Human Immunodeficiency Virus (HIV) – An Overview

Posted on August 16, 2018

HIV is a virus that attacks the immune system. If HIV is not treated, within a few years it can progress and lead to acquired immune deficiency syndrome (AIDS), a set of symptoms and infections that eventually cause death. Although HIV is not yet curable, it is very treatable. Taking proper treatment consistently and leading a healthy lifestyle enables most people with HIV to live a normal lifespan.

What is HIV?

HIV is passed by specific types of contact with infected blood, semen, pre-seminal fluid, vaginal secretions, rectal fluid, and breast milk. In order to infect someone, the infected fluid must come into contact with the bloodstream, a mucous membrane, or damaged tissue such as an open wound. HIV is most commonly passed during anal or vaginal sex without condoms or by sharing used needles or other injection equipment.

HIV infects a specific type of immune system cell called CD4 lymphocytes or T-helper cells. The role of healthy CD4 cells is to organize other cells to respond to infection, effectively stimulating the immune response. When HIV infects a CD4 cell, it hijacks the process by which the cell replicates itself and uses it to produce copies of HIV instead, releasing them into the body to infect more CD4 cells. HIV also destroys CD4 cells, weakening the immune system and leaving the body unable to rally an effective response to cancer and infection.

Read more about cause, prevention, and risk factors for HIV.

The history of HIV

AIDS was identified in the United States in 1981, although it was not well understood at the time. Doctors scrambled to figure out how AIDS was spread and how to stop it. It would take years to piece together that HIV infection leads to AIDS, and many more years to undo the myth that HIV could only affect gay men.

Researchers now know that HIV originated in Kinshasa, Democratic Republic of Congo, in 1920 when HIV crossed species from chimpanzees to humans. By 1980, HIV had already spread to five continents – North America, South America, Europe, Africa and Australia. The first cases were presented to the U.S. Centers for Disease Control (CDC) in 1981. Five previously healthy gay men in Los Angeles had acquired a rare lung infection called Pneumocystis carinii pneumonia (PCP). The CDC began to receive more reports of severe immune deficiency among gay men. By the end of 1981, there were 270 reported cases of the mysterious disease and 121 deaths.

The media began to raise an alarm that AIDS affected gay men. Many in the media called it “gay-related immune deficiency” or “GRID,” furthering the stigma. Cities like San Francisco and New York began campaigns to close bath houses and private sex clubs. A travel ban was imposed to stop immigrants with AIDS from entering the United States.

Over the next few years, scientists found more and more evidence that people who inject drugs, women who have sex with men, and children developed AIDS, too. At the same time, doctors recorded several cases of AIDS in hemophilia patients who received blood transfusions.

In 1982, a nonprofit called the World Federation of Hemophilia presented evidence to the CDC and blood banking companies that AIDS may be a blood-borne disease. The CDC rejected this claim due to “lack of research,” and blood banking companies refused to change the way they screened donors. At that time, the CDC wrongly believed that AIDS only affected homosexuals and was not an infectious disease. Screening for AIDS/HIV would not begin at blood banks until 1985. Between 1981 and 1985, half of the population of hemophilia patients in the U.S. was infected with HIV because of tainted blood products, which contained pooled plasma from thousands of donors. AIDS rates in Europe during this time were estimated to be as high as 80 or 90 percent of the hemophilia A population.

In 1986, the International Committee on the Taxonomy of Viruses officially designated the virus that causes AIDS as human immunodeficiency virus (HIV). Scientists realized that HIV is a virus that can be passed between any humans, and AIDS is the final stage of the infection, developing later as the immune system becomes weak.

The FDA approved the first antiretroviral drug, Zidovudine (available today in combination drugs including Combivir, Retrovir, and Trizivir), as treatment for HIV in March 1987. Antiretroviral drugs could prevent AIDS from developing in those with HIV.

The stigma of HIV was slow to be corrected. In 1990, the Americans with Disabilities Act (ADA) was enacted, prohibiting discrimination against people with disabilities, including those with HIV. It wasn’t until 2010 that the travel ban barring HIV-positive people from entering the U.S. was lifted. High-profile celebrities with HIV such as Magic Johnson helped dispel stereotypes.

Ryan White, a teenager from Indiana with hemophilia, acquired HIV after a blood transfusion. White faced discrimination and became a prominent activist for the rights and dignity of those with AIDS. White was banned from attending school due to stigma and fear of HIV infection, but his mother fought his case in court and won. On April 8, 1990, Ryan died of an AIDS-related illness at age 18. President George H.W. Bush signed the Ryan White CARE Act into law in August 1990, allocating $2 billion to fight HIV/AIDS.

The FDA approved the first protease inhibitor, Invirase (Saquinavir), in 1995. The new class of ART (antiretroviral therapy) drugs is credited with an immediate decline between 60 and 80 percent in rates of AIDS-related deaths and hospitalization in countries with access to the treatment.

In July 2012, the FDA approved pre-exposure prophylaxis (PrEP) medication regimen to prevent HIV-negative people with a high risk from becoming infected with HIV. PrEP can reduce the risk of becoming infected with HIV by sexual contact by more than 90 percent and from intravenous drug use by 70 percent, according to the CDC.

By 2017, more than half of the global population with HIV – over 19.5 million people – was receiving antiretroviral treatment. Global HIV advocacy organizations are promoting the slogan “Undetectable = Untransmittable,” or “U=U.” This anti-stigma campaign is based on scientific evidence that people with HIV who achieve an undetectable viral load while on treatment cannot pass the virus to others.

How common is HIV?

An estimated 1.1 million people in the U.S. have HIV. About 14 percent of those with HIV, or 1 in 7 people, do not know they carry the virus. Gay and bisexual men are the demographic most impacted by HIV, making up 67 percent of those diagnosed. However, women and heterosexual men also contract HIV. People in their 20s and 30s are more likely to be diagnosed with HIV than those in other age groups. In the U.S., people of African and Latino descent have a much higher risk for being diagnosed with HIV than those of other ethnic backgrounds. Read more about risk factors for HIV.

How is HIV diagnosed?

Doctors diagnose HIV with blood tests or saliva tests. Home HIV tests are also available. If you are diagnosed with HIV, the doctor may conduct further tests to check for infections that can occur as complications of HIV.

Learn more about the HIV diagnosis process.

What are the symptoms of HIV?

HIV symptoms vary by the stage of HIV infection. In the acute stage, one or two months after a person is first infected, they may experience flu-like symptoms for a few weeks. During the clinical latent stage, which lasts approximately 10 years without treatment, the person may experience swollen lymph nodes or no symptoms at all. With strict adherence to the recommended treatment regimen, most people with HIV will never experience progression of the disease.

Without treatment, HIV progresses within about 10 years to a symptomatic phase characterized by frequent infections, fever, fatigue, diarrhea, and weight loss. In the final stage of HIV, known as AIDS, a person has a severely compromised immune system, leading to severe infections and cancers that eventually cause death.

Learn more about HIV stages and symptoms.

How is HIV treated?

HIV is treated with antiretroviral therapy, or ART. There are many different classes of ART medications, and most people are treated with a combination of drugs from more than one class. Certain types of preventative ART can also protect against transmission. Infections that develop as a complication of HIV may be treated with antibiotics, antifungals, and other classes of antiviral medications.

Learn more about HIV treatments.

Resources

External resources

myHIVteam resources

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FAQs

Can you die from HIV?

Yes. Although modern drug regimens greatly reduce levels of the virus and its effects, people still die of HIV/AIDS. In 2014, more than 6,700 Americans died of HIV/AIDS. HIV does not directly cause death, but it destroys the immune system, leaving the body vulnerable to the infections and cancers of AIDS. People with AIDS can die from infections that most people with healthy immune systems can easily overcome. Early diagnosis and taking prescribed HIV medications every day as directed significantly reduces the risk of HIV progression, death, and passing the infection to others.

Can people with HIV have children?

Yes. Modern HIV treatments can make it possible to have a healthy pregnancy without the risk of passing HIV to one’s partner or child. Women with HIV should work with their doctors to establish a treatment regimen before and during pregnancy. Some women with undetectable levels of HIV can deliver their baby via a vaginal birth, but for others, a caesarean section (C-section) is recommended. Mothers with HIV may be recommended to feed their babies formula since HIV can be passed via breast milk.

Some men with undetectable levels of HIV can father a child naturally without fear of passing HIV to their partner or child. However, some men may be advised to submit their sperm for a process called “sperm washing,” wherein sperm is separated from the HIV-containing semen. The “clean” sperm is then artificially inseminated into the female partner for conception.

Is there a cure for HIV or AIDS?

There is no cure for HIV or AIDS. However, treatments for HIV are so effective that they prevent AIDS from developing in nearly every case, reducing HIV from a death sentence to a treatable chronic illness. Treatments can also effectively lower the risk of transmitting HIV between sexual partners.