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I just found out I’m HIV positive
Do I have HIV or need to test?
I just found out I’m HIV positive
HIV stands for Human Immunodeficiency Virus. It’s a virus that attacks and weakens the immune system. If it’s untreated, HIV causes so much damage that the body is no longer able to defend itself.
People who have been infected with HIV are often referred to as being HIV-positive (sometimes this is written as HIV+, or even +ve). Although there have been many advances in treatment in recent years, there is still no cure for HIV infection.
HIV-1 and HIV-2 are two different viruses. HIV-1 is the main family of HIV and accounts for 95% of all infections worldwide. HIV-2 is mainly seen in a few West African countries. The spread in the rest of the world is negligible. Although HIV-2 generally progresses more slowly than HIV-1, some HIV drugs (like nevirapine and efavirenz) do not work against HIV-2.
On a structural level HIV-1 and HIV-2 have important genetic differences. A technical description of the difference is that the vpu gene found in HIV- 1 is replaced by the vpx gene in HIV-2. In addition, the protease enzymes from the two viruses, which are aspartic acid proteases and have been found to be essential for maturation of the infectious particle, share about 50% sequence identity. There are, however, differences in substrate and inhibitor binding between these enzymes. Most notably between the CGP 53820 inhibitory binding.
On functional level, there is a difference between the two viruses in terms of how easy it is for the virus to infect someone. HIV-1 enters the immune system by attaching onto the CD4+ receptor found on the surface of certain white blood cells. HIV-2 has a harder time gaining such a foothold.
Both viruses are fragile and highly susceptible to physical and chemical agents and therefore do not survive well outside the human body. HIV in blood or sexual fluid for example is not infectious after it has been outside the body for a few minutes.
HIV is the virus that can lead to AIDS. AIDS stands for Acquired Immune Deficiency Syndrome and is seen by the appearance of the opportunistic infections (infections like tuberculosis which take advantage of a weakened immune system) that are a result of HIV.
If you are diagnosed with HIV early, and respond well to treatment, you are not likely to develop AIDS.
The name ‘AIDS’ was more appropriate many years ago, when doctors didn’t fully understand the late stages of HIV infection. Today we know that AIDS is not a syndrome at all, because a syndrome is a collection of symptoms that do not have an easily identifiable cause. A more current name for the illness caused by the late stages of HIV infection is HIV disease. However, AIDS is still the name that most people use to refer to the immune deficiency caused by HIV.
As treatment for HIV infection has becomes more effective, very few people in the UK are now given an AIDS diagnosis.
Most people experience some symptoms shortly after infection with HIV. This is commonly referred to as seroconversion illness (SCI), or primary HIV infection. It usually occurs in over 60% of men around two to six weeks after they have been infected.
The main symptoms of SCI are:
- A sore throat
- Body aches
- A rash
Other common symptoms include:
- Mouth ulcers
- Joint pain
- Loss of appetite
- Weight loss
- Muscle pain
- Feeling overly tired or sick.
These symptoms are only linked to infection with HIV if you have put yourself at risk (such as unsafe sex) in the last six weeks. Because these symptoms are common to other illnesses, many people do not realise that they are a sign that they have become infected with HIV.
What do I do if I have these symptoms?
If you have any of these symptoms and have had unsafe sex in the last six weeks, it is worth visiting your doctor or sexual health clinic and getting tested for HIV so that you know what your HIV status is. Different HIV tests will be appropriate, depending on how long ago your risk was. Men who have recently been infected have very high levels of viral load which makes it more likely that HIV will be transmitted if they have unprotected sex. Even if you have had recent risky sex, it does not necessarily mean that those flu-like symptoms are seroconversion illness. It could just be the flu.
Doctors use two key tests to assess the strength of your immune system – a CD4 cell count and a viral load test. HIV damages your immune system even though you may look and feel well. That’s why new guidelines recommend that everyone with HIV starts treatment whatever their CD4 count.
Viral load explained
The viral load test shows how active HIV is in your body.
The test for viral load measures how many particles of HIV are circulating in the blood. The results are given as the number of ‘copies’ of HIV per millilitre of blood – for example 200 copies/ml.
Your viral load test results can fluctuate a lot if you’re not taking HIV treatment. Looking at the trend over a number of months may be more useful than comparing two test results.
A high viral load will usually – but not always – mean a low CD4 count. Knowing what is going on with your immune system can help you make decisions about lifestyle and treatment.
What’s happening inside you after infection?
When you first get HIV, your body starts to produce antibodies to fight it off.
You may feel ill for a while at this stage. This is often called ‘seroconversion illness’ because it coincides with the time that blood (‘sero’) tests for antibodies to HIV become (‘conversion’) positive.
Once seroconversion has taken place, you may stay well for a number of years without treatment. But there will be some signs of damage being done to your immune system.
As you can see on the graphic above, you will also be infectious during this period, even though you may not be aware you have HIV. That’s why it is so important to get diagnosed early, so you can start treatment as soon as possible – before too much damage has been done to your immune system.
The strength of your immune system can be detected by laboratory tests. Doctors will use two key tests at your regular clinic appointments – a CD4 cell count and a viral load test.
What is the CD4 cell count?
This test gives a rough indication of the strength of your immune system.
A normal CD4 cell count in an HIV-negative man is between 400 and 1600 per cubic millimetre of blood (but doctors normally just give a figure, e.g. 500). CD4 cell counts in HIV-negative women tend to be a little higher, between 500 and 1700.
Soon after infection with HIV, your CD4 cell count probably dropped sharply, before stabilising at around 500 to 600. Even while you are well and have no obvious symptoms of HIV, millions of CD4 cells are infected by HIV and lost every day, and millions more are produced to replace them. General illness can also have an impact on your CD4 count, which may subsequently rise again.
Without treatment, an HIV-positive person’s CD4 cell count will fall over time (see the graphic above).
Starting treatment – new guidelines
Recently the British HIV Association (BHIVA) treatment guidelines have been changed to say that anyone with HIV who is ready to commit to treatment should start regardless of their CD4 count. This reflects the findings of the START study.
START found that people who waited to start treatment until their CD4 count dropped to 350 (which is when people were previously advised to start) had a much higher chance of developing AIDS-related illnesses such as cancers.
Starting treatment also reduces the chances that you will pass on HIV.