HIV/AIDS FAQ Thread

The following information was taken from a booklet created by the NSW HIV/AIDS Information Line.


Part 1 - GENERAL QUESTIONS.

What is HIV?
HIV is a virus which can cause an incurable and life threatening medical condition called AIDS. HIV stands for the Human Immunodeficiency Virus. Over time, this virus attacks the body’s natural defence against diseases (the immune system), which makes a person vulnerable to certain infections and malignancies.

There are two types of HIV.

• HIV-1 is the main form found around the world.
• HIV-2 is found mainly in parts of West Africa.

What is AIDS?
AIDS is a medical diagnosis caused by long term HIV infection. AIDS stands for Acquired Immune Deficiency Syndrome. Someone has AIDS when their immune system has been damaged so badly by HIV that they are unable to fight off a wide range of illnesses that people without an immune related illness, such as HIV, would normally be able to cope with.

It may take years for signs and symptoms of AIDS to occur. Most AIDS defining illnesses can be treated or prevented with medication. With current medications, many people living with HIV/AIDS remain well for many years and do not need hospitalisation.

How does HIV cause illness?
HIV causes illness by damaging the immune system through infecting the immune system’s helper cells. The immune system is the body’s natural defence mechanism against infection. An important part of this system is a group of white blood cells called lymphocytes. Lymphocytes can be further divided into various subgroups which each perform specific tasks. T4 cells, also called CD4 cells, are a type of lymphocyte that recognise anything foreign and activate the immune system to protect the body.

When HIV enters the bloodstream, it infects and destroys these T helper cells. By doing this, it causes a gradual destruction of parts of the immune system. Eventually, the body becomes vulnerable to other infections.

What type of virus is HIV?
HIV is a retrovirus. Most viruses infect cells and reproduce in the main body of the cell simply by inserting their genetic material (DNA) into the cell’s reproductive machinery. However, a retrovirus has a different type of genetic material (RNA), which needs an enzyme called reverse transcriptase to change the RNA to DNA before taking over the cell’s reproductive machinery. This turns the cell into a virus factory, reproducing copies of HIV rather than new, healthy cells.

HIV is also different from most viruses as is specialises in attacking the very cells that are the body’s defence against viruses – the immune system.

Where did HIV originate?
It is generally agreed that Simian Immunodeficiency Virus (SIV) found in African chimpanzees and monkeys became both forms of Human Immunodeficiency Virus (HIV) in humans (HIV-1 and HIV-2), but exactly how and when this occurred is disputed, although the leading theory is that SIV was transferred to hunters who were infected while butchering monkeys for food.

What are the symptoms of becoming HIV positive?
It can be difficult to diagnose HIV infection, as your body’s response to HIV infection is the same as for any other viral infection. There are no specific symptoms that will tell you that you have been infected with HIV and not everyone who is infected with HIV experiences symptoms, some only mild symptoms and only a small number experience severe symptoms.

However, a few weeks following infection with HIV, some people have a severe “flu-like” illness with fever, rash and swollen lymph nodes (the “seroconversion illness”). During this time the virus spreads rapidly through the body. An HIV test preformed at this time may not show up the virus. It can take several weeks or months for the test to become positive – this is called “the window period”.

It is important to note that anxiety and stress can also cause similar symptoms.

The only way to know if you have become infected with HIV or not is to have a specific blood test after allowing for the window period.

If you have been involved in any high risk activities, such as unsafe sex, and have concerns about possible recent HIV infection, you should consult a GP or a sexual health clinic and consider being tested for all STIs too.

What is the incubation period of the virus? (This is not the same as the window period.)
This is the period of time it takes from becoming infected with HIV to developing symptoms of disease or illness. This period varies from person to person, but without treatment, the average time period is considered to be around 7-10 years. This period may also vary due to interventions with anti-retroviral medications. During this time there may be no outward evidence of illness, but the virus remains active (replicating and mutating) in the body, can still be detected by a blood test and the person is infectious.


Part 2 - TRANSMISSION AND PREVENTION.

Who is at risk of HIV infection?
HIV does not discriminate against race, social groups, sexuality or on sexual preference. The virus can infect anyone. It is behaviour that puts a person at risk, not the type of person one is or has sex with.

However, because many factors contribute to health, in some countries, people from minority populations have been disproportionately affected.

How do you become infected?
As previously stated, HIV is the virus, which is transmitted, and AIDS is a later stage condition, which may result from HIV infection.

Transfer of blood or sexual fluids from an infected person into another person’s body (usually by injection or sexual intercourse) is the principal mode of transmission. Once outside the body, HIV is fragile and dies quickly in normal circumstances.

HIV is transmitted by three major means:

1. Blood to Blood transmission

• By sharing injection equipment, e.g. syringes, water, filters etc, which may contain blood from an infected person. Remember the blood may not be visible.
• By having a tattoo or piercing done where the tattoo/piercing equipment is not sterilised.
• By receiving infected blood via a blood transfusion or blood products. Note: In most countries, the blood supply has been tested for HIV antibodies, however, if a donation occurred during the window period, the test may not have detected HIV. To cover this, all blood donors have to sign a declaration, which states that they haven’t put themselves at risk of acquiring HIV. Today more sensitive testing can be done to further reduce the likelihood of this happening.
• A person may be at higher risk if they received a blood transfusion or blood products overseas.

2. Sexual Transmission
Unprotected sexual intercourse is considered a high risk activity for both partners.
Having vaginal or anal sexual intercourse without a condom, or any other sexual activity where blood, semen, or vaginal fluid from an infected person may pass into the blood stream of another person, can lead to infection. Breaks in the skin caused by eczema, sores, or ulcers, could increase risks by allowing infected semen, blood or vaginal fluid to enter the blood stream. Absorption can also occur through the mucous membranes lining of the female cervical canal, the rectum, the male urethra and under the foreskin.

3. Parent to Child Transmission
HIV can be transmitted to an unborn child through the placenta during pregnancy, during a natural delivery as the baby comes into contact with infected blood and vaginal secretions in the birth canal and through milk if breast-feeding.

To reduce the possibilities of having a HIV positive child the infected parent should be on HIV anti-retroviral medications with undetectable or very low levels of the HIV virus present in their blood. To prevent infection to the baby during birth, delivery should be by a caesarean section. And to prevent infection to the baby after birth breast feeding should not be done.

The risk of transmission from the infected individuals to the baby increases if in the later stages of HIV/AIDS or if a woman is infected during pregnancy.

Can HIV be transmitted through oral sex?
Oral sex is considered to be a low risk for the transmission of HIV. HIV is not transmitted by saliva (see below “Can you become infected by kissing?”) however having cuts, ulcers, or damage to the mouth and gums may allow infected blood, semen, or vaginal fluid into the bloodstream via the mouth.

There is virtually no risk of acquiring HIV from receiving oral sex as the exposure is only to saliva. However, you should remember that other STIs may be transmitted this way.

How infectious is pre-seminal fluid (pre-cum)?
Pre-seminal fluid has been found to contain HIV in infected persons.
For this reason any penetrative sex without a condom must be considered unsafe. This includes coitus interruptus (withdrawing the penis before ejaculation). Any pre-seminal fluid involved in oral sex would also pose a theoretical risk of infection, however the actual risk would seem to be low. Studies are presently being conducted to measure to levels of HIV virus in semen.

Can you become infected by kissing?
Although HIV has been detected in saliva in some HIV positive people, it is in much lower concentrations than in semen, blood or vaginal fluid and therefore is not considered a risk for transmission of HIV. It is believed that some of the proteins in saliva may partially inactivate HIV.

Can you become infected with HIV through mutual masturbation?
The skin is a very effective barrier that keeps things like blood and sexual fluid, and therefore HIV, out of the bloodstream. It is not possible for HIV to enter the bloodstream via intact skin.

Theoretically, infection with HIV through masturbation could only happen if there are open (meaning bleeding or fresh) cuts or abrasions on the fingers, hands or on the body that come into contact with sexual fluid or blood. There are no documented cases of HIV transmission in which mutual masturbation was the only risk factor.

Can a person become infected with HIV from receiving or giving a massage?
As stated in the previous question, there is no entry point to the blood stream through intact skin. Blood, sexual fluid or vaginal secretions would need to get into the bloodstream. Blood or sexual fluid would need to get into a significant area of skin loss (such as a bleeding wound), which is extremely unlikely from massaging or being massaged.

I have seen a sex worker and am now worried that I may have been exposed to HIV. Can I catch the virus by having sex with a sex worker?
As mentioned, it is not the “type” of person who you have sex with but the behaviour that puts a person at risk. The principles of HIV transmission apply to everyone who you have sex with and the type of sexual behaviour that has occurred.

If safe sex is practised, you will not be at risk.

Can other sexually transmitted infections make you more susceptible to HIV?
The presence of other STIs can make it easier for HIV to enter the blood stream during unprotected sex (or in/on the mouth of a person performing oral sex). Having a STI makes it easier to both infect another and become infected with HIV.

Can you get infected at the doctor’s, dentists or by ear piercing, electrolysis, acupuncture or tattooing?
Not if professional infection control guidelines are followed. If you have any procedure, which pierces the skin, ask how equipment is sterilised between clients. All professional service providers are required to follow strict infection control guidelines. If you have any doubts, check that your practitioners use either disposable or sterile equipment for each client, and that they follow infection control procedures.

Can you become infected by pricking yourself on a hypodermic needle by standing on it or otherwise piercing the skin?
The risk of acquiring HIV from a discarded needle and syringe is very low. To date there is no documented cases of this happening. The reasons for this low risk of transmission are:

• The used needle and syringe is usually very small, therefore holding no or very little potential infectious fluid.
• It may be some time since the needle was used, therefore any viral matter present has died.
• There may be no blood in the syringe.
• If there is blood in the syringe, it would have congealed and could not be injected out of the needle.
• The injury from the needle may not be deep.

Other blood borne viruses are more easily transmitted than HIV, such as Hepatitis B and C; even so, there are still only two documented cases of transmission of any of these viruses (one Hepatitis-B and one Hepatitis-C) occurring from discarded needles. Seek medical advice if you are concerned.

If infected blood is spilt, how can the area be disinfected?
Even though skin is a good barrier to HIV infection, it is recommended that you wear gloves to clean up the spill. Use paper towels if possible. Then wash the area with detergent, clean the cloth in the normal way and put gloves and paper towels into a plastic bag for disposal.

Can you get infected by household contact such as kissing or hugging, coughing or sneezing, or by sharing toilet seats, glasses, cutlery, towels, books or other implements?
You cannot become infected with HIV through general social contact. It would be unwise, however, to share razor blades or toothbrushes as blood might be present and able to pass through cuts or breaks in your skin, which may be a risk for other blood-borne diseases.

Can you get infected in swimming pools, spas, hot tubs or saunas?
Chlorine or salt water will destroy the virus. In water, the virus would also be diluted which means there will be no risk of transmission.

How do children get HIV/AIDS?
If the parents are infected, infants can become infected during pregnancy or at birth. Also, the virus can be transmitted through breast milk. Children are not at risk during normal home, school, or playground activities even when HIV infected children are present. Children should be made aware of the risks of contact with blood and should be instructed not to touch or play with discarded needles or syringes. Games such as “blood brothers” are not advised.

In the past (before 1985) children have become infected during transfusions of blood products (such as Factor 8 to treat haemophilia). This is unlikely to occur today as blood banks test all blood donations and heat process some blood products such as Factor 8 to inactivate the virus.

What is "safe sex"?
Safe sex is any sexual practice, which does not allow infected blood, semen, or vaginal or anal secretions to pass into the blood stream of another person.

Wearing a condom during sexual intercourse is the most effective protection. Condom breakage can occur if not used properly. Remember to squeeze the air out of the tip of the condom to leave room for the ejaculate. Always use water-based lubricants (e.g. wet stuff, KY). NEVER use oil based lubricants, (such as moisturisers, baby oil, or Vaseline), since these lubricants weaken the condom's latex and increase risk of breakage. If a condom does break, douching (flushing the area with water) is not advised as this may increase the risk of infection by weakening the lining of the rectum or vagina. Condoms should be stored as recommended and used before the expiry date, which is printed on the wrapper. Store condoms away from direct sunlight preferably in a cool place.

How long does the virus stay active outside the body?
We know that the virus is fragile and cannot survive long outside the human body in normal conditions. An exact time cannot be given as it depends on the environmental conditions, but HIV is extremely sensitive to changes in external temperatures, dilution and drying out.

Can I be infected by a HIV positive person?
Yes, but by specific means only, such as unprotected sexual intercourse or sharing needles with them You cannot become infected by casual social contact, such as: kissing, hugging, sharing food or cutlery/crockery, toilet seats, swimming pools, coughing or sneezing.

Is transmission of HIV by HIV positive people automatic?
There are recorded cases of one partner remaining uninfected despite regular sexual contact. However, the risk of transmission is high without appropriate precautions and avoidance of contact with blood, semen, vaginal or anal secretions is strongly recommended. It is not always clear why sometimes an infection occurs when on other occasions it has not.

Can you tell when people are HIV positive?
Most HIV positive people are healthy. The only way to tell someone has HIV is by a specific blood test. Therefore, if you do not know the status of your sexual partner, it is wise to take precautions and always use condoms.

Are HIV positive people a danger in the workplace?
The virus is mainly transmitted by sexual contact or sharing needles. HIV positive people can work in all professions and do not need to inform their employer. It is unlawful in Australia for an employer to ask an employee their HIV status.

Some people are required to know their status and change their practices if they are HIV positive. This is only for people who in the course of their job perform “exposure prone procedures”, such as specific types of surgery or dentistry. It does not relate to all health care workers. Standard infection control precautions should be in place to prevent contact with blood or body fluids in every workplace regardless of whether employees are known to be HIV positive or not.

Do I report people with HIV/AIDS?
Doctors have the responsibility to make such legal notifications as necessary while maintaining patients' confidentiality. (Legal requirements for doctors to notify health authorities may vary from country to country) However, in Australia, all notifications of a new HIV diagnosis is coded in such a way as to not divulge the identity of the client.

People living with HIV have the same right to confidentiality as anyone.

Is there a Vaccine for HIV?
Despite many years of research, a vaccine has not been successfully developed, although one was recently being trialled but that trial has since ceased.


Part 3 - TESTING FOR HIV.

What is the HIV antibody test?
Specific blood tests are used to determine whether there are antibodies to HIV in the blood or not. Detection of HIV antibodies would mean you have been infected with the HIV virus. More than one test may be used to confirm a positive result.

The first test usually done is known as an ELISA test (Enzyme-Linked Immuno-Sorbent Assay.) This test is extremely sensitive, and while it gives very accurate results, it can occasionally give a false positive result. This is why a positive ELISA result will always needs to be confirmed by a second test, called a Western Blot.

When both of these tests are done, a result is considered extremely reliable. A positive ELISA and positive Western Blot test together means that a person is infected with HIV. A negative result on the Western Blot test means that a person does not have HIV even if the result has come back positive on an ELISA test.

What are antibodies?
Antibodies are chemical compounds found in the blood, which are produced by the immune system in response to the presence of a foreign substance, such as an infection. With many infections, the antibodies help the body to recover and fight off infections. With some viruses such as measles, hepatitis A and chicken pox, the antibodies can protect a person from future infection. This is not the case with HIV.

What is the window period? (Or why do I have to wait 12 weeks to test?)
This is the time it takes, following a possible risk of infection with HIV, until a HIV antibody test can give a conclusive result. With the tests that are used for HIV screening in Australia this “window period” is considered to be 12 weeks.

It can take up to 12 weeks for your body to produce these antibodies if you have been infected so testing will be usually be done 12 weeks following the risk . During the window period it is still possible to be infected and to infect others with HIV. It is therefore strongly suggested that condoms be used at all times or that a person abstains from activities that may put them or their partner/s at further risk.

Under certain circumstances it may be possible to get a result before the 12 week window period. However, it is recommended that people wait at least 12 weeks after a risk to ensure result accuracy.

Are there other tests for HIV?
The p24 antigen test looks for the presence of a specific HIV protein. This protein can be found before the appearance of HIV antibodies in a recently infected person. Although this test is useful in certain circumstances it can not be used for confirmation of HIV infection alone. While a positive p24 antigen result means HIV infection, a negative result does not confirm that there is no infection with HIV. Therefore this test is not routinely done when testing for HIV infection but may be used if suspecting a very recent infection when antibody tests are negative and in the 'seroconversion' or 'window period'.

HIV pro-viral DNA PCR testing is not widely available as most laboratories do not have the equipment to run this test. It is sometimes called Nucleic Acid testing (NAT) or PCR testing and is most sensitive test available for confirming the presence of HIV virus. The main use for this test in detecting HIV is in situations when standard testing is inappropriate such as in the diagnosis in newborn infants, pre-seroconversion or where standard testing has been disputed or inconclusive. This test does not replace screening tests or diagnostic testing alone.

ß2-microglobulin testing can be used to see if a HIV infection is recent or not. The test looks for a protein found in blood serum which has been shown to increase the longer a person has had HIV. Elevated concentrations are also found in serum of individuals with advanced HIV infection and in spinal fluid of individuals with AIDS Dementia Complex (ADC), a neurological complication of advanced HIV disease.

HIV RNA or viral load testing is most commonly used to measure the amount of HIV in the blood of someone who is already diagnosed HIV-positive.

What about CD4 testing?
T-cells or CD 4 cells are one of the immune system cells and are destroyed by HIV.
CD4 testing is a common test to look at the strength of the immune system. Although having a low CD4 cell count can indicate immune system damage, it does not necessarily mean that a person has HIV. A HIV test should be taken if there is any concern about HIV. More information on CD4 testing for people who are HIV-positive can be found at the end of this booklet.

What about Rapid HIV Tests?
Rapid tests give same day results but due to a higher number of false positive results two separate tests must be done to confirm a positive result. This means that all potential positive rapid test results cannot be considered confirmatory until standard blood testing is done.

What about Home Test kits?
Home Testing Kits may sound convenient. It involves taking a blood spot or saliva sample at home and then posting it to a laboratory for testing. However, this type of testing may mean that the individual does not receive adequate pre and post-test information, nor counselling and support. The current guidelines for HIV testing in Australia require certain issues to be discussed to enable the individual to make an informed decision regarding testing. At present these test kits are not licensed for use in Australia.

What about Self Test Kits?
A self test kit is defined as one where an individual can administer the test and read the result themselves. Although at present there are self test kits available in some countries, they are not yet licensed nor approved for use in Australia, the United States, United Kingdom or Canada. The accuracy of this test kit is thought to be comparable to that of the rapid testing and home test kits mentioned above.

When should a HIV test be done?
In most cases, it is recommended to wait at least 12 weeks after the possible exposure. This is to allow enough time for HIV antibodies to appear which is what the most commonly run test to detect HIV infection. During this period it is recommended that a person practise safe sex and use condoms to ensure they do not pass HIV on to their partner(s). There may be circumstances when testing earlier than 12 weeks might be considered, eg. due to the presence of specific symptoms, but a conclusive result may still take 12 weeks.

If you are considering testing for HIV, you should also consider testing for other Sexually Transmitted Infections at the same time.

How can I get a HIV test?
Tests are available from your medical practitioner or your nearest Sexual Health Clinic

HIV test results can take up to a week to come back from the laboratory. This is because HIV tests are done in batches and may not be run every day.

Having a HIV test has many implications. Someone should discuss these implications with you as HIV testing should only be done with informed consent (see “What is informed consent” below). For this reason we suggest going to a centre where pre and post-test counselling is carried out.

What is informed consent?
This means you should be able to understand what you are testing for and weigh up the advantages and disadvantages of having a HIV test and assess the potential implications of a positive or negative result. Things to consider are how you would cope with a positive result given your current life circumstances, what supports you would have, and how you have coped with a crisis in the past. It is also necessary under law (in some jurisidictions) that a person diagnosed with HIV must inform current and future sexual partners of the diagnosis before engaging in sex, even if condoms or other methods of protection are used. These things should be discussed with you prior to having a test. The testing procedure will also give information regarding how to potentially prevent HIV infection.

Protection of your privacy.
In most jurisidictions, testing and reporting of a HIV result using a person’s full name and address is unlawful except under specific circumstances, such as for insurance or immigration purposes, testing a hospital patient, or when the person being tested has consented to their name being recorded. It is a good idea to ask the centre where you wish to be tested if they use a coding system that does not identify people by personal details.

 

Thank you, JayHew for the vote of confidence.

I trust that the above information will be of use to EC members who have questions relating to HIV/AIDS.

I am currently in the process of updating an FAQ dealing with STD/STIs and with EC the mods permission I will post that as well.