What are the symptoms of HIV ?

The majority of people who are infected with HIV will have no symptoms in the early stages. People are often unaware they have the infection and so may be spreading the infection to others. A doctor may suspect you have HIV after a series of unusual infections known as 'opportunistic infections' or cancers, examples of opportunistic infections include:

• Thrush - in the mouth, genital area or gullet (oesophagus).
• Herpes simplex virus - a virus which can cause coldsores or genital herpes.
• Toxoplasmosis - parasite that causes lung and brain infections.
• Cytomegalovirus (C.M.V.) - a virus that causes pneumonia, bowel infections and severe eye infections that may end in blindness.
• Mycobacterium Avium Complex (M.A.C.) - an infection that can cause high fever, diarrhoea and weight loss. If it spreads it can cause blood infections, hepatitis or pneumonia.
• Tuberculosis.
• Pneumocystis Carinii Pneumonia (P.C.P.) - a infection that can cause a deadly form of pneumonia.
• Kaposi's sarcoma - a cancer that causes purple-coloured spots or lesions on the skin or lining of the mouth.
• Peripheral neuropathy - a disease of the nerves that may be a side affect of the HIV drugs or a result of one of the other infections mentioned above. Neuropathy can be a minor problem but in serious cases can cause disabling weakness e.g. difficulty in standing or walking.

What are the stages of HIV infection?

HIV can usually be broken down into 4 stages: -
Stage 1- Primary stage.
This stage of infection lasts a few weeks and will often be accompanied by a flu like illness which occurs just after infection. A HIV test at this time may not yet prove positive.
Stage 2 - Clinically asymptomatic stage.
This stage can last for an average of 10 years and as its name suggests usually has no symptoms, although there may be swollen glands. HIV remains infectious and will now show up positive in a test.
Stage 3 - Symptomatic HIV infection.
Over time the immune system loses the struggle to contain HIV, this is for 3 main reasons: -
1. The lymph nodes and tissues become damaged because of viral activity over the years.
2. HIV becomes stronger and more varied, leading to more CD4 cell destruction.
3. The body fails to keep up replacing the CD4 cells that are lost.
As a result you may get infections and cancers that normally the immune system would prevent causing 'symptomatic HIV infection'.
Stage 4 - Progression from HIV to AIDS now properly called advanced HIV infection.
As the immune system becomes more and more damaged the illnesses that occur become more and more severe leading to an AIDS diagnosis. People can be very ill with HIV but not have an AIDS diagnosis.

What treatment is available for HIV ?

There is no cure for AIDS and at present there is no vaccine to prevent people from becoming infected with HIV
However, there are a wide range of treatments now available and recent research has shown that taking a combination of anti-HIV drugs (combination therapy) can slow down the damaging effect of HIV on the immune system. When the treatment is successful, it can improve and sustain the health of someone with HIV meaning they are less likely to develop AIDS defining conditions. There are a minority of people who are unable to benefit from the current anti-HIV drugs but many who were seriously ill with HIV have returned to good health and in many cases returned to work as a result of the drugs.

Having an HIV test?

There are no specific symptoms which can tell whether a person is infected or not, the only way to know for certain is by having a HIV antibody test. The test looks for HIV antibodies in a person’s blood.

‘Window Period’

Remember, it can take 3 months for HIV antibodies to develop to a level where they will show up on a test result. A model that has risky sex with another person on day one is able to pass on HIV as little as four days after infection. However the window period for HIV using the conventional antibody test is 3 months. This means that they can potentially test negative for three consecutive months but still be positive and able to pass on HIV if they have had risky sex at any point in that time period.

The results of a HIV test can take anything from a few hours to a week or more to come back, you may have to book up in advance if you want the result the same day.
If you have a test at a clinic it should be strictly confidential to you and the staff concerned, staff will advise you to tell your doctor but no one will be told without your permission.

Anyone in the U.K. can have a free HIV test, they are available from your doctor and local GUM clinic, however obtaining a certified certificate may cost a variable amount depending on the clinic attended. It is advisable to check any costs of obtaining the certificate before attending for the test.

When you attend for a test, you will see a doctor or a specialist nurse in private. There are three different types of test – different clinics will offer different tests or combinations of tests. Any test will only be performed when you have given consent for it to be done. For standard testing a small sample of blood is taken and a result is available within 15 minutes or alternatively may take up to a week to produce the result.


The standard HIV Antibody Test

The first type of test is the HIV antibody test. This test shows whether a person has been infected with HIV, the virus that causes AIDS.  Antibody tests are also known as ELISA (Enzyme-Linked Immunosorbent Assay) tests. The usual way of testing for HIV infection is by testing for the presence of antibodies to the HIV virus in a blood sample. Antibodies are specific proteins which the immune system produces in response to infections. Although 90% of individuals will have detectable antibodies as early as six weeks after HIV infection, in 10% of cases antibodies to the HIV virus may not become detectable in a blood sample for up to twelve weeks (three months).

Because of this, a HIV antibody test result is only considered 99.9% accurate if at least twelve weeks (three months) have elapsed since the last sexual exposure.

A common HIV antibody test is the Abbott Determine HIV-1/2 rapid assay. This test detects both HIV 1 and HIV 2 and gives results within 15 minutes. The sensitivity of this test, as reported in the medical literature, is between 99.4 and 100%.


The p24 Antigen/Antibody Test (the ‘28 Day HIV Test')

The second type of test is an antigen test. Antigens are the substances found on a foreign body or germ that trigger the production of antibodies in the body. The antigen on HIV that most commonly provokes an antibody response is the protein p24. Early in the infection, (normally from two to five weeks), p24 is produced in excess and can be detected in the blood serum by a commercial test (although as HIV becomes fully established in the body it will fade to undetectable levels). p24 antigen tests are sometimes used to screen donated blood, but they can also be used for testing for HIV in individuals, as they can detect HIV earlier than standard antibody tests. Some of the most modern HIV tests combine p24 and other antigen tests with standard antibody identification methods to enable earlier and more accurate HIV detection.

In practice, a p24 antigen test is usually combined with an antibody test and this is known as the Vidas HIV DUO test. This is frequently advertised as the “28 Day HIV test”. However, clinical trials have shown that on average the HIV DUO test will identify HIV infection about one week earlier then a standard HIV antibody test.


The 'Early' HIV-1 Proviral Test (PCR test)

The third type of test is a PCR test (Polymerase Chain Reaction test). The whole process of extracting genetic material and testing it with a PCR test is referred to as Nucleic Acid-amplification Testing or 'NAT'. PCR tests detect the genetic material of HIV itself, and can identify HIV in the blood within two or three weeks of infection. This test can detect the presence of HIV-1 as early as ten days following infection and does so with a sensitivity of around 96 to 99%. Because of the complexity of this test, a result is not usually available for five to seven working days.

Because the sensitivity of the early HIV test is not 100%, if you have a Proviral test you will usually be advised to have a standard HIV test after the twelve week window period has elapsed, for complete assurance.


If your HIV test is positive.....

If your HIV test result is positive, this will need to be confirmed with a further set of three confirmatory HIV tests to ensure the result is genuine and that it is not a 'false positive' result. The likelihood of receiving a 'false positive' result is around 4 in 1000 for a standard HIV test and less then 1 in 100 for a HIV-1 Proviral test. The confirmatory tests yield a result within 24 hours.


Living with HIV

People living with HIV will need to have 2 tests regularly to monitor the infection and to see how well the treatment is working.
A CD4 (T-helper) count - this measures the number of CD4 cells in the blood, this will give you and your doctor an idea of how the infection is progressing. The lower the amount of CD4 cells (usually below 200) the more prone you are to infections. Healthy people have between 800 and 1,500 CD4 cells in a millilitre of blood.
A viral load test - this measures the amount of HIV in the blood. The higher the viral load the more virus there is in your blood. This test is used along with the CD4 cell count to help your doctor decide when to start or change your treatment.
Your doctor will also advise you to get immunizations to prevent infections such as pneumonia and influenza.
If you are a smoker or use drugs not prescribed by your doctor you should quit. Try to maintain a healthy diet, exercise regularly (if you are able) and find time to relax and ensure you get enough sleep.


What happens if I have HIV?

Living with the knowledge of a life threatening condition is very stressful; you will need to look at ways of taking particular care of your own health. It also means you can pass the virus on to others. You will be offered a referral on to a HIV specialist, to discuss whether to start treatment.

Remember, you are at no risk of getting the infection from normal everyday contact with a person infected with HIV or AIDS.