Testing for HIV

Before a person becomes sick with the potentially deadly disease known as AIDS, he or she must first be infected with the human immunodeficiency virus, or HIV. This virus is spread through the sharing of blood, breast milk, semen, and vaginal secretions. While anyone can contract HIV, some people have a higher risk than others. These include, people who have unprotected vaginal, anal, or oral sex with multiple partners ...People who have injected sex with shared equipment, such as needlesPeople who have been diagnosed with another sexually transmitted disease, hepatitis, or tuberculosis... ...And anyone who has had sex with a partner who engaged in these acts. Men who have sex with men and people who have unprotected heterosexual contact make up 79 percent of new HIV cases, so these groups in particular should be tested regularly. When a person contracts HIV, his or her immune system starts to produce antibodies against the virus to ward off infection. Although these antibodies are not effective in fighting HIV, it is their presence in the blood that results in a positive HIV test. This test can be conducted at an STD clinic, a government funded HIV testing site, a hospital, or a doctor's office. The screen can be done in a number of ways, but the most common is a conventional blood test. In this case, a sample is drawn by a health care provider and sent to a lab for screening. A similar HIV test involves an oral fluid sample which is swabbed from the inside of the mouth before being tested. A slightly less accurate method involves a urine sample. In all three of these tests, results should arrive within two weeks, and a positive test must be followed up by a confirmatory one. This guards against the risk of a false positive. For individuals who are in need of very quick results, a rapid test is also available. In a rapid test, a blood or oral sample is collected and tested immediately in a lab. The results are available in as little as ten minutes. No matter the type of test, the procedure can be very scary, and for this reason, many testing centers provide counseling. If you'd rather not get tested in public, you have another option: home testing. It's important to know that only ONE home testing kit is approved by the FDA, the Home Access HIV-1 Test System. A home testing kit allows a person to prick his or her finger, place drops of blood on a special card, and mail the card into a lab. An HIV test can be scary, but a negative result will put your mind at ease. If your HIV test is positive, you have just taken an important first step on the road to treatment.

AIDS is an incurable disease that is the end result of infection by the human immunodeficiency virus, or HIV. An individual who contracts HIV may become sick quickly...or can live symptom-free for years. HIV and AIDS are not one-and-the same. Many people who become infected with HIV do not develop AIDs, or don't do so for decades...especially with modern treatments. AIDS, which is an acronym for "acquired immune deficiency syndrome," is the final stage of HIV infection. Because the virus attacks T-cells in the body's immune system, a person has AIDS when their T-cell levels fall below 200/mmc3, as opposed to the 500 to 1,500 found in a healthy person. An extremely low T-cell count means that a person's immune system is no longer healthy enough to effectively fight off intruding viruses and bacteria. Signs that HIV may be turning into AIDS include: extreme fatigue, rapid weight loss, persistent diarrhea, a high fever, and swollen glands in the neck, armpits, or groin. Even if a person doesn't have a low T-cell count, they are still classified as having AIDS if they contract any one of 26 opportunist conditions. These are a group of illnesses that don't generally occur in most people, but do show up in AIDS patients. Two of these are cancers. One, Kaposi's sarcoma, results from a tumor in the blood vessel walls. Kaposi's sarcoma usually appears as disfiguring pink or purple lesions on the skin and mouth. The other cancer, Non-Hodgkin's lymphoma, originates in the disease-fighting blood cells known as lymphocytes. This appears as swelling of the lymph nodes. Several opportunist conditions that confirm an AIDS diagnosis stem from invading bacteria, like tuberculosis and bacterial pneumonia. Bacterial pneumonia is a potentially deadly inflammation of the lungs that is one of the most common infections occurring in people with HIV worldwide. Tuberculosis is the leading opportunistic infection in developing nations where access to medications and health care is low. It occurs when bacteria infect the lungs and manifests as prolonged coughing fits. Sometimes, an opportunist infection can be fungal, like candidiasis. Candidiasis causes a white coating to form on the mouth, tongue, or vagina. Although HIV itself is a virus, another virus can enter the body and cause an opportunist infection. One example is cytomegalovirus, or CMV, a herpes virus that healthy adults fight easily. In people with HIV, however, the virus causes damages to the body, most notably the eyes. If untreated, CMV can lead to blindness. Other complications that lead to an AIDS diagnosis include wasting syndrome, whereby a person loses 10 percent or more of body weight, and AIDS dementia complex, where nerve cell damage causes diminished mental functioning. These conditions, and others, mean that HIV has progressed to AIDS. While this is disheartening, many modern medications can keep AIDS infections from progressing indefinitely. If you have HIV, talk to your doctor about diseases that can occur following infection and the best ways to treat them.

HIV is incurable and can lead to the potentially deadly disease AIDS. The GOOD news is that medications can slow the spread of HIV, and allow people who are infected to remain healthier for longer. To understand how medications work, it's helpful to understand the life cycle of HIV. This cyclical process begins when HIV enters the body and attaches to receptors on T-cells located in the immune system. One group of anti-HIV medications, entry inhibitors, stops this attaching process. An entry inhibitor binds either to the immune system's T-cells or to the invading HIV, thereby blocking the virus from bonding with healthy T-cells. Currently, the only FDA-approved entry inhibitor is marketed as Fuzeon, but others are being tested. Two other types of medication work to stop the second part of HIV's life cycle, reverse transcription. When HIV infects a cell, it copies its genetic code into that cell's DNA. As a result, the T-cell is "programmed" to create more copies of HIV. But because HIV is in the form of ribonucleic acid, or RNA, it must convert itself to the body's genetic make-up, which is deoxyribonucleic acid, or DNA, before it can infect the T-cells. This is what happens during reverse transcription. Nucleoside Reverse Transcriptase Inhibitors, or NRTIs, are one type of medication that stops this process, by interfering with the nucleotides, or building blocks, that convert RNA to DNA. In this manner, the new DNA cannot be built, and a cell cannot produce more HIV. The first HIV drug, "AZT," or Retrovir, is an NRTI medication. Other FDA-approved NRTIs include Emtriva, and Videx. Another type of medication which blocks RNA from converting to DNA is called Non-Nucleoside Reverse Transcriptase Inhibitors, or NNRTIs. While NNRTIs have the same mission as NRTIs, they accomplish it differently. HIV cannot transcribe its RNA to DNA without the aid of a transcriptase enzyme. NNRTI medications attach themselves to this enzyme and prevent the virus from converting. Four FDA-approved NNRTI medications can help stop this conversion process. A final anti-HIV treatment works to stop the last step of HIV infection, viral assembly. During viral assembly, a strand of DNA is cut up and put together to form new copies of HIV. This process requires the help of an enzyme called protease. A group of medications called protease inhibitors, or PIs, block the protease enzyme from cutting up the genetic material that will become HIV, thus stopping new cells of the virus from forming. There are ten PI medications on the market, including Aptivus, Kaletra, and Viracept. For antiretroviral treatment to be effective for a long time, multiple medications are usually taken. Most HIV patients are familiar with the term HAART, which stands for Highly Active Anti-Retroviral Therapy and it used to describe the combining of 3 or more HIV drugs. One drug, Atripla, which is known as the "triple cocktail" combines two NNRIs with one NNRTI. This medication is generally considered to be a once-a-day, all-inclusive HIV treatment. HIV treatment is an individualized process, so it's important to adhere to your doctor's instructions when taking medication to ensure that your body remains as healthy as it can for as long as possible!

No matter how effective an anti-HIV drug cocktail may be, there is always the risk that you may develop resistance to one or more of your medications. This happens if you're not consistent about when and how you take your medications.This can allow the fast-replicating virus to create mutations, which the medication isn't able to block. Remember, an off-again on-again battle against HIV ALWAYS loses the war. You may also trigger resistance to your medication if you introduce new strains of the HIV virus into your body- through unprotected sex or shared needles. Just because two people are HIV positive, it doesn't mean they have the same strain of HIV virus, so they still must protect themselves from one another's infection. Drug-resistance testing is an important part of keeping your treatment plan effective. Two types of blood tests are done: Phenotypic testing checks how effective each antiretroviral drug is against your HIV virus. Genotypic tests identify SPECIFIC mutations that may have occurred to your strains of the HIV virus. The results allow the doctor to determine the EXACT combination of medications YOU need to keep your HIV infection under control. Your doctor will also look at your overall viral load. If it has started to rise, after medications have originally brought it down, you may be advised to switch medications or to wait and see if the rise continues. Discuss your options and evaluate the risks of drug resistance and the benefits of trying new medications before moving forward. For more information on living with HIV, check out other videos on this site.

There's a lot to be said for following directions, especially when it comes to HIV MEDICATIONS. The life-saving power of adherence -or STICKING to your treatment plan - could be the MOST important step you take in your battle to control HIV. Taking the correct dose at the correct time protects the effectiveness of your prescription medication cocktail known as "HAART" -- or Highly Active Antiretroviral Therapy. Skipping a dose or not taking it on schedule allows the virus to amp up its reproduction -increasing your viral load, weakening your immune system, and creating drug-resistant NEW forms of the virus. All of which makes your medication less effective. But despite the importance of sticking to the drug regimen, many people find it hard to do. The first few months of therapy are often the hardest, when uncomfortable side effects may discourage you from taking the drugs. Instead of skipping a dose, ask your doctor for ways to reduce the side effects. And if it is hard to swallow so many pills, ask about using COMBINATION pills that could reduce the number you have to take. Most side effects ease up after a few months, as your body gets used to the medications - so stick with it, it WILL get easier. For help managing the medication routine, work with a social worker, nurse or a support group to set up a notification system on your computer or phone that alerts you to when it's time to take your meds. And if you have trouble affording medication, reach out to local, state and federal agencies for assistance; there are many programs available to help. Other ways to keep your treatment on track include: Using a daily, weekly, or monthly pill box at home so you can see when you have-or haven't-taken your last dose. And keep an extra dose with you at all times. For more information on living with HIV, check out other videos on this site

HIV is a life-changing illness. So, when you're diagnosed, you'll want to make SMART CHANGES in your day-to-day routines. Create a daily schedule-even if you're already pretty well organized. Your medication regimen needs to be followed precisely, so set up systems and reminders to keep you on schedule. And pencil in periods of rest and relaxation--your body needs time to revive and recuperate from stress and physical activity. Also make time in your schedule for support group meetings. They make it easier to handle the all the many challenges of living with HIV. - Make your sex life a SAFE sex life. You MUST disclose your diagnosis to spouses and partners and ALWAYS practice safe sex, EVEN IF your partner is also HIV positive -- you can still catch and spread various strains of the virus, plus, you're at increased risk of catching other STDs. And women, discuss birth control methods with your doctor. - Upgrade your diet. To boost your strength and guard against medication-related digestive upset, you'll want to eat smaller, nutrient-rich, meals throughout the day. Steer clear of foods that can harbor bacteria, such as undercooked meat, raw fish or unpasteurized dairy. And speak to your doctor before taking any supplements. Exercise wisely. Moderate exercise can strengthen your immune system, but too much can weaken your immune system. It's important to know your limits. Become aware of transmission risks. Don't share razors and toothbrushes, for example, since the virus is easily spread through infected blood. If you have an open cut, you'll want to disclose your diagnosis to those helping you. And you can no longer donate blood or organs. But, it's just as important to recognize what does NOT change once you're diagnosed: Who you are as a person. While your diagnosis may initially strain some relationships, those who truly care about and love you, will be there to support you the best they can. For more information on living with HIV, check out other videos in this series.

If somebody is always at risk for HIV, because of just high risk behavior, whether that again is sharing needles or having occasional episodes of unprotected sex, the FDA in just the last year or so approved something called pre-exposure prophylaxis, or PrEP. You have to take a pill once a day, kind of like a multivitamin. By taking it once a day you create a chemical barrier that helps condoms and other barriers you may use. So, pre-exposure prophylaxis is really based on the patient's risk. If you are someone who is at risk for HIV, recurrently at risk, then you may be someone who should take pre-exposure prophylaxis. If you have something that's called zero discordant partners; one that's positive and one that's negative, the HIV negative partner takes pre-exposure prophylaxis and still practices condoms and all the other safe sex measures -- it really takes care of mistakes that can happen. The idea of chemoprophylaxis, which is what PEP and PrEP are, are a great addition to barrier protection like condoms. No matter what, no matter how scared you are, it's important to make sure that at least once a year, if you're at risk for HIV, that you get tested. Because there is nothing scarier than being sick, at all. Knowing that you have HIV prevents a lot of complications. So, my personal message of the day is just get tested.

HIV weakens your immune system, making you more susceptible to everything from the common cold to fungal infections. But there are several ways you can reduce your infection risk, starting with your antiretroviral medication regimen, if you're on one. Highly Active Antiretroviral Therapy (HAART) not only reduces the amount of HIV in your body, it also strengthens your immune system. Other ways to bolster your immune system include:Eating a balanced diet. Make vegetables, fruit, whole grains and lean proteins such as fish and skinless poultry your dietary staples. Just be sure to avoid undercooked meats, raw fish and unpasteurized dairy. Exercising regularly-without overdoing it. Know your limits and avoid exhaustion. Making sure you don't smoke or drink heavily. Staying up to date on vaccines your doctor recommends. Practicing good hygiene. That includes trimming your nails regularly, washing your hands after using the bathroom and before eating or preparing food, and avoiding pet excrement-let someone else change the kitty litter or walk the dog. And of course, sticking to your antiretroviral medication regimen. Poor adherence can lead to drug resistance, which leaves your immune system vulnerable to the ravages of HIV and additional infections.For tips on how to stick with your medication routine, check out other videos in this series.

If you're on anti-HIV medication, you know antivirals can come with side effects. But you might not know that diabetes is one of the possible complications. The multidrug cocktail known as HAART or highly active antiretroviral therapy, which is so effective in controlling HIV, often increases insulin RESISTANCE. Insulin is a hormone that helps move glucose from the bloodstream into your cells for energy. If the insulin can't do its job, your blood sugar levels rise-and that MAY trigger type 2 diabetes. If you develop chronic high glucose levels, you may have to modify your medication regimen. Since switching treatment is a complex process, work with your doctor to find the best way to control both your HIV and your glucose levels. Other possible diabetes triggers that many HIV positive people have include hepatitis C and high blood pressure. Pregnant women on antiviral therapy need to make sure they eat a healthy diet and monitor their blood sugar levels, as they have an increased risk of developing GESTATIONAL diabetes. If you do develop type 2 diabetes, it is essential that you try to reduce the risk of diabetes-related complications, like heart disease and nerve damage. Additionally, having regular check-ups, getting consistent exercise, eating a well-balanced diet, and quitting smoking can help you lower your blood sugar levels and hopefully avoid these additional health issues altogether .

Regular blood tests will help you know what HIV is doing in your body, and how well your medication is working. Here's a quick look at what the test results will indicate. A viral load test will measure the amount of HIV virus in your blood. A viral load test, if given right after you were infected by HIV, often registers MILLIONS of copies of the virus per cubic millimeter of blood. Once you start treatment-or if you change medications--you will have a viral load test every 2 to 8 weeks. If your load is going DOWN, that means the medications are doing their job. You blood test may come back as an "undetectable viral load." This can happen within 6 months of starting treatment IF you stick to your medication regimen exactly. An undetectable viral load means that the blood levels are too small to detect. It does NOT mean you are virus-free. You should get viral load tests every 3 to 6 months; and you'll be looking for TRENDS in your load, not any one reading. A blood test will also track your CD-4 count. CD-4s are infection-fighting T cells in your immune system. A healthy CD-4 count in someone without HIV is between 500 - 1500 cells per cubic mm of blood. Most doctors now feel you should start Antiviral treatment as soon as you're diagnosed, regardless of your CD-4 count. After starting treatment, regular tests every 3 to 6 months should confirm that your CD-4 count is going UP, and that your treatment is effective. It's normal for slight fluctuations to happen in a CD-4 count -- depending on when you have the test, your stress levels, if you're a smoker or whether or not you're fighting off other illnesses. So if your CD-4 count DECREASES, opt for re-testing before drawing any conclusions. CONSISTENTLY falling counts may indicate that you have become resistant to your medication and need to switch to a new treatment regimen. A count lower than 200, indicates a diagnosis of AIDS.

For people who have been exposed to HIV; so they've had a condom break, they shared a needle or they found out one of their partners is HIV positive, there's something called post-exposure prophylaxis, or PEP. What that is is a 28 day regimen of HIV medicines, and if you start it within 72 hours of the exposure people prevent getting HIV. So it actually stops the virus from taking ground in their immune system. We know from healthcare workers, and also from mothers who deliver babies, that it's probably between 70 and 90 percent advantageous in preventing HIV. You have to do it within 72 hours of the exposure, the sooner the better. So if you can do it within 2 hours, great. If you get pasted 72, there's really not much point in doing it. So generally for post-exposure prophylaxis, the guidelines say you have to take it for 28 days after the exposure. So you're going to want to get tested a few weeks after post-exposure prophylaxis ends and 3 and 6 months after that. It's absolutely worth it if there's a risk. Generally if you're insured you're able to access the meds, sometimes there is a copay . There are a lot of programs in a lot of cities that allow you to access it for either free or affordable. Often public hospitals will have programs, sometimes AIDS service organizations will have programs, gay/ lesbian / bisexual/transgender clinics often have programs. You should really look online to see best options, but if you think you've been exposed or potentially exposed, definitely worth your time to go to an emergency room or walk in or call your doctor.

Anything that pushes HIV therapy into a cheaper bracket is great. So the fact that some meds will go into generics is actually great news. It makes it more accessible, payers are more willing to pay it and people who don't have insurance may be able to support such a cost rather than the $15,000 to $18,000 or $2,000 a month that HIV medicines cost, depending on what you're on. The fear we all have is that insurance companies will say, 'well, you have to be on the generic.' And sometimes you have to individualize HIV medications to both the patient's virus and to the patient's life. So that flexibility is critical. You would lose some bang for your buck from HIV medicines if you're forced to use only one or two regimens, it may not work. Your first line regimen for a generic will probably be a ok, but if doctors, and other healthcare providers, have a lot of hurdles to jump in order to get other medicines just to create a viable HIV regimen, it's going to be a significant impact on the HIV positive population. If you have a person on medicines and they don't match their life, they don't take them as often and they get resistance they can go on and have a complication like an infection or another opportunistic condition. Or get resistance and require a change in regimen to very expensive meds. There have been studies where they've looked at cost effectiveness of generics for HIV and it actually ends up being less cost effective because of resistance and intolerance. So you have to put everything into the equation and not just how much the drugs cost. All of the parts of the formula that have to go in to figure out if it's cost effective, it's not just ' the drug costs 30 bucks,' it's it costs 30 bucks and it works and it matches people's lives. It's a great step, it needs to be rolled out in a smart way.

If you've recently tested positive for HIV, you'll want to learn about the disease and how to best manage it. So start by asking your doctor these questions. How much experience do you have with HIV positive patients? If your doctor doesn't have much experience, ask him or her for a referral to a physician who does. Once you have an HIV specialist, ask: What are my treatment options? And when should I start? Depending on the stage at which you're diagnosed and any pre-existing conditions you may have, the start time and medication regimen may vary. So make sure to tell your doctor your complete medical history. What are the side effects from the medications? Side effects from HIV treatment are common, but they're different for everyone, and usually ease over time. Keep your doctor posted about what you're experiencing. What kind of regular tests do I need to get? You'll get regular blood tests to measure your immune strength -or CD4 count--and the strength of the HIV virus -or viral load-- especially when starting treatment. These tests let you know if treatment is working. How do I keep from spreading the virus? You can't spread HIV through casual contact, but you shouldn't share toothbrushes, razors or anything else that may contain bodily fluids or blood. Your doctor can explain the risks associated with oral, anal and vaginal intercourse, suggest effective methods of protection, and fill you in on the effect of anti-HIV drugs on hormonal birth control. In addition, you may want to ask about getting financial aid to pay for your medications and information on support groups. For more detailed answers to these and other questions, check out the videos in this series.