The HIV test is simple. Home tests are available. You can also get tested at labs that keep your identity secret. You can also get tested by your doctor, and at your public health department. If you are doing a home test, or if you order a test from a lab, a positive result means you should see a doctor to confirm that you’re really infected.
If you know you are at high risk of HIV infection and come down with a bad case of the flu, see a doctor right away. It could be the early signs of HIV infection. Tell your doctor about your risk behavior. There are very sensitive tests that can tell if you’ve got HIV - and treatment during this very early stage of infection works best.
Before getting tested, think about what your test result will mean. Most people need help with this, so see a counselor, psychologist, or doctor for advice - or call your local AIDS hotline. Prepare for your result.
If you test negative, you may want to talk about how to reduce your future risk. There are many private AIDS organizations that can give you this kind of help. Usually these organizations have "been-there, done-that" counselors you can relate to.
If you test positive, you’ll need help deciding what to do. HIV infection isn’t a death sentence. It does mean that you will need to take special care of your health. It also means that you will have to take special care not to infect anybody else with the AIDS virus.
If you test positive for HIV, you must have medical care. If you don’t have a doctor, a local AIDS organization or AIDS hotline can help you find one. Get some help from a person you trust. If you don’t have a person like this in your life, get help from a professional counselor. Have this person go with you to the doctor.
If you test positive, you have to tell your sex and/or needle-sharing partners that they, too, need to be tested. But you don’t have to tell everybody else. Tell only those people who can support you. If you have children, talk with a counselor about what to tell them, and when.
What Are the Treatments?
Treatment with combinations of AIDS drugs can keep people with HIV from getting AIDS.
In clinical studies, where everybody gets state-of-the art treatment and very regular medical exams, the drugs work for the vast majority of people. In the real world, some AIDS doctors say, the drugs fail in about half of their patients.
Why? Not all AIDS drugs work for all people. It’s absolutely essential to take the drugs at the right time of day, every single day. Sometimes the drugs’ side effects - or simple human nature - make this very hard to do. And because HIV is constantly mutating, no two people are infected with exactly the same virus.
Treatment must be planned and adjusted for every individual person with HIV. When to start treatment is a big question. Everybody agrees that starting aggressive treatment in the early days after infection - the stage of acute HIV infection - is most effective. But most people don’t find out they have HIV until the stage of chronic HIV infection, when the virus has a firm hold on the body. There’s no hard and fast rule about when to start treatment for such patients.
Most AIDS/HIV doctors now recommend holding off on treatment until a person’s immune system starts to fail. This decision is based on the CD4 T-cell count, the best measure of HIV disease. Another factor is how much HIV is in the blood - a measure called viral load.
When treatment begins, the decision on which anti-HIV drugs to use is crucial. New tests can tell which drugs will work best on the HIV infecting an individual patient.
There are several types of anti-HIV drugs. Because HIV mutates so quickly, it soon is able to resist any single treatment. That’s why doctors use combinations ("cocktails") of anti-HIV drugs. Virus that’s resistant to one drug gets killed by another. Over time, even this strategy isn’t always enough, and virus resistant to multiple drugs may appear. At this point, a doctor will switch to another drug combination. While there are many AIDS drugs, the possibilities are not endless. Researchers are working hard to find new ways to treat patients who have run through several different combination treatments.
The different types of anti-HIV drugs each target a different aspect of HIV’s life cycle:
Entry. HIV has to get into a T cell to start its dirty work. First it has to latch on to the cell. Next it has to fuse its own outer membrane to that of the cell. New drugs called attachment inhibitors and fusion inhibitors are being tested in humans.
Early replication. HIV’s goal is to take over a T cell’s genetic machinery. After fusing with a cell, the virus spills its genetic material into the cell. HIV has a problem here - its genetic code is written in a form called RNA. But in humans, our genetic code is written in DNA. HIV solves this problem by making an enzyme - called reverse transcriptase or RT - that translates its RNA into DNA. The class of AIDS drugs called nucleoside RT inhibitors ("Nukes") fools HIV into making flawed reverse transcriptase out of bogus raw materials. Another class - the non-nucleoside RT inhibitors or Non-Nukes - gums up reverse transcriptase so it doesn’t work. Several Nukes and Non-Nukes are now in use.
Late replication. HIV has to snip apart the cell’s DNA, put its own DNA in, and sew the DNA strand back together. The sewing kit it needs to do this is called integrase. Human tests of an integrase inhibitor began in 2001.
Another approach is to make the body’s immune system fight HIV more effectively. One way to do this is with a chemical messenger called interleukin-2 or IL-2, now in advanced human tests. Other immune stimulators are in various stages of development.
Yet another strategy is to use antisense drugs. These are strands of genetic material that form a kind of mirror image of HIV’s genetic code. This throws a monkey wrench into the virus’s replication machinery. One antisense drug has entered human tests.
Side effects are common with all of these medications. These can include:
Nausea and vomiting. These side effects are most common in the first weeks or months of anti-HIV treatment. Often they go away as the body gets used to the drugs.
Diarrhea. Most common early in treatment. Call your doctor if diarrhea lasts for more than three days.
Rash. Rash is common among people who start taking anti-HIV drugs. Usually it goes away by itself. IMPORTANT: Rash could be a sign of an allergic reaction to a drug. This happens more often to patients taking Ziagen, but also happens to a few patients taking Viramune, Rescriptor, or Sustiva. If you get a rash after taking these drugs, call your doctor right away.
Problems falling asleep or staying asleep.
Dry skin and/or ingrown toenails sometimes happen with Crixivan.
Pain, numbness, tingling, and or burning in the hands and/or feet.
Kidney stones sometimes occur in people who take Crixivan.
Revision date: July 6, 2011
Last revised: by Andrew G. Epstein, M.D.