Over the last 30 years, the way we think about and treat HIV has changed drastically. Although it was once thought to be a death sentence, today HIV is a chronic disease that can be successfully controlled with the right treatment. But despite developments in education and medication, many people still don’t understand the basics of HIV. Infectious Disease Specialist Stacey Rizza, M.D. answers common questions she hears from her patients. 1. Q: What’s the difference between HIV and AIDS? A: HIV, or human immunodeficiency virus, is the name of the virus that weakens the immune system by killing the Cluster of Differentiation 4 (CD4) T cells, which help the body fight infections. HIV is transmitted through bodily fluid like blood, semen or saliva. AIDS, or acquired immune deficiency syndrome, is the end-stage, clinical syndrome of the HIV infection. Once the CD4 T cell count has dropped below 50, (a healthy CD4 T count is over 500) and the person is getting opportunistic infections like recurrent pneumonia, or certain fungal infections and cancers, then it’s called AIDS. 2. Q: How is HIV diagnosed? A: HIV is diagnosed through a blood test by your primary care physician, public health department, gynecologist or obstetrician, or other health organization. In these blood tests, essentially we’re looking for a specific antibody that your body produces to fight the virus. The antibody usually takes about 2-4 weeks on average to show up on a blood test, so when we’re screening someone for HIV, we check them at six weeks, 12 weeks, and then four months after the potential infection. Don’t wait until you suspect you’ve been infected to be tested. 20% of people with HIV don’t know they have it. And the Centers for Disease Control and Prevention (CDC) recommends all adults between the ages of 13 and 64 be tested at least once. If you have risk factors for getting HIV, like having frequent unprotected sex, using IV drugs, or past blood transfusions in countries that don’t screen, then you should get tested for HIV at least once a year. 3. Q: How is HIV treated? A: In order to treat HIV, you need to have three active antiretroviral drugs in your body at all times. Usually, the regimen consists of two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), which stop a virus from making copies of itself, and one drug of another class, like protease inhibitors (PIs), which block the protease enzyme and prevent the cell from producing new viruses, Non-nucleoside reverse transcriptase inhibitors (NNRTIs), which block the virus from infecting new cells, or Integrase inhibitors, which prevent the HIV virus from integrating its DNA into your CD4 cells’ DNA. Nowadays, you can frequently get all three therapies in one pill. With HIV treatment, it’s extremely important to take your medication every single day, because if you miss a day, your virus can develop resistance to the medication and you may have to switch to a medication that may produce serious significant side effects, like vivid nightmares, nausea or vomiting. Before prescribing medication, we make sure our patients are willing and ready to take their pills every single day for the rest of their lives. It’s better to take nothing than to take it poorly. When I first started my medical career in 1995, there weren’t as many HIV-treatment options. In 1996, when the FDA approved protease inhibitors, it allowed for combination therapy, which meant we could give HIV patients three medications from at least two classes of antiretroviral drugs. That’s when the face of HIV treatment radically changed. Now, so much research is being done on finding a cure, and by just looking at how much has changed with treatment throughout my career, I’m pretty optimistic that we’ll find one within my lifetime. 4. Q: How is HIV monitored? A: The two numbers that you will hear often after an HIV diagnosis is your viral load and your CD4 T count. The viral load refers to how much virus is replicating freely in your body. The goal of therapy is to get that to undetectable levels, so the disease is “virally suppressed” and our machines can’t detect it in the non-lymphatic, or “peripheral” blood. We know the virus is still hiding away in the lymphoid tissue, liver and spleen which is why, at least at this time, it can’t be cured. The viral load tells you if it’s replicating anywhere else in the blood. CD4 T cells are one of the subsets of T-cells in our body that we use to fight infection. A normal CD4 T count is above 500. If it starts to drift down below 200, you increase your risk for certain serious infections. When it’s below 50, it’s considered AIDS. However, as long as you get on and stay on therapy, your HIV should never progress to AIDS. 5. Q: What lifestyle changes should people with HIV make? A: The number one recommendation we make is to wear condoms to prevent the spread of the disease. If you’re trying to conceive a child and on treatment, in a monogamous relationship and have been honest with your partner, you may be okay not using a condom, but this should be discussed with your HIV doctors first. Studies have shown that when HIV is virally suppressed with therapy, there’s a reduced risk of transmitting the disease. We also recommend HIV patients avoid smoking, drinking too much alcohol, and using intravenous drugs (good advice for everyone, not just HIV positive patients) because unhealthy habits can contribute to medication compliance issues. Other than that, you really don’t have to worry about normal, everyday interactions. You can still hug and kiss your children or family members. Just avoid sharing razors or toothbrushes, since occasionally you can cut yourself shaving or get a little blood on your toothbrush. 6. Q: What is the life expectancy of someone newly diagnosed with HIV? A: Back in the 80s and 90s, a diagnosis of HIV was considered a death sentence. But that was before combination anti-retroviral therapy. Right now, if you’re diagnosed early in your infection and take your medication as directed, it’s not unreasonable to believe you’ll be able to enjoy an almost normal life expectancy. 7. Q: What do you wish people knew about HIV? A: One of the biggest myths that still exists about HIV is that it only affects homosexuals and hemophiliacs. In reality, people of every age group and every socioeconomic class are becoming infected. In fact, most of the patients now walking in my office door are 50 years old or older. It’s estimated that over 1 million people in the United States have HIV and 20% of those infected are unaware of it. It’s extremely important that every adult gets tested for HIV – just like you get mammograms and colonoscopies – because if everyone who had HIV knew and was being treated for it, we could wipe out this disease in one generation.