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How Do I Know If I Have HIV?

The only way to know for sure if you have HIV is to be tested.

The Centers for Disease Control and Prevention (CDC) provides the national guidelines for testing in the USA. They report that the average person will develop the antibodies to HIV within 25 days. After 3 months there is a 97% chance the HIV test will detect any antibodies and in rare cases it may take up to 6 months for antibodies to be found. Therefore, the official recommendation of the CDC is for anyone with a risk factor to be tested after 6 months. Most people have the 3-month test and then re-test at 6 months. To review the official recommendations go to www.cdc.gov/HIV.

The reason for the waiting periods is because the tests aren't looking for the HIV, they look for the antibodies produced by the body to fight the HIV. The two tests, the Elisa and Western Blot, are used in combination to assure any HIV antibody present is found.

Getting tested is simple. It is a small sample of blood sent to a laboratory. (Home testing kits are available.) Testing is done both confidentially and anonymously, so be sure to check whether or not your name is associated with any testing if that is a concern. The advantage to being tested by a public health clinic or doctor is the counseling that is provided. Waiting for test results can take from several days to weeks, depending upon the test used. HIV testing is never done without the person's written informed consent. No other blood tests can be used to tell if a person is HIV infected.

The Meaning of Test Results

The decision to take the HIV test includes accepting that there are risk factors. Something happened where you may have come in contact with the HIV. This can feel stressful and cause people to avoid getting tested. This is understandable, but it isn't smart. Getting tested as soon as the guidelines recommend assures that if one is infected, treatment can be initiated that may make a difference.

It is usually important to talk to someone about what being tested means and how one will deal with the results. Counselors, religious leaders and doctors help people think about what testing means to them. If you don't have someone to support you as you get tested, call your local HIV/AIDS community organization. They usually have volunteer counselors who often have been through the testing experience. You don't have to go through it alone.

If your HIV test is positive, you need to create a plan for how you will take care of yourself and protect others. HIV is not a death sentence like it once was. Many people live long happy lives with HIV. If you don't have a doctor, your local public health department may have an HIV clinic or the local HIV/AIDS organization may be able to make a referral. Medical care is essential to live successfully with HIV.

Anyone who tests positive also has a responsibility to tell those they have had contact with so they can be tested. This includes all sexual and needle sharing partners. Revealing you have HIV is a very personal and private decision. You decide who knows and when you tell them. If there are children involved, it's helpful to include a counselor to assist you.

What Are the Treatments?

If a person discovers they have HIV, they may not begin taking medications immediately, depending on how long they have been infected and their CD4 T-cell count. The decision to start treatment is very individual and includes all aspects of a person's personal health profile. This is why the drugs don't have the same results for every person. Fortunately, we now have many drugs to use and they are used in combinations to prevent the HIV from figuring them out.

The HIV is a smart virus and is constantly changing or mutating. This is a problem because it has discovered how to get around many of the medications once used to treat it. When a person first discovers they have HIV they will be tested to determine what kind of HIV they have and what drugs it is resistant to. This is why it isn't safe for two people who have HIV to have unprotected sexual contact, because they may pass different strains of the HIV to each other.

Currently HIV is treated in combination therapies, often called "cocktails." When the virus figures out how to get around one drug, there's another one present to block it. As the epidemic grows, there are mutations of HIV now that are resistant to many of the drugs available, so it is important to work with a doctor who can determine what combination will work for any particular person. The good news is that HIV researchers are constantly discovering new drugs to block the HIV at different points in its life cycle.

Current HIV Medications work at various parts of the HIV replication cycle:

Entry. Viruses depend on other cells to reproduce themselves. This is essential for HIV, as it only lives a short period of time. The HIV uses the CD4 T-cell by attaching to the T-cell and getting inside. The newest class of HIV drugs, called entry inhibitors keep the HIV from entering the CD4 T-cell. There are two new drugs are being tested in clinical trials.

Replication. The HIV depends on the CD4 T-cells DNA to reproduce itself because it has no DNA of its own. and must use an enzyme called reverse transcriptase, RT, to change it's RNA into DNA. There is a class of AIDS drugs called nucleoside reverse transcriptase inhibitors, NRTIs. These drugs fool the HIV into making unusable DNA. There is also a class of drugs that were designed to prevent the RNA from working at all, the non-nucleoside reverse transcriptase inhibitors. People call these the "nukes" and "non-nukes" for short. There are 12 NRTI "nukes" available and 3 NNRTI "non-nukes" that are included in the medication cocktails physicians create for people living with AIDS.

Re-Assembly. Once the HIV has invaded the cells DNA and fooled it into making the pieces of HIV needed, it has to put the pieces back together. This is done using an enzyme called protease. We now have drugs called protease inhibitors, PIs, that prevent the virus from putting itself back together, and creating new virons. We have 10 protease inhibitors available for doctors to include in patients' drug cocktails. The PIs are given credit for saving the lives of may people living with AIDS who had used up the other drugs and are now recovering and returning to normal lives.

Medication Side- Effects. These are powerful drugs that can create side effects, especially when a person first starts to use them. Often the side effects go away as the body adjusts to the medication.

• Nausea and vomiting. Common at the beginning of treatment.
• Diarrhea. Needs to be managed if it lasts beyond 3 days.
• Rash. May be a sign of an allergic reaction, so should always be reported to one's doctor immediately. If not an allergy, rash usually goes away by itself.
• Sleep disturbances. Trouble falling or staying asleep.
• Pain, numbness or tingling in the hands and/or feet. Needs to be reported quickly to one's doctor.
• Excess fat. The body may begin storing fat between the shoulders, in the breasts or on the belly as a result of some medications. This is called lipodystrophy syndrome.
• Kidney stones. Especially with specific medications.

Whenever a person experiences side effects from medications, it is important to remember how often they occur and what time of day. This information may help their doctor determine how to best manage them. A person should never stop taking their medications because they have side effects. This can give the virus a chance to grow more quickly. Working with one's doctor to adjust or change medications is the way to manage the side effects.