HIV & AIDS

What is HIV &AIDS?

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome). The virus is passed from an infected person to another person through blood-to-blood contact, sexual contact, or from mother to infant during pregnancy, birth process or breast feeding.

HIV attacks certain types of white blood cells, primarily T4 cells (commonly known as T-cells) and macrophages, which are crucial to the normal functioning of the immune system. The disruption of these cells causes the breakdown in the immune system that characterizes AIDS.

AIDS is an illness that damages a person's ability to fight off disease, leaving the body open to attack from unusual types of cancer and from infections that the body's immune system could ordinarily fight off. These types of infections are known as "opportunistic" infections because they take advantage of a weakened immune system to cause illness. AIDS is not a single disease, but rather a collection of symptoms caused by opportunistic infections and/or cancers. Pneumocystis carinii pneumonia and Kaposi's sarcoma, once a rare type of cancer, have been the most common causes of death in people with AIDS in the US

Where did HIV come from?

Unfortunately, we don't know. Scientists have different theories about the origin of HIV, but none have been proven. The earliest known case of HIV was from a blood sample collected in 1959 from a man in Kinshasa, Democratic Republic of Congo and the source of his infection is not known. Genetic analysis of this blood sample suggests that HIV may have stemmed from a single virus in the late 1940s or early 1950s.

We do know that the virus has existed in the US since at least the mid to late 1970s. From 1979 to 1981 rare types of pneumonia, cancer, and other illnesses were being reported by doctors in Los Angeles and New York among a number of gay male patients. These were conditions not usually found in people with healthy immune systems.

In 1982 public health officials began to use the term "acquired immunodeficiency syndrome," or AIDS, to describe the occurrences of opportunistic infections, Kaposi's sarcoma, and Pneumocystis carinii pneumonia in previously healthy men. Formal tracking of AIDS cases began that year in the US Scientists isolated the HIV virus as the cause of AIDS in 1983.

Is it common?

Through December 2000, a total of 774,467 cases of AIDS had been reported in the US to the Centers for Disease Control (CDC). Because many people contract the virus and don't know they are infected, the CDC estimates that between 800,000 and 900,000 or 1 out of every 300 people are living with HIV or AIDS in the US.

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How is it transmitted?

This virus is passed from an infected person to another person through blood-to-blood contact, sexual contact, or mother-to-infant contact. These body fluids have been proven to spread HIV:

  • Blood
  • Semen
  • Vaginal fluid
  • Breast milk
  • Other body fluids containing blood

HIV enters the body through cuts in the skin, open sores, tiny tears in the mucous membranes of the mouth, rectum, or vagina, and directly into the blood by a needle. It is generally accepted that the virus is transmitted through direct exposure to contaminated bodily fluids that have not been exposed to the air. HIV is commonly spread by:

  • Having unprotected sexual intercourse with someone who has the virus
  • Getting HIV-infected blood, semen, or vaginal secretions into open wounds or sores
  • Sharing needles or syringes with someone who has the virus
  • Being deeply punctured with a needle or surgical instrument contaminated with the virus
  • Passing from a woman to her infant during pregnancy, birth, or breast feeding
  • Receiving transfusions of blood products donated by someone who has the virus (although the risk of transmitting HIV by a screened blood transfusion is practically nonexistent. Since 1985, the US blood supply has been screened for HIV and is believed to be very safe.)

HIV cannot go through unbroken skin. In comparison to the flu and common cold viruses, HIV is actually quite fragile and will die rather quickly if exposed to air. HIV is not transmitted through:

  • Insect bites
  • Human bites
  • Dry kissing
  • Saliva, tears, urine, or sweat
  • Contact with public toilets or drinking fountains
  • Shaking hands, giving hugs or sharing a cup

In order to assess your risk in intimate activities, consider the continuum of risk below:

Very low risk -- no reported cases due to these behaviors

  • Masturbation or mutual masturbation
  • Touching or massage
  • Erotic massage or body rubbing
  • Casual kissing
  • Oral sex on a man with a condom
  • Oral sex on a woman with a dental dam

Low risk - rare reported cases due to these behaviors

  • Deep kissing
  • Unprotected oral sex
  • Vaginal sex with a condom or female condom
  • Anal sex with a condom

High risk -- millions of reported cases

  • Vaginal sex without a condom
  • Anal sex without a condom

The important fact to remember is that an individual can transmit the virus to others, even if s/he shows no symptoms.

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What are the symptoms?

It is possible to be infected with HIV and to transmit the virus without showing symptoms of illness. Many people do not develop any symptoms when they first become infected with HIV. Some people, however, have a flu-like illness within a month or two after exposure to the virus. They may have symptoms including:

  • Fever
  • Headaches
  • Lack of energy
  • Enlarged lymph nodes easily felt in the neck and groin

These symptoms usually disappear within a week to a month and are often mistaken for the flu. The only way to determine for sure whether you are infected is to be tested for HIV infection. The following symptoms may develop after years of being infected with HIV and may signal that the infection has progressed to AIDS:

  • Rapid weight loss
  • Deep, dry coughing
  • Recurring fever or profuse night sweats
  • Profound and unexplained fatigue
  • Swollen lymph glands in the armpits, groin, or neck
  • Diarrhea that lasts for more than a week
  • Bruising more easily than normal
  • White spots or unusual blemishes on the tongue, in the mouth, or in the throat
  • Recurring yeast infections
  • Pneumonia
  • Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
  • Numbness or pain in the hands or feet
  • Loss of muscle control and reflex, paralysis, or loss of muscular strength
  • Memory loss, depression, and other neurological disorders.

Because these symptoms can take years to manifest, their absence is not an indicator of HIV status. Only a medical provider can diagnose AIDS based on specific criteria established by the CDC.

How soon after exposure to HIV will symptoms appear?

More persistent or severe symptoms may not surface for 10 years or more after HIV first enters the body in adults, and within 2 years in children born with HIV. This period of "asymptomatic" infection is variable, however, and can depend on many factors, including a person's health status and their health-related behaviors. Some people may begin to have symptoms in as soon as a few months, whereas others may be symptom-free for more than 10 years. During the asymptomatic period, however, HIV is actively infecting and killing cells of the immune system. HIV's effect is seen most obviously by measuring the levels of T cells in the blood -- the immune system's key infection fighters. The virus initially disables or destroys these cells without causing symptoms.

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How is it diagnosed?

HIV
The tests commonly used to detect HIV infection look for the presence of antibodies that fight HIV. The length of time between infection and when there are enough antibodies to be detected by the HIV test is often called the "window period." According to the CDC, while almost all people infected with HIV (99%) develop detectable antibodies against the virus within 3 months of infection, it is still possible that the window period is longer, However, CDC studies indicate that it is highly unlikely that HIV infection would go unrecognized for over 6 months in persons who are infected. If an HIV test is negative 3 months after a high risk experience, an individual should consult their medical provider to determine if the test should be repeated.

Health Services offers the Rapid Oral HIV test for Brown students. This sensitive screening test, called Oraquick, detects HIV antibodies through an oral swab sample; therefore, no blood needs to be drawn. Students can expect their results in about 20 minutes. You can make an appointment at Health Services by calling 401.863-3953. On weekdays when classes are in session, you can also walk in for HIV testing at any time between 10am and 4pm, no appointment needed. You can learn more about HIV testing, and rapid testing in particular, by viewing this 10 minute video developed by the Brown University AIDS Program.

There are other testing sites in Providence and RI that can be accessed by clicking here for locations and phone numbers. Note that the types of tests offered at these sites can differ. Depending on the type, tests may require an oral swab or a blood sample, and results may be available quickly (in under an hour) or may not be available for a period of days. Be sure to ask the clinic which testing options they offer.

AIDS
An HIV-infected person receives a diagnosis of AIDS after developing one of the CDC-defined AIDS indicator illnesses and having a t-cell count below 200. However, studies have revealed that most people infected with HIV carry the virus for years before enough damage is done to the immune system for noticeable AIDS symptoms to develop. So an HIV infected person who has not had any serious illnesses can receive an AIDS diagnosis on the basis of certain blood tests (T cell counts). The loss of T cells in people with HIV is a very strong predictor of the development of AIDS.

What is the difference between confidential and anonymous testing?

Confidential testing for STIs, including HIV, means that the test results will be part of your medical record. This information cannot be accessed by anyone other than you and your medical providers unless you give written permission to release your information. Anonymous testing means that you never provide your name. You are given a number or a code and no one besides you and your testing counselor will ever know your results.

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What should I do if I test positive for HIV?

  • Consult a medical provider experienced in treating HIV/AIDS. Discuss the use of anti-viral therapies to slow the progress of the infection.
  • Protect your sex partner(s) from HIV by abstaining from sex or by practicing safer sex.
  • Inform past and current sex partner(s) so that they can get tested.
  • Do not share needles or works (injection equipment)
  • Get psychological support with a therapist and/or join a support group for people with HIV.
  • Get information and social and legal support from AIDS service organizations.
  • Maintain a strong immune system with a healthy lifestyle and regular medical exams.
  • Always inform medical providers so that you can receive appropriate care.

How is an HIV infection treated?

Today there are medical treatments that can slow down the rate at which HIV weakens the immune system. Sixteen drugs have been approved for treating HIV infection. They are called anti-retroviral drugs because they attack HIV, which is a retrovirus. Once inside the cell, HIV uses specific enzymes to survive. Anti-retroviral drugs work by interfering with the virus' ability to use these enzymes. They fall into two categories:

  • Reverse transcriptase inhibitors interfere with an enzyme called reverse transcriptase (RT) that HIV needs to make copies of itself.
  • Protease inhibitors interfere with the protease enzyme that HIV uses to produce infectious viral particles.

In addition to the anti-retroviral drugs, there are other treatments that can prevent or cure some of the illnesses associated with AIDS. As with other diseases, early detection offers more options for treatment and preventative care. Unfortunately, the drugs currently available cannot cure an HIV infection. HIV can become resistant to any one drug and even a combination of drugs cannot suppress the virus indefinitely. However, scientists continue to develop new drugs and treatments that are helping many people infected with HIV live longer and healthier lives.

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Links you can use

For more information about HIV/AIDS, you can visit:

The CDC's National Prevention Information Network

The CDC's Divisions of HIV/AIDS Prevention

Frequently asked questions on HIV/AIDS

AIDS Info, U.S. Department of Health & Human Services

Brown University's AIDS Program (BRUNAP)

BRUNAP Rapid HIV Testing Informational Video

Hivtest.org

nineandahalfminutes.org

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Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed. Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911. Please contact us if you have comments, questions or suggestions.