Infection And Infectious Diseases
HIV: Undetectable Equals Untransmittable
HIV is able to enter the body via intact mucous membranes, eczematous or injured skin or mucosa and by parenteral inoculation. When transmitted by sexual contact, HIV attaches first to dendritic cells or macrophages/monocytes HIV using CCR-5 as a co-receptor is then preferentially replicated . HIV is taken up by macrophages and replicated as shown for M cells in the mucosa . HIV exposure to blood cells can result in the direct infection of T helper cells and the transmission of R5 and X4 viruses . As mentioned above, 1 HID is equivalent to approximately 500-1,000 HIV particles, with a higher dose required for infection via mucous membranes compared to infection via the bloodstream, e.g. by needle stick injury. The majority of new HIV infections are still transmitted sexually. Another epidemiologically relevant route is parenteral administration of drugs and also snorting of drugs with epistaxis.
Transmission of HIV via blood or transplanted organs, including bone, is possible from about days 5-6 after infection of the donor. Mother-to-child transmission has been demonstrated from the 12th week of gestation, but transmission occurs predominantly in the final trimester and particularly shortly before or during birth . HIV can be transmitted via breast milk .
How Long Does It Take For Hiv To Test Positive
In the event that PEP has been taken for a period of time, most modern HIV tests can detect HIV within four weeks of exposure. It depends on the type of test you are offered and when your risk was, as well as the type of test you were offered, whether you will be asked to return for more tests and a follow-up.
Viral Suppression And Undetectable Viral Load: What Do They Mean
If taken as prescribed, HIV medicine reduces the amount of HIV in your blood to a very low level. This is called viral suppression. Viral suppression is defined as having less than 200 copies of HIV per milliliter of blood. Viral suppression helps to keep you healthy and prevents transmission.
HIV medicine can make your viral load so low that it doesn’t show up in a standard lab test. This is called having an undetectable viral load.
Reaching and maintaining HIV viral suppression is a primary goal of HIV treatment. Treatment with HIV medicine is recommended for all people with HIV, regardless of how long theyve had the virus or how healthy they are.
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How Long Does Seroconversion Take
The timeframe between when a person contracts HIV and when tests can detect the infection is known as the window period. Everyones immune system is different. This makes it difficult to predict how long this stage will last.
Scientists have developed sensitive blood tests since the early days of the HIV epidemic. Its now possible to detect HIV antibodies, as well as other components of HIV, earlier than ever before. According to the Johns Hopkins Bloomberg School of Public Health, most people test positive within a few weeks of contracting HIV. For others, it may take
During the window period, a person may develop symptoms similar to the flu or other common viruses that include:
- swollen lymph nodes
Symptoms may last from a few days to a few weeks. And they may range from mild to severe. But its possible to pass through the early infection stage without experiencing any symptoms at all. During this time, a person may not even realize that theyve contracted HIV.
How Do I Talk To My Partner About Their Risk Of Acquiring Hiv
People living with HIV can involve their partners in their treatment plans. Research shows that adhering to treatment often can improve with support from loving relationships and from the community.
Pre-exposure prophylaxis , in which an HIV-negative person takes antiretroviral medication to prevent infection, can be part of the conversation. Learn more about PrEP.
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Can You Have Hiv For 20 Years And Not Know
While its common for people with HIV to experience symptoms similar to the flu after a few weeks of the initial infection, some people may experience no symptoms at all during the early stages of HIV.
If a person with HIV goes undiagnosed and the virus develops into stage 2, HIV will continue to develop and may last for 10-15 years without the appropriate HIV testing and treatment . Its important to note that this stage can also bring with it little to no symptoms and people may not even feel sick.
The only way to know your HIV status is to get tested. This can be done by visiting your local HIV testing centre, your local doctor, or from home with an at-home lab test. Early detection is crucial to getting prompt treatment and going on to lead both a happy and healthy life.
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Get And Keep An Undetectable Viral Load
- If you take HIV medicine and get and keep an undetectable viral load, you will not transmit HIV to your sex partner.
- Having an undetectable viral load likely reduces the risk of HIV transmission through sharing needles, syringes, or other drug injection equipment , but we dont know by how much.
- Getting and keep an undetectable viral load is the best thing you can do to stay healthy and protect others.
- Learn more about HIV treatment.
What if I cannot get an undetectable viral load?
Some people face challenges that make it hard to stick to a treatment plan. A few people cannot get an undetectable viral load even though they take HIV medicine as prescribed. If your viral load is not undetectableor does not stay undetectableyou can still protect your partners by using other prevention options.
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How Well Does The Use Of Hiv Treatment To Maintain An Undetectable Viral Load Prevent Hiv Transmission To A Baby During Pregnancy And Birth
Without treatment, there is a 15% to 30% chance that a baby born to a person living with HIV will get HIV during pregnancy or delivery. Taking HIV treatment is the most effective way to reduce transmission to the baby. In fact, research has shown that if a pregnant person starts HIV treatment before conception and maintains an undetectable viral load throughout pregnancy and delivery, they do not transmit HIV to their baby. A short course of HIV medications is also given to the infant to prevent HIV transmission.
For the last three decades, a growing body of evidence has shown that babies are much less likely to be born with HIV if the pregnant parent is on treatment. A study of the French Perinatal Cohort, conducted between 2000 and 2011, is the largest study to show the impact of treatment on preventing HIV transmission to a newborn. This study found that no HIV transmissions occurred among 2,651 infants born to cisgender women who were on treatment before they conceived and throughout their pregnancy, who had an undetectable viral load at delivery and who did not breastfeed.
How Long Do I Have To Be On Treatment Before My Viral Load Becomes Undetectable
HIV/AIDS 101 (6:57)
It will be possible for most people diagnosed with HIV to reach an undetectable viral load within 3 to 6 months of starting treatment. However, if someone starts treatment very late and therefore has a low CD4 count, or they dont take their pills as prescribed, then it will make reaching undetectable more difficult. It is important not to assume that everyone who is living with HIV will be able to reach or sustain an undetectable viral load.
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What To Expect Next
If you find out you are HIV-positive, its important to keep in mind the condition is treatable. Antiretroviral therapy is recommended for all people with HIV, regardless of how long theyve had the virus or how healthy they are. It works by lowering the amount of virus in the body to very low levels. This treatment can also slow the progression of the infection and protect the immune system.
Taking ART medications is vital to slowing the progression of HIV. Left untreated, HIV will progress to the second stage. During this stage, people may experience no symptoms at all. If no treatment is administered, an individual can stay in this stage for 10 to 15 years.
For people who have no symptoms of an acute HIV infection, it takes an average of seven years to proceed to AIDS.
What Are The Tests For Detecting Hiv
Various tests may be used for HIV detection:
- HIV antibody test: This test detects the antibodies produced in the body in response to HIV.
- Antigen test: This test can be done at an earlier stage than an HIV antibody test. It measures a protein called p24 antigen, present in the virus and produced in high amounts after the infection.
- Nucleic acid test : It is also called an RNA test. It is a very specific test that looks for the virus itself and can detect HIV as early as about 10 days of infections.
- In-home test kits: Although less accurate than the laboratory-based tests, home-based kits have the advantage of testing in the privacy and comfort of the home. Only FDA approved home-based kits should be used.
- Viral culture: This involves using the patients sample and growing the virus in the lab. It takes longer to get the results and is not the most preferred test for HIV.
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Get Tested Regularly If You Are At Greater Risk Of Hiv
If you are at greater risk of HIV get tested regularly.
Gay, bisexual, trans and other men who have sex with men should get tested every 3 months . This may vary depending on how many sexual partners you have during the year.
Talk with your doctor or sexual health specialist for advice. They can also provide information about how to reduce your risk for HIV and other STIs.
How Hiv Viral Load Affects Cd4 Cell Count
HIV attacks CD4 cells . These are white blood cells, and theyre part of the immune system. A CD4 count provides a rough assessment of how healthy a persons immune system is. People who dont have HIV usually have a CD4 cell count between 500 and 1,500.
A high viral load can lead to a low CD4 cell count. When CD4 count is below 200, the risk of developing an illness or infection is higher. This is because having a low CD4 cell count makes it harder for the body to fight infection, increasing the risk of illnesses such as severe infections and some cancers.
Untreated HIV can cause other long-term complications and can develop into AIDS. However, when HIV medication is taken daily as prescribed, the CD4 count tends to increase over time. The immune system gets stronger and better able to fight infections.
Measuring viral load and CD4 count shows how well HIV treatment is working both to kill the HIV in the bloodstream and to allow the immune system to recover. The ideal results are to have an undetectable viral load and high CD4 count.
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When Do Symptoms Occur
Some people have flu-like symptoms within two to four weeks after infection, but others may not feel sick or not develop symptoms at all until later.
See a healthcare provider if you have symptoms of HIV and think you may have been exposed to HIV. Getting tested for HIV is the only way to know for sure.
You can prevent HIV by using condoms correctly every time you have sex pre-exposure prophylaxis, a prevention method in which the HIV-negative partner takes daily HIV medicine to prevent HIV and treatment as prevention, a method in which the HIV-positive partner takes daily HIV medicine to achieve and maintain an undetectable viral load.
Only antigen/antibody tests or nucleic acid tests can diagnose acute HIV infection. NATs look for actual virus in the blood, and antigen/antibody tests look for HIV antibodies and antigens. Antibodies are produced by your immune system when youre exposed to viruses like HIV, and antigens are foreign substances that cause your immune system to activate.
However, no test can detect HIV immediately after infection. NATs can usually tell if you have an HIV infection 10 to 33 days after exposure, while antigen/antibody tests can tell 18 to 45 days after exposure.
- Swollen lymph nodes
- Mouth ulcers or sores
Types Of Hiv Tests And Their Window Periods
- Nucleic Acid Test A NAT can usually tell you if you have HIV infection 10 to 33 days after exposure
- Antigen/Antibody TestAn antigen/antibody test performed by a laboratory on blood from a vein can usually detect HIV infection 18 to 45 days after exposure. Antigen/antibody tests done with blood from a finger prick take longer to detect HIV .
- Antibody TestAn antibody test can take 23 to 90 days to detect HIV infection after an exposure. Most rapid tests and self-tests are antibody tests. In general, antibody tests that use blood from a vein detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid.
Ask your health care provider or test counselor about the window period for the test youre taking and whether you will need a follow-up test to confirm the results. If youre using a self-test, you can get that information from the materials included in the tests package.
If you get an HIV test after a potential HIV exposure and the result is negative, get tested again after the window period. Remember, you can only be sure you are HIV-negative if:.
- Your most recent test is after the window period
- You havent had a potential HIV exposure during the window period. If you do have an exposure, then you will need to be retested.
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If I Am Hiv Negative And My Hiv
In the age of U=U, prevention and safer sex now means an undetectable viral load, condoms, PrEP, or a combination of these, depending on your needs and feelings. If your partner is undetectable, they cannot transmit HIV through sex. However, your decisions about condoms should be based on your sexual behavior and your partner sexual behavior. Remember that U=U only protects against HIV transmission! Condoms are still the best way to prevent STIs and pregnancy. If you are HIV negative and have other partners, you should consider and condoms or emergency PEP . However, if you are in a monogamous relationship and your partner is undetectable, you could choose not to use any other forms of protection. It is very important to have an open and honest conversation with your sexual partner and your doctor about which prevention methods are right and most comfortable for you.
Get Tested Every Three Months
What it means to have HIV
Whats the best time to get tested for HIV and STIs? We recommend people who are sexually active and people who inject drugs get tested for HIV and sexually-transmitted infections every three to six months.
Establishing a regular testing schedule for yourself is a great way to take charge of your sexual health. Encouraging your regular sex partners to do the same is a great way of helping your partners and the community.
If you live in San Francisco or the Bay Area, stop by any of our locations for free HIV and STI testing. A counselor will be able to recommend a testing schedule for you. Schedule tests far in advance so they become routine.
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What Is Involved In The Consistent And Correct Use Of Hiv Treatment To Maintain An Undetectable Viral Load For Hiv Prevention
The consistent and correct use of HIV treatment to maintain an undetectable viral load includes:
- high adherence to medications, to achieve and maintain an undetectable viral load
- regular medical appointments to monitor viral load and receive adherence support, if needed
Regular testing and treatment for sexually transmitted infections is also important because HIV treatment does not protect against STIs.
A person on HIV treatment needs to work with their doctor to determine an appropriate schedule for medical checkups and viral load monitoring.
Where To Get Tested For Hiv
Getting an HIV test is easy. Tests for HIV and other STIs are confidential and available from your local doctor , or a sexual and reproductive health clinic.
It is a good idea to have some pre-test counselling. Before the test, talk with your doctor, nurse, or peer tester about any concerns, your level of risk, whether you are likely to be HIV-positive and what a positive result may mean.
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Does Being Durably Undetectable Mean That The Virus Has Left My Body
Even when viral load is undetectable, HIV is still present in the body. The virus lies dormant inside a small number of cells in the body called viral reservoirs. When therapy is halted by missing doses, taking a treatment holiday or stopping treatment, the virus emerges and begins to multiply, becoming detectable in the blood again. This newly reproducing virus is infectious. It is essential to take every pill every day as directed to achieve and maintain a durably undetectable status.
Who Are At Risk Of Getting Hiv/aids
- Persons who have sex without a condom.
- Persons with many sex partners
- Persons who have had repeated Sexually Transmitted Infections
- Male and female prostitutes
- Sexually active homosexual and bisexual males
- Persons who have sex with someone who is HIV positive
- Past or present users of needles to inject illicit drugs, e.g. heroine
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