism called
Pneumocystis carinii caused the infection. However, recent research suggests
that a fungus called Pneumocystis jiroveci is the cause. The condition is still
commonly referred to as Pneumocystis carinii pneumonia (PCP).
According to the U.S. Centers for Disease Control and
Prevention (CDC), PCP is classified as an AIDS-defining illness. This means
that when HIV-infected patients develop PCP, their condition has progressed to AIDS.
Individuals with a CD4 cell (helper T-cells that help fight against disease and
infection) count lower than 200 cells per microliter of blood have the greatest
risk of developing PCP. In addition, people who have CD4 cell counts lower than
300 who have already had another opportunistic infection have an increased risk
of developing PCP.
This infection almost always affects the lungs causing a
type of pneumonia. The first signs of PCP are difficulty breathing, fever, and
a dry cough. Other common symptoms include chest discomfort, weight loss,
chills, tachypnea (rapid breathing), tachycardia (fast heart rate), mild
crackles (bubbling or rattling sounds that occur when air moves through
fluid-filled airways), cyanosis (bluish discoloration of the skin), nasal
flaring, and intercostal retractions (visible use of muscles between the ribs,
which indicates labored breathing). The patient may also cough up blood,
although this is considered a rare symptom.
Historically, mortality ranged from 20-40%, depending on the
severity of the disease when it was diagnosed. Today, however, mortality rates
range between 10-20%.
Today, PCP is almost entirely preventable, and it can be
treated effectively with medications. Unfortunately, PCP is still common in
patients who are infected with HIV for a long time before they begin
antiretroviral therapy (ART). In fact, 30-40% of HIV patients develop PCP if
they begin treatment when their CD4 cell counts are very low (around 50 cells
per microliter of blood).
Mycobacterium avium complex (MAC): Mycobacterium avium
complex (MAC), or mycobacterium avium intracellulare (MAI), is a bacterial
infection that is caused by either Mycobacterium avium or Mycobacterium
intracellulare. These bacteria are commonly found in water, soil, dust, and
food. In fact, these bacteria are present in almost every human. However, a
healthy immune system prevents the bacteria from causing an infection. HIV/AIDS
patients are at risk of developing MAC.
According to the CDC, MAC is considered an AIDS-defining illness.
It is estimated that up to 50% of individuals with HIV/AIDS develop MAC,
especially if their CD4 count is lower than 50 cells per microliter of blood.
MAC rarely causes infections in patients who have CD4 cell counts higher than
100 cells per microliter of blood.
MAC infections may be localized (limited to one part of the
body) or disseminated (spread throughout the entire body, sometimes called
DMAC). MAC infection often occurs in the lungs, intestines, bone marrow, liver,
Common symptoms of MAC include weight loss, fever, chills,
night sweats, swollen glands, abdominal pain, diarrhea, inflammation, and an
overall feeling of weakness. MAC usually affects the intestines and inner
The most common complication of DMAC is anemia (low levels
of red blood cells), which may require a blood transfusion. If the infection
involves many organs, it may lead to respiratory failure and death. Patients
who have localized infections that have not spread to other parts of the body
have a low mortality rate because they are easier to treat.
Toxoplasmosis: Toxoplasmosis (toxo) is a parasitic infection
that is caused by a single-celled parasite called Toxoplasma gondii.
Toxoplasma gondii is one of the most common parasites, found
all over the world. Individuals may be exposed to the parasite in soil, cat
feces, or in raw or undercooked meat (especially lamb, pork, or venison). There
have also been rare reports of toxoplasmosis infection as a result of organ
transplantation or blood transfusion.
It is estimated that more than 60 million Americans carry
the parasite. However, 80-90% of infected patients are carriers (experience no
symptoms) because the body's immune system prevents the parasite from causing
illness. Toxoplasmosis is considered an AIDS-defining illness, according to the
HIV patients often experience symptoms such as headache,
confusion, poor coordination, seizures, and ocular toxoplasmosis (severe
inflammation of the retina) as well as lung problems that are similar to
tuberculosis or pneumocystis pneumonia.
Tuberculosis: Tuberculosis (TB) is a bacterial infection of
the lungs, which is caused by the bacterium Mycobacterium tuberculosis.
Symptoms may include cough, shortness of breath, pleurisy (pain with breathing
or coughing), fever, weight loss, night sweats, chills, and loss of appetite.
The disease can cause serious breathing problems, which can be life
threatening, especially if left untreated.
Tuberculosis is highly contagious. The disease is
transmitted through airborne droplets when a person with the infection coughs,
talks, or sneezes.
About 10-15 million Americans have latent TB infection,
which means they are not sick, but they carry the bacterium that causes the
disease. Only 10% of individuals with latent TB ever develop the infection.
While tuberculosis is not considered an AIDS-defining
illness, HIV patients have an increased risk of developing TB because they have
weakened immune systems. The risk of developing active TB increases 7-10% in
HIV patients who have latent TB. HIV patients are more likely to experience
symptoms in areas of the body other than the lungs. This is called
extrapulmonary TB. The disease may affect the bones, joints, nervous system, or
urinary tract. Also, TB appears to make HIV infection worse; researchers have
observed faster HIV replication when tuberculosis is also present.
HIV and pregnancy:
Babies born to HIV-infected mothers may become infected
during pregnancy, delivery, or breastfeeding. Therefore, the U.S. Centers for
Disease Control and Prevention (CDC) recommend that all pregnant women get
tested for HIV.
Antiretroviral therapy can significantly reduce the
likelihood of an HIV-infected pregnant mother passing the virus to her baby.
Patients who were taking antiretroviral medication before becoming pregnant
should talk to their healthcare providers to determine the safest and most
effective treatment option. In general, efavirenz (Sustiva©), stavudine
(Zerit©), hydroxyurea (Droxia© or Hydrea©), and the oral liquid formulation of
amprenavir (Agenerase©) should not be taken during pregnancy because they may
cause harm to the fetus.
Because a baby may become infected though exposure to the
mother's blood and vaginal secretions during delivery, the risk of infection
increases with delivery time. Mothers with high levels of the virus in their
blood might reduce their risk if they deliver their babies by cesarean section
(surgical delivery of an infant), also called c-section. While c-sections may
reduce the risk of transmission during birth, it is not typically necessary in
patients taking antiretroviral therapy.
HIV infection rates of babies shortly before or after birth
have been shown to drop to as low as 1-2% if their mothers take combination
antiretroviral therapy during pregnancy, as well as zidovudine or nevirapine (Viramune©)
preventative therapy during labor and after birth.
HIV-infected mothers should not breastfeed their babies
because the virus may be transmitted via the breast milk. Instead, baby
formulas should be used.
General: HIV is diagnosed after HIV antibodies or HIV itself
is detected in the patient's body. As soon as the virus enters the body, the
immune system produces antibodies, which are proteins that detect foreign
substances in the body, including infectious agents like HIV. The presence of
HIV antibodies in the blood, oral fluid, or urine can be used to determine
whether HIV is in the body. Blood tests are the most commonly used HIV tests.
It may take some time for the immune system to produce
enough antibodies for the antibody test to detect them. This time period, known
as the "window period," varies among patients. Most people will
develop detectable antibodies two to eight weeks after exposure, with the
average being 25 days. However, some individuals might take longer to develop
detectable antibodies. Of those infected with HIV, 97% develop antibodies
within the first three months of infection. In very rare cases, it can take up
to six months to develop antibodies to HIV. Therefore, if a patient tests
negative for HIV in the first three months after possible exposure, repeat
testing should be considered at least three months after the exposure.
In the United States, the test results must remain
confidential. Individuals who are younger than 18 years old can consent to or
refuse to be tested for HIV, without the involvement of their legal guardians.
Test results may not be released to the patient's legal guardian(s) without
Who should get tested: The U.S. Centers for Disease Control
(CDC) recommends that the following individuals get tested for HIV:
Individuals between the ages of 13 and 64 should be tested
Individuals who have injected illegal drugs.
Individuals who have had unprotected vaginal, anal, or oral
Individuals who have multiple or anonymous sexual partners.
Individuals who have exchanged sex for drugs or money.
Individuals who been diagnosed with or treated for
hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD), such as
syphilis, gonorrhea, or chlamydia.
Individuals who have come in direct contact with an
HIV-infected person's blood.
Individuals who have had unprotected sex with someone who
meets any of the above stipulations.
Pregnant women should be screened for HIV as part of regular
Pre-test counseling: According to the U.S. Centers for
Disease Control and Prevention's (CDC) new guidelines for HIV testing, HIV
prevention counseling is not required to accompany HIV screening. However, the
CDC still recommends that patients receive information about HIV infection,
transmission, and prevention. Patients should receive information about HIV
testing and the meaning of test results. Healthcare providers should also tell
the patient when to expect results and that confirmatory testing is necessary
if the test result is positive. This is because it is possible for a false
positive test result.
The patient may receive information through a pamphlet,
brochure, video, or a one-on-one meeting with a certified counselor. Patients
who are tested with a rapid HIV test should have equal access to the same types
Prevention counseling: Prevention counseling is not
mandatory, but it should be offered to all patients when they receive their
test results. Counseling focuses on reducing the risks of HIV infection or
transmission. The counselor makes a personalized detailed risk assessment of
the patient. The counselor should also suggest behavior changes that may help
reduce the patient's risk of developing or transmitting HIV. The counseling session
is a chance to clear up any misconceptions or questions the patient may have
about the disease.
Enzyme-linked immunosorbent assay (ELISA): The most common
HIV tests use blood to detect HIV infection. The enzyme-linked immunosorbent
assay (ELISA) tests a patient's blood sample for antibodies. Oral fluid (not
saliva), collected from the cheeks and gums, may also be used to perform an
ELISA. Oral fluid ELISA tests are considered as sensitive as a blood test. A
urine sample may also be used during an ELISA, but this is considered less
accurate than a blood or oral fluid test. A positive (reactive) ELISA for all
samples must be used with a follow-up (confirmatory) test, such as the Western
blot test, to make a positive diagnosis. Although false negative or false
positive results are extremely rare, they may occur if the patient has not yet
developed antibodies to HIV or if a mistake was made at the laboratory. When
used in combination with the confirmatory Western blot test, ELISA tests are
Western blot test: A Western blot test is typically used to
confirm a positive HIV diagnosis. During the test, a small sample of blood is
taken and it is used to detect HIV antibodies, not the HIV virus itself. The
Western blot test separates the blood proteins and detects the specific
proteins (called HIV antibodies) that indicate an HIV infection. The Western
blot is used to confirm a positive ELISA, and the combined tests are 99.9%
Polymerase chain reaction (PCR): Polymerase chain reaction
(PCR) tests are used to detect HIV's genetic material, called RNA. These tests
can be used to screen the donated blood supply and to detect very early
infections before antibodies have been developed. This test may be performed
just days or weeks after exposure to HIV. Although these tests are the most
accurate, they are not performed as often as the other HIV tests because they
are expensive and also time- and labor-intensive.
Rapid test: A rapid test produces results in about 20
minutes. Rapid tests use a sample of blood or oral fluid to detect HIV
antibodies. The patient's sample is placed on a test strip that contains HIV
antigens. If the patient has developed HIV antibodies, the strip will change
colors, indicating a positive result. A positive HIV test should be confirmed
with a follow-up confirmatory test before a final HIV diagnosis can be made.
These tests have similar accuracy rates as traditional ELISA screening tests.
Home-testing kit: Consumer-controlled test kits, also called
home-testing kits, were first licensed in 1997. The Home Access HIV-1 Test
System™ is a home kit that is approved by the U.S. Food and Drug Administration
(FDA). The Home Access HIV-1 Test System™ is available at most local
pharmacies. The individual pricks a finger with a special device and places
drops of blood on a specially treated card. The card is then mailed to a
licensed laboratory for testing. Home testing kits are confidential, and
patients do not need to provide any personal information (such as name or
address) when submitting samples. Instead, they call for results using a
personal identification number (PIN). Callers may speak to a counselor any time
before, during, or after the test. All individuals with positive test results
are given referrals for follow-up confirmatory tests, as well as information
and resources on treatment and support services. FDA-approved tests are equally
as accurate as the tests performed in a doctor's office when performed
HIV drug resistance testing: Drug resistance testing is used
to determine whether a patient with HIV has a mutated form of the virus that
does not respond to antiretroviral therapy (ART).
If an HIV-infected patient becomes resistant to a drug and
continues to take the same medication, HIV is able to multiply faster because
the drug cannot stop it from replicating. When the new, mutated form is
favored, it is called selective pressure. If the resistant virus makes enough
copies of itself, it may eventually become the dominant type of HIV in the
body. Once this happens, the medication is ineffective, and the patient will be
resistant to the specific medication.
The FDA has approved the drug resistance test TrueGene™. The
sensitivity, specificity, and reproducibility for many other tests have not
been well established. However, several tests are available, and many health
insurance plans cover them. There are two main types of drug resistance tests:
genotypic and phenotypic resistance tests.
Genotypic resistance testing examines the genetic structure
(genotype) of a patient's HIV. A blood sample is taken from the patient, and
the HIV is analyzed for the presence of specific genetic mutations that are
known to cause resistance to specific drugs. For instance, researchers have
determined that lamivudine (Epivir©) and emtricitabine (Emtriva©) are not
effective against forms of HIV that contain the mutation "M184V" in
its reverse transcriptase gene. If a patient tests positive for this mutation,
it is highly likely that he or she is resistant to both drugs, and different drugs
should be prescribed.
Phenotypic testing directly measures the sensitivity
(phenotype) of a patient's HIV in response to specific antiretrovirals. Many
experts believe that these tests are more accurate and comprehensive than
genotypic tests. These tests can help a physician determine the amount or
concentration of a drug that is needed to stop a specific strain of HIV from
replicating in a patient.
Genetic testing: Genetic testing can be done on several
genes that affect HIV and the course of the infection. For example, a genetic
mutation causing a protein defect called CCR5 delta 32 has been shown to be
resistant to the HIV virus. Mutations in the major histocompatibility complex,
class I, B (HLA-B) gene is also linked to the HIV virus. There are several
variations in HLA-B that can either slow the progression of HIV to AIDS or
speed it up. Mutations in the killer cell immunoglobulin-like receptor, three
domains, long cytoplasmic tail, 1(KIR3DL1) gene and the chemokine (C-C motif)
ligand 3-like 1 (CCL3L1) gene have also been associated with varying rates of
General: Although current antiretroviral drugs cannot cure
HIV/AIDS, they may suppress the virus, even to undetectable levels. The
guidelines for antiretroviral treatment are the same for adolescents and
In emergency situations, or if parental involvement is
impossible or could cause harm, and if the patient can adhere to treatment
regimens, a minor can consent to treatment without parental involvement.
However, communication with legal guardians should be encouraged in all
patients who are younger than 18 years old and need to make healthcare
Patients who were taking antiretroviral medication before
becoming pregnant should talk to their healthcare providers to determine the
safest and most effective treatment options. In general, efavirenz (Sustiva©),
stavudine (Zerit©), hydroxyurea (Droxia© or Hydrea©), and the oral liquid
formulation of amprenavir (Agenerase©) should not be taken during pregnancy
because they may cause harm to the fetus.
Highly active antiretroviral therapy (HAART): HIV patients
typically receive a combination of antiretroviral drugs because a single
patient may have several different strains (types) of the virus circulating in
the blood. The different strains of the virus may respond differently to
specific types of drugs. Therefore, highly active antiretroviral therapy
(HAART), which is a combination of drugs from at least two different drug
classes, is recommended. There are five major classes of antiretrovirals:
fusion inhibitors, nucleoside/neucleotide reverse transcriptase inhibitors
(NRTIs/NtRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs),
protease inhibitors, and integrase inhibitors. Each drug class disrupts different
stages of HIV's life cycle.
Fusion inhibitors prevent the virus from entering and
infecting human cells. The U.S. Food and Drug Administration (FDA) has approved
the fusion inhibitor, enfuvirtide (Fuzeon©), also called T-20. Clinical trials
have demonstrated that enfuvirtide-based therapy is an effective treatment for
patients who have taken other types of antiretrovirals in the past. Enfuvirtide
should not be taken in patients who have never received antiretroviral drugs
before because it is only recommended when other drugs have not worked.
Nucleoside reverse transcriptase inhibitors (NRTIs) and
nucleotide reverse transcriptase inhibitors (NtRTIs), also called nukes,
inhibit HIV replication. HIV replicates by converting the viral RNA into
complementary DNA (cDNA), which then integrates into the host DNA. A viral
enzyme called reverse transcriptase (RT) converts the viral RNA into cDNA using
host nucleotides, which are the building blocks of DNA. NRTIs are nucleoside
analogs, or fake versions of nucleosides (which are the precursors to
nucleotides), and the resulting DNA cannot be incorporated into the host DNA.
NtRTIs are neucleotide analogs and do not need to be converted. Therefore,
NtRTIs may have fewer side effects than NRTIs. The FDA has approved the
following NRTIs: lamivudine/zidovudine (Combivir©), emtricitabine (Emtriva©),
lamivudine (Epivir©), abacavir sulfate/lamivudine (Epzicom©), zalcitabine
(Hivid©), zidovudine (Retrovir©), abacavir sulfate/lamivudine/zidovudine
(Trizivir©), emtricitabine/tenofovir disoproxil fumarate (Truvada©), didanosine
(Videx©, Videx EC©), stavudine (Zerit©), and abacavir sulfate (Ziagen©).
Tenofovir disoproxil fumarate (Viread©) is an FDA-approved NtRTI.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs),
also called non-nucleoside analogs, interfere with viral replication. HIV
replication requires the enzyme reverse transcriptase (RT), which is targeted
by NNRTIs. When patients take non-nucleoside reverse transcriptase inhibitors
(NNRTIs), the drug attaches to HIV's enzyme before it can use the patient's
nucleic acid to multiply. NNRTIs significantly reduce the ability of HIV to
multiply and infect new cells. The FDA has approved several NNRTIs, including
delavirdine (Rescriptor©), efavirenz (Sustiva©), and nevirapine (Viramune©).
Also, in July 2006, the FDA approved the multi-class combination drug
efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla©), which
includes one NNRTI and two NRTIs.
Protease inhibitors (PIs) also interfere with HIV
replication, they prevent the production of viral proteins that require an
enzyme called protease. When protease is blocked, the new copies of HIV do not
form properly and cannot infect new cells. The FDA has approved several
protease inhibitors including: amprenavir (Agenerase©), tipranavir (Aptivus©),
indinavir (Crixivan©), saquinavir mesylate (Invirase©), opinavir/ritonavir
(Kaletra©), fosamprenavir calcium (Lexiva©), ritonavir (Norvir©), darunavir
(Prezista©), atazanavir sulfate (Reyataz©), and nelfinavir mesylate (Viracept©).
In October 2007, the FDA approved an integrase inhibitor,
called raltegravir (Isentress©), for the treatment of HIV in combination with
other antiretrovirals. Integrase inhibitors are a new class of antiretrovirals
that block the integrase enzyme that HIV uses to incorporate cDNA into host
Antiretroviral side effects: Individuals taking
antiretroviral drugs often find it difficult to follow complicated drug plans.
Current treatments involve taking at least two different classes of
antiretroviral drugs daily. Also, some of the drugs may cause nausea or
vomiting, some pills should be taken on an empty stomach, and others should be
taken with food. Specific side effects depend on the specific drugs. In
general, common side effects include changes in body fat distribution and blood
lipid levels. Glucose metabolism (the breakdown of carbohydrates to produce
energy) is also affected, which may lead to the onset or worsening of diabetes.
It is estimated that about 2-10% of people taking antiretrovirals have
The National Institute of Allergy and Infectious Diseases is
among many research organizations that is investigating simpler, less toxic,
and more effective drug plans.
Synergistic enhancers: Another group of medications, called
synergistic enhancers, may also be used in combination with other
antiretroviral drugs to treat HIV. These medications do not act as
antiretrovirals when taken alone, but they have been shown to improve the
antiretrovirals effects of other drugs, including ritonavir. Very small doses
of synergistic enhancers may also be used to reduce the liver metabolism of
other antiretroviral drugs.
Surgery: Patients infected with the human immunodeficiency
virus (HIV) may require surgery to treat infections and diseases associated
with the condition. With the introduction of HAART, HIV patients are able to
live longer lives. As a result, it is possible that surgical interventions may
be needed to diagnoses and/or treat long-term conditions. For example, lung
infections, which may be caused by Pneumocystis jiroveci pneumonia (formerly
called Pneumocystis carinii pneumonia, PCP), Mycobacterium avium complex (MAC),
and tuberculosis often require invasive diagnostic procedures, such as
bronchoalveolar lavage or an open lung biopsy. Like any surgical procedure,
there are potential health risks. It remains unclear whether HIV patients are
more likely to develop complications than HIV-negative patients.
Common complications of surgery include bleeding,
infections, and nerve damage. It has been suggested that HIV patients may have
an increased risk of surgical complications (especially infections) because
they have weakened immune systems. However, there is currently no scientific
data on the prevalence of surgical complications among HIV patients compared to
Researchers believe that the risks of surgical complications
for HIV patients can be predicted in a way similar to the method used in
HIV-negative patients. Prior to surgery, healthcare providers should perform a
physical examination, detailed medical history, and laboratory testing to
determine the patient's overall health. Healthcare providers must also consider
possible interactions between the patient's anti-HIV drugs (antiretrovirals)
and medications, such as pain relievers, that are used before, during, and after
It remains unclear whether a patient's CD4 cell count
influences their risk of surgical complications. Healthy individuals have a CD4
cell count between 600 and 1,200 cells per microliter of blood. The lower the
CD4 count, the weaker the patient's immune system. Some studies have found no
correlation between low CD4 cell counts and surgical complications, while
others have found an increase in complications with lower CD4 counts. Further
research is needed before a firm conclusion can be made.
Organ transplants: As mentioned above, HAART enables
HIV/AIDS patients to live longer lives. Today, most patients with HIV/AIDS are
dying from end-stage organ disease and organ failure rather than
AIDS-associated opportunistic infections. Since HAART prolongs the lives of HIV
patients, it is possible for chronic conditions to progress to organ failure.
For instance, HIV patients may experience end-stage liver disease as a
complication of chronic hepatitis C virus. Glomeruli diseases are also common
among HIV patients, and they may lead to kidney failure. In advanced stages of
liver or kidney damage, organ transplants may be the patient's only chance of
Until recently, people who had HIV were not considered good
candidates for organ transplantations. Many patients were denied transplants
under the assumption that they had shorter life expectancies and less favorable
survival rates than other patients in need of transplants. However, now that
patients are living longer lives, many groups are re-considering whether HIV
patients should be transplant candidates.
Although the United Network for Organ Sharing
(UNOS) does not consider HIV infection a contraindication for organ
transplantation, individual transplant centers are in charge of deciding
whether or not to perform surgery in an HIV-positive patient. Some centers will
not provide organ transplants to HIV-positive patients, even if they are good
candidates based on their physical and mental health.
Some health insurance companies are reluctant to cover
transplantation in HIV-positive candidates because they consider it to be an
experimental procedure. Currently, only a few medical centers worldwide perform
organ transplants in HIV-positive patients. However, health insurance companies
and doctors consider organ transplantations in HIV-negative patients to be a
well-established, reimbursable procedure.
Recent legislation in California and a ruling in Arizona may
help increase HIV patients' access to transplant surgery. In October 2005, an
administrative law judge declared that Medicaid had to pay for a liver
transplant for an Arizona woman who was HIV-positive. In the same month,
California Governor Arnold Schwarzenegger signed a law that prohibits health
insurance companies from denying coverage for organ transplants in HIV patients
solely on the basis of their HIV-status. The law is the first of its kind to
target such denials.
The limited number of transplants that have been performed
in HIV patients have produced encouraging results. However, organ transplants
for people with HIV/AIDS have not gained widespread medical support, and there
are still concerns regarding the long-term prognosis for HIV-positive
Treatment adherence: In order for anti-HIV drugs to work
correctly, they must be taken exactly as prescribed. Skipping doses or not
taking the medications correctly can cause the amount of an antiretroviral drug
to decrease in the bloodstream. If the drug level becomes too low, HIV can
begin reproducing more quickly. The faster HIV reproduces, the more mutations
occur, including those that may be resistant to drugs. When a patient becomes
resistant to a drug, the medication is no longer effective, even if it is taken
in the future. As a result, patients have fewer treatment options.
According to several studies, HIV patients must be more than
95% adherent to their treatment plans in order for them to remain effective.
This means that missing more than one dose per month may reduce the drugs'
Healthcare providers evaluate treatment effectiveness by
measuring CD4 cell counts in the patient's blood. These immune cells are the
primary targets of HIV. If the CD4 cell count is maintained, the likelihood of
the virus mutating into resistant strains is decreased. HIV patients who are
otherwise healthy and symptom-free should have their CD4 cell count and viral
load tested about 2-4 times a year. However, symptomatic patients should be
tested more frequently to evaluate both the risk of opportunistic infections and
the response to HIV drug treatments.
Note: Integrative therapies should not replace
antiretroviral therapy (ART) in HIV patients. Patients should consult their
healthcare providers before taking any herbs or supplements because they may
interact with treatment. In particular, patients should not take St. John's
wort because it may interact with HIV treatment.
Unclear or conflicting scientific evidence:
Aloe vera: Clear gel from the pulp of Aloe vera leaves has
been used on the skin for thousands of years to treat wounds, skin infections,
minor burns, and other skin conditions. Although aloe has been suggested as a
possible treatment for HIV infection, further research is needed before a firm
conclusion can be made.
Avoid if allergic to aloe or other plants of the Liliaceae
family (garlic, onions, and tulips). Avoid injecting aloe. Do not apply to open
skin, surgical wounds, or pressure ulcers. Avoid taking by mouth with diarrhea,
bowel blockage, intestinal diseases, bloody stools, or hepatitis. Avoid with a
history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes,
heart disease, or kidney disease. Avoid taking by mouth if pregnant or
Alizarin: Limited available evidence suggests that alizarin
may be of benefit in the treatment of viral infections. Additional research is
needed in this area.
Avoid if allergic or hypersensitive to alizarin or any
plants in the Rubiaceae family. Alizarin may be toxic and should not be handled
for long periods of time, rubbed in the eyes, or eaten. Avoid if pregnant or
Antineoplastons: Antineoplastons are substances found in
human blood and urine. Preliminary study reported increased energy and weight
in patients with HIV who were treated with antineoplaston AS2-1, as well as a
decreased number of opportunistic infections and increased CD4 cell counts.
However, this evidence cannot be considered conclusive. Currently, there are
drug therapy regimens available for HIV with clearly demonstrated effects
(highly active anti-retroviral therapy), and patients with HIV are recommended
to consult with their physicians about treatment options.
Avoid if allergic or hypersensitive to antineoplastons. Use
cautiously with high medical or psychiatric risk. Use cautiously with an active
infection due to a possible decrease in white blood cells. Use cautiously with
high blood pressure, heart conditions, chronic obstructive pulmonary disease,
liver disease/damage, or kidney disease/damage. Avoid if pregnant or
Astragalus: Antiviral effects have been reported in early
studies for HIV. Additional research is warranted.
Avoid if allergic to astragalus, peas, or any related plants
or with a history of Quillaja bark-induced asthma. Avoid with aspirin or
aspirin products or herbs or supplements with similar effects. Avoid with
inflammation (swelling) or fever, stroke, transplant or autoimmune diseases
(like HIV/AIDS). Stop use two weeks before surgery/dental/diagnostic procedures
with a risk of bleeding and avoid use immediately after these procedures. Use
cautiously with bleeding disorders, diabetes, high blood pressure, lipid
disorders or kidney disorders. Use cautiously with blood-thinners, blood sugar
drugs, or diuretics or herbs and supplements with similar effects. Avoid if
pregnant or breastfeeding.
Beta sitosterol: Beta-sitosterol is found in plant-based
foods, such as fruits, vegetables, soybeans, breads, peanuts, and peanut
products. It is also found in bourbon and oils (such as olive oil, flaxseed,
and tuna). Due to data that suggest immune modulating effects of
beta-sitosterol and beta-sitosterol glucoside, these sterols have been studied
in combination in the treatment of HIV. Larger populations of patients with HIV
should be evaluated in randomized controlled trials to draw any conclusions.
Avoid if allergic or hypersensitive to beta-sitosterol,
beta-sitosterol glucoside, or pine. Use cautiously with asthma or breathing
disorders, diabetes, primary biliary cirrhosis (destruction of the small bile
duct in the liver), ileostomy, neurodegenerative disorders (like Parkinson's
disease or Alzheimer's disease), diverticular disease (bulging of the colon),
short bowel syndrome, celiac disease, and sitosterolemia. Use cautiously with a
history of gallstones. Avoid if pregnant or breastfeeding.
Bitter melon: Laboratory studies have shown that a protein
in bitter melon called MAP30 may have antiviral activity against HIV. However,
this has not been studied in humans. Further research is needed before a firm
conclusion can be made.
Avoid if allergic to bitter melon or members of the
Curcurbitaceae (gourd or melon) family. Avoid ingesting bitter melon seeds.
Avoid with glucose-6-phosphate dehydrogenase deficiency. Use cautiously with
diabetes, glucose intolerance, or with hypoglycemic agents due to the risk of
hypoglycemia (low blood sugar). Avoid if pregnant or breastfeeding.
Blessed thistle: Laboratory studies report no activity of
blessed thistle against herpes viruses, influenza, or poliovirus. Effects of
blessed thistle (or chemicals in blessed thistle called lignans) against HIV
are not clear. Human research of blessed thistle as a treatment for viral
infections is lacking.
Blessed thistle is generally considered to be safe when
taken by mouth in recommended doses for short periods of time, with few
reported side effects such as birth defects, bleeding, breathing problems,
bruising, cancer of the nose or throat, increased production of stomach acid,
itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach
ulcers, and vomiting. Allergic reactions to blessed thistle including rash may
occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity
may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot,
daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed
or other plants in the Asteraceae/Compositae family. Avoid if pregnant or
Boxwood: Trials have been conducted for SPV30 (extract of
boxwood, Arkopharma, France) to evaluate its potential effectiveness for
HIV/AIDS. Rigorous clinical study is needed to confirm these early study
Avoid if allergic or hypersensitive to boxwood, its
constituents, or any plants in the Buxaceae family. Use cautiously with HIV or
AIDS. Avoid if pregnant or breastfeeding.
Carrageenan: Carrageenan-based gels may reduce HIV
transmission during sexual intercourse and have been investigated for safety
and acceptability in published studies involving healthy females. Overall,
studies suggest that carrageenan is not associated with abnormal genital
clinical findings or severe side effects, and is considered acceptable for use
by females and their male partners. Additional research is needed to better
determine the role of carrageenan for HIV infection prevention.
Use oral carrageenan cautiously in infants. Use cautiously
in patients with, or at risk for, cancer. Use cautiously in patients treated
with azoxymethane or nitrosomethylurea. Use cautiously in patients with
gastrointestinal, immune, inflammatory, or bleeding disorders, or in patients
with low blood pressure or diabetes. Use cautiously intravaginally. Use
cautiously in patients using antilipemic agents. Use cautiously in combination
with any oral medication, as the fiber in carrageenan may impair the absorption
of oral medications.
Ways to prevent acquiring and/or transmitting HIV:
Individuals who are either at risk for acquiring HIV or are 13-64 should be tested
for HIV annually. This is because this age group is most likely to be sexually
Needles or syringes should be avoided.
Unprotected sexual contact, including vaginal, anal, or oral
sex, should be avoided with an infected person. Unprotected sexual contact with
someone with unknown HIV status should also be avoided.
Behavioral modification may help prevent HIV/AIDS infection.
In Uganda, there has been a dramatic decline in HIV prevalence as well as a
decline in multi-partner sexual behavior. The decrease in HIV/AIDS infection
came after the launch of behavior change programs largely developed by the
Ugandan government and local NGOs. The 'ABC' initiative (Abstain, Be faithful,
or for those who refuse to do either, use Condoms) resulted in a significant
decrease in HIV infections in generalized epidemics. Researchers explained that
once the ABC program was launched, rates of 13- to 16-year-olds having sex in
one district of Uganda dropped from nearly 60% in 1994 to less than five
percent in 2001. Uganda's message for the majority of the population focused on
mutual fidelity; the reduction in casual sex, not the elimination of all sex,
seems to have led to Uganda's falling HIV rates. Uganda has shown a 70% decline
in HIV prevalence since the early 1990s, linked to a 60% reduction in casual
Gloves should be worn when in contact with blood or other
body fluids that could possibly contain blood, such as urine, feces, or vomit.
Cuts, scrapes, sores, or breaks on the exposed skin of both
the caregiver and patient should be covered with bandages.
Any body area that comes into contact with blood or other
body fluids should be thoroughly washed. Surfaces that have been tainted with blood
should be disinfected with antibacterial soap.
Practices that increase the likelihood of blood contact,
such as the sharing of razors, toothbrushes, and nail clippers, should be
Needles and other sharp instruments should be used only when
medically necessary and handled appropriately.
In 1985, the U.S. Centers for Disease Control and Prevention
(CDC) issued a list of routine precautions for all personal-service workers,
such as hairdressers, barbers, cosmetologists, and massage therapists, to take.
Instruments that penetrate the skin, such as tattoo and acupuncture needles or
ear piercing guns, should either be used once and disposed of or thoroughly
sterilized. Instruments that are not meant to penetrate the skin, but may come
in contact with blood (such as razors), should not be shared unless thoroughly
Antiviral therapy during pregnancy can significantly lower
the chance that the virus will be passed to the infant before, during, or after
birth. The treatment is most effective if it is started as early as possible
during pregnancy. However, there are still health benefits if treatment is
begun during labor or shortly after the baby is born.
Delivering the baby by cesarean section has been shown to
reduce the risk of transmission to the newborn. However, this is not the
standard preventative care for HIV-infected pregnant women. It should only be
considered in certain clinical circumstances (such as for patients who have a
very high viral load or for patients who do not adhere to antiretroviral
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