Fequently Asked Questions
HIV/AIDS Quiz
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What are HIV and AIDS?
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Peter Leone, M.D.
Medical Director, HIV/STD Prevention & Care Branch
Associate Professor of Infectious Diseases, UNC-CH School of Medicine
HIV infection refers to the time period when a person has acquired the virus, and that is usually through sexual intercourse. It can be through maternal-child transmission where the mother passes it on to a newborn infant, or through blood products and contaminated needles. The lifetime of infection refers to HIV infection. AIDS refers to the endpoint of HIV infection, usually on average, around five to ten years after someone's acquired HIV infection, and at that point their immune system has been devastated. They have very low white blood cells that help fight infection, these are called CD4 cells, usually below 200 per unit of blood – mLs, cc's of blood – or they have opportunistic infections, infections that a healthy immune system could fight off.
How does HIV spread?
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Peter Leone, M.D.
Medical Director, HIV/STD Prevention & Care Branch
Associate Professor of Infectious Diseases, UNC-CH School of Medicine
HIV is spread through person-to-person transmission or through contaminated products like needles. So from person-to-person, it's sexually transmitted, and that refers to either vaginal, oral, or anal intercourse. Usually we're talking about vaginal or anal intercourse. It can be between men and women or men and men. It can also be transmitted through contaminated blood products, but in the United States we screen our blood products now for HIV, and that is an incredibly unusual event. That also means if needles or other medical instruments are contaminated with blood or body fluids, that can result in transmission. Again, it's a relatively rare event except in health care settings. Then there's mother-to-child transmission. That can occur either when the mother is pregnant and carrying the baby or usually when the baby is passing through the birth canal, or if the mother is undiagnosed, from transmission from the mother's breast milk – if she's breastfeeding – to the baby itself.
How can people protect themselves from HIV?
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Peter Leone, M.D.
Medical Director, HIV/STD Prevention & Care Branch
Associate Professor of Infectious Diseases, UNC-CH School of Medicine
HIV is transmitted either through sexual intercourse or through contaminated needles or blood products. In the case of sexual intercourse, we recommend you take the following steps to protect yourself. Abstinence. Abstinence clearly is the only way we can prevent a person from acquiring HIV. However, if you choose to be sexually active, then we would recommend the following steps. One, you know your status. Go and get an HIV test. You can do that through any one of the publicly funded clinics in North Carolina for free. Know your partner's status. Not only make sure they get tested, but make sure you know what those test results are. We would recommend the use of condoms. Condoms, when used consistently and correctly, can reduce the risk of acquiring and transmitting HIV. When we talk about sexual transmission, we're talking about risk – either vaginal intercourse, anal intercourse, or oral sex. The greatest risk is through receptive anal intercourse, followed by vaginal intercourse, followed by insertive anal intercourse, and the lowest risk is oral sex. It's a very low risk, but it's not zero, so if a person is engaging in oral sex, we would still recommend all the steps that we just talked about as ways to reduce sexual transmission. Needles are an important source of HIV transmission. In North Carolina, we do see transmission occurs through people sharing needles. North Carolina does not have legislation in place to actually allow needle exchange programs to exist, but those of us with the Department of Health and Human Services really strongly recommend and encourage the state to consider passing legislation for needle exchange. Needle exchange has been proven to be effective in reducing transmission of HIV. If you share needles, you need to make sure you take steps to reduce transmission, and that means clean the needles or make sure you use clean needles if sharing with a partner.
What are the symptoms of HIV?
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David Wohl, M.D.
Co-Director, UNC AIDS Clinical Trials Unit.
Associate Professor of Infectious Diseases, UNC-CH School of Medicine
The tricky part is that many people who have HIV infection won't have any symptoms at all. A person can acquire HIV, and it can really take years before they develop any symptoms at all. When people become symptomatic, have symptoms of HIV, generally that indicates that they are in the advanced stage of the disease, and that may mean they've had the HIV infection for years. I think it's important to differentiate that HIV is a germ, it's a virus, and that people acquire this virus, catch this virus, from other people. The disease that HIV can cause, sometimes after years of infection, that disease is called AIDS. So people with AIDS typically have some symptoms of their HIV infection. They might have weight loss. They might have dry skin. They might have thrush, a coating in their mouth that indicates fungus that's overgrowing in the mouth. In more severe cases, they may have night sweats. They may have pneumonias. They may have infections that are sort of unusual for people with normal immune systems to have.
I think it's really important also to recognize that early in an HIV infection – and when I mean early I say in the first few days to a week or two after someone acquires the HIV infection – that they may have some symptoms, some nonspecific symptoms that indicate they've gotten a virus. It's very unclear how many people exactly have symptoms associated with their acute, or immediate, infection with HIV, but we're thinking at least half of the people we've been able to detect in North Carolina in the throes of the acute HIV infection have had some symptoms. Again, they're fairly nonspecific, so we're talking about flu-like illness, but in some cases, people may have a rash. People may have severe headaches. Generally people report being pretty sick; they may have to be in bed, miss work, miss school. And when we ask people years later, do you remember having that kind of illness after your exposure, about half the people said, yeah, I kind of do remember that. Again, that's often missed, unfortunately, and that's the problem for us in emergency rooms and urgent care centers and primary care doctor's offices, is to kind of keep this in the back of our minds a little bit, to think this is a young person or an older person who maybe has new sexual partners - ask about that – who's coming in with a rash, maybe some ulcers in their mouth, maybe a flu-like illness. Is it the flu? If it's not flu season, it could be something else. It could be HIV. So I think you just have to keep it in your head, if you're not going to consider the diagnosis, you're not going to make that diagnosis.
Where can someone get tested for HIV, and how reliable are the results?
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Peter Leone, M.D.
Medical Director, HIV/STD Prevention & Care Branch
Associate Professor of Infectious Diseases, UNC-CH School of Medicine
HIV tests can be obtained for free through any of the 120 different publicly funded sites throughout the state of North Carolina. There are state health departments, both STD clinics as well as outreach activities called nontraditional testing sites that are run by the local health departments throughout the state of North Carolina. In addition, the CDC now is going to be encouraging every sexually active adult to at least get one HIV test, and if you're not in a mutually monogamous relationships, to continue to be tested periodically to know your status. That can be obtained through your primary care provider, so if you're not sure, call up your local health department, you can schedule an appointment to come get tested. The tests for HIV are extremely reliable. The screening test for HIV, if a person is in the early phase of the HIV infection where they actually develop antibodies, is very sensitive. However there is a phase of HIV called acute HIV in which the antibody test may not pick up that phase of infection. If you go through one of our publicly funded clinics, we will screen individuals for that early phase by actually looking for the virus itself. If a person goes in to a local physician to be tested, and they have an acute viral illness – meaning high fever or rash and are concerned that they may recently have had an exposure to HIV, we would encourage them either to get a repeat test done within several weeks of that event, or make sure that they go in and ask to be tested specifically for the virus itself, either through a test called Polymerase Chain Reaction – or PCR for HIV – or a P-24 Antigen Test. That way we can look for the virus itself.
What should someone do if he or she has a positive HIV test?
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David Wohl, M.D.
Co-Director, UNC AIDS Clinical Trials Unit.
Associate Professor of Infectious Diseases, UNC-CH School of Medicine
The first thing people have to do when they get a positive HIV test is get more information. Back in the early parts of the epidemic, there was a saying that went along the lines of knowledge equals power. Knowledge does equal power. Things have changed dramatically over the last five, ten, 15, and certainly 20 years of the HIV epidemic, so I think it's really important for people not to lose hope. HIV is no longer a death sentence. It doesn't mean the same thing it meant ten years ago. And by that I mean we now have medicines that can keep people alive for decades, decades after they're infected. And who knows what kind of developments we're going to see over the next ten, 15, 20 years that will extend that and capitalize upon the gains we've made over the last few years. So I try to tell people to be fairly optimistic. Concretely, I think what people have to do is get in with a very good HIV provider, so a clinic, a physician's office. Here in North Carolina, we have UNC, we have Duke, we have ECU, there are places to be seen in Charlotte, places all over where you can get excellent HIV care. I would try to get in as soon as possible to talk to somebody, get the information you need, find out more about your own individual status. The other thing, of course, is to recognize that if you have HIV infection, as indicated by a positive test, you can transmit this virus to other people, so you have to take measures to make sure you don't transmit the virus to others, either by abstaining from sex or using a condom if you're going to have sex. Certainly people who share needles – which is not as big a problem here in North Carolina as other places across the country – would also not share their needles.
How is HIV treated?
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David Wohl, M.D.
Co-Director, UNC AIDS Clinical Trials Unit.
Associate Professor of Infectious Diseases, UNC-CH School of Medicine
HIV has really benefited from a tremendous effort put in by our federal government and by private industry to understand better how we can treat this infection and make it a long-term problem. In clinic, we typically say to people who are newly diagnosed, HIV is very much like diabetes. Diabetes is a disease we have no cure for, and a lot of people who have diabetes end up dying from diabetes-related complications, but they die from them 30, 40, 50 years after they're diagnosed with diabetes. The same thing is happening with HIV, seeing people diagnosed, getting treatment, and living with this infection for decades, often times with high quality of life and no symptoms or hardly any symptoms whatsoever. What we do now is we wait for the right point to start treating HIV, and we decide this based upon looking at blood tests and how people are doing clinically. And once we decide to start therapy, we start therapy that inhibits the ability of the virus to make any more of itself. We shut down the amount of virus that's being produced every day in the blood and body tissues, and after a while that virus can be controlled at a very low level. When we do that, the immune system, which is under attack by HIV, can be restored, and we can protect people from the infections that are all around us and within us. So over a long period of time, the goal is to try to use medicines that gang up on the virus, prevent it from making more copies of itself, and over time letting the immune system rebound and flourish and protect people the way it should normally do.
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