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HIV/AIDS Symptoms and Signs

Many people with HIV do not know they are infected. In the United States, it is likely that 20%
of HIV-positive individuals are unaware of their infection. HIV infection progresses in different
stages.
Many people do not develop symptoms after they first are infected with HIV. Others will have
signs and symptoms in the early stage of HIV infection, referred to as primary or acute HIV
infection. The most common symptoms are similar to a flu-like illness within several days to
weeks after exposure to the virus. Early HIV symptoms include fever, headache, tiredness, rash,
sore throat, and enlarged lymph nodes in the neck. A characteristic feature of primary HIV
infection is open sores or ulcers in the mouth. These symptoms usually disappear within a few
weeks. After that, the person feels normal and has no symptoms. This asymptomatic phase
often lasts for years.
The progression of disease varies widely among individuals. This stage of HIV infection may last
from a few months to more than 10 years.
During this period, the virus continues to multiply actively and infects and kills the cells of the
immune system.
The virus destroys the cells that are the primary infection fighters, a type of white blood cell
called CD4 cells.
Even though the person has no symptoms, he or she is contagious and can pass HIV to others
through the routes listed above.

HIV/AIDS Transmission
HIV is transmitted when the virus enters the body, usually by injecting infected cells or semen.
The virus can enter in several possible ways.
Most commonly, HIV infection is spread by having sex with an infected partner. The virus can
enter the body through the lining of the vagina, vulva, penis, rectum, or mouth during sex.
Although intercourse is the primary risk factor, oral sex transmission is also possible.
HIV frequently spreads among injection-drug users who share needles or syringes that are
contaminated with blood from an infected person.
Women can transmit HIV to their babies during pregnancy or birth, when infected maternal cells
enter the baby's circulation, or through breastfeeding.
HIV can be spread in health-care settings through accidental needle sticks or contact with
contaminated fluids.
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Very rarely, HIV spreads through transfusion of contaminated blood or blood components. All
blood products are tested to minimize this risk. If tissues or organs from an infected person are
transplanted, the recipient may acquire HIV. Donors are now tested for HIV to minimize this risk.
HIV has been spread when organs from an infected person are transplanted into an uninfected
recipient. Because donors are tested for HIV routinely in the United States, this does not usually
happen. However, a recent incident in Taiwan occurred when the HIV test results for the donor
were mistakenly thought to have been negative.
People who already have a sexually transmitted infections, such as syphilis, genital herpes,
chlamydia, human papillomavirus (HPV), gonorrhea, or bacterial vaginosis, are more likely to
acquire HIV infection during sex with an infected partner.
The virus does not spread through casual contact such as preparing food, sharing towels and bedding, or
via swimming pools, telephones, or toilet seats. The virus is also unlikely to be spread by contact with
saliva, unless it is contaminated with blood.

HIV/AIDS Treatment andMedications
Over the past years, several drugs have become available to fight both the HIV infection and its
associated infections and cancers. These drugs are called highly active antiretroviral therapy
(HAART) and have substantially reduced HIV-related complications and deaths. However,
medications do not cure HIV/AIDS. In one case, a patient treated for cancer apparently was
cured of HIV through use of a stem cell transplant, but this "stem cell cure" is not
recommended for HIV due to the high risk of mortality and uncertain chance of success.
Another case involved a baby in Mississippi who was treated aggressively 30 hours after birth
with antiretroviral drugs and is now off HIV drugs and considered "functionally cured." This is,
however, an isolated event.
Therapy is initiated and individualized under the supervision of a physician who is an expert in
the care of HIV-infected patients. A combination of at least three drugs is recommended to
suppress the virus from replicating and boost the immune system. The following are the
different classes of medications used in treatment.
Reverse transcriptase inhibitors: These drugs inhibit the ability of the virus to make copies of
itself. The following are examples:
Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs): These include medications
such as zidovudine (AZT/Retrovir), didanosine (ddI/Videx), stavudine (d4T/Zerit), lamivudine
(3TC/Epivir), abacavir (ABC/Ziagen), emtricitabine (FTC/Emtriva), and tenofovir (TDF/Viread).
Combination NRTIs include Truvada (tenofovir/emtricitabine), Combivir
(zidovudine/lamivudine), Epzicom (abacavir/lamivudine), and Trizivir
(abacavir/zidovudine/lamivudine).
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Non-nucleoside reverse transcriptase inhibitors (NNRTIS) are commonly used in combination
with NRTIs to help keep the virus from multiplying. Examples of NNRTIs are efavirenz (Sustiva),
nevirapine (Viramune), delavirdine (Rescriptor), and etravirine (Intelence). Rilpivirine (Edurant),
the newest member of this class of drugs, was approved by the U.S. FDA in May of 2011.
Two complete HIV treatment regimens that combine two NRTIs and one NNRTI in one pill taken
once a day are available for convenience.
Atripla: a combination of efavirenz, emtricitabine, and tenofovir. Atripla was approved for use
by the FDA in 2006.
Complera: a combination of rilpivirine, emtricitabine, and tenofovir. This combination pill was
approved in August 2011 by the FDA as another first-line treatment for HIV infection in patients
who need to start therapy.
Protease inhibitors (PIs): These medications interrupt virus replication at a later step in its life
cycle, preventing cells from producing new viruses. These include ritonavir (Norvir), a lopinavir
and ritonavir combination (Kaletra), saquinavir (Invirase), indinavirsulphate (Crixivan),
fosamprenavir (Lexiva), darunavir (Prezista), atazanavir (Reyataz), tipranavir (Aptivus), and
nelfinavir (Viracept). Using PIs with NRTIs reduces the chances that the virus will become
resistant to medications.
Fusion and entry inhibitors are newer agents that keep HIV from entering human cells.
Enfuvirtide (Fuzeon/T20) was the first drug in this group. It is given in injectable form like insulin.
Another drug called maraviroc (Selzentry) binds to a protein on the surface of the human cell
and can be given by mouth. Both drugs are used in combination with other anti-HIV drugs.
Integrase inhibitors stop HIV genes from becoming incorporated into the human cell's DNA. This
is a newer class of drugs recently approved to help treat those who have developed resistance
to the other medications or used in initial treatment in combination with NRTIs. Raltegravir
(Isentress) was the first drug in this class approved by the FDA in 2007. Elvitegravir is the latest
integrase inhibitor developed and FDA-approved in 2012 as a component of a fixed-dose
combination pill taken once daily called Stribild (elvitegravir/cobicistat/tenofovir/emtricitabine).
Pregnant women who are HIV-positive should seek care immediately because HAART therapy
reduces the risk of transmitting the virus to the fetus. Therapy can also be given during
childbirth, or perinatal period, in order to help prevent HIV infection in the newborn. There are
certain drugs, however, that are harmful to the baby. Therefore, seeing a physician to discuss
anti-HIV medications is crucial.