HIV and AIDS: Know the Facts
Treatments Work, but Prevention Is Key
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\n It\u2019s been more than 30 years since a disease now called AIDS was first recognized in the United States. Back then, it was considered a death sentence. No treatments were available, its cause was unknown, and people often died within a few months after being diagnosed. Today, people infected with HIV\u2014the virus that causes AIDS\u2014can live full, healthy lives, in large part because of medicines and other discoveries made with NIH support.
\nThe terms HIV and AIDS can be confusing, because they\u2019re related but different. HIV is a virus that harms your immune system by invading and then destroying your infection-fighting white blood cells. AIDS is the final stage of an untreated HIV infection. People with AIDS can have a range of symptoms, because their weakened immune systems put them at risk for life-threatening infections and cancers.
\nHIV virus passes from one person to another through certain body fluids, such as blood and semen. About 90% of new HIV infections in the U.S. occur during sex. Shared needles and injection drug use is the second most common route of infection. HIV can also spread from an infected mother to her newborn. HIV isn\u2019t spread through casual contact, such as shaking hands, hugging, sneezing, sharing utensils, or using bathrooms.
\nToday, by taking a combination of HIV-fighting medicines (called antiretroviral therapy), fewer Americans with HIV are developing AIDS. And some HIV infections can now be prevented by taking daily medications (called PrEP).
\nBecause of these advances, some people may think that there\u2019s little need to be concerned about HIV and AIDS. But nothing could be further from the truth. Nationwide, more than 1 million people are infected with HIV, and each year over 50,000 more become newly infected. About 1 in 7 Americans who have HIV don\u2019t even realize they\u2019re infected, so they may be unknowingly spreading the virus to others. The problem is even more severe in developing nations, especially in parts of Africa.
\nEven though treatments and prevention strategies can keep HIV in check, there\u2019s still no cure and no vaccine to prevent HIV infections. That\u2019s why NIH-funded scientists continue to search for new, more effective ways to halt HIV infections.
\n\u201cIf you get a diagnosis of HIV infection, and you begin antiretroviral therapy in a timely fashion, before your immune system becomes substantially compromised, your prognosis is excellent,\u201d says Dr. Anthony S. Fauci, NIH\u2019s infectious disease chief, who first began treating AIDS patients in the early 1980s. Studies show that with early treatment, HIV levels may become so low that the virus becomes undetectable in the blood. That lengthens life and reduces the risk of spreading HIV to others. \u201cIf those who are infected stay on therapy, they can save their own lives and also help keep HIV from infecting their sexual partners,\u201d Fauci says.
\nKeeping HIV infections in check requires early diagnosis and taking daily HIV medications for life. Even if it\u2019s undetectable in the blood, once a person\u2019s been infected with HIV, it remains forever hidden in the body. \u201cHIV has the ability to integrate itself into your cells and hide in an inactive form, called a reservoir,\u201d says Fauci. Although medicines can keep virus levels low, they don\u2019t clear out the viral reservoir. So if treatment lapses, HIV comes out of hiding and rushes back into the bloodstream.
\nFor some people, keeping up with this daily health regimen can be a challenge. Nationwide, fewer than 1 in 3 people with HIV takes antiretroviral medicines regularly enough to reduce the virus to undetectable levels. That\u2019s why ongoing NIH-funded studies are creating and evaluating medications that might be taken less often, such as once a month. This approach will be tested in a large clinical trial expected to begin in Africa later this year. Other approaches that don\u2019t depend on daily anti-HIV drugs are also being tested.
\nResearch over the past few decades has identified preventive strategies that work: limit your number of sexual partners, never share needles, and use condoms correctly and regularly. NIH is also exploring new ways to prevent HIV infections, including experimental vaccines.
\nOne preventive approach for people at increased risk for HIV infection involves taking a daily dose of an antiretroviral drug. \u201cIn terms of prevention, a game-changer that we\u2019ve got right now is pre-exposure prophylaxis, or PrEP,\u201d says Dr. Carl W. Dieffenbach, who heads NIH\u2019s global research efforts in HIV/AIDS. \u201cThis strategy protects you from getting infected with HIV if you take the medication daily.\u201d
\nA pill form of PrEP (called Truvada) is approved by the U.S. Food and Drug Administration for people at high risk of getting HIV. Truvada combines 2 antiretroviral drugs already used to treat HIV infections.
\nWhen it comes to treatment and prevention, Dieffenbach says, \u201cthe most important activity that you can engage in is first getting an HIV test.\u201d Your health care provider, community health clinic, and others may offer quick HIV tests, often at no cost to you. The U.S. Centers for Disease Control and Prevention recommends at least a yearly HIV screening for people considered at high risk for infection. Testing is especially important for young people from ages 13 to 24, because more than half in that age group who tested positive for HIV didn\u2019t know they\u2019d been infected.
\nSome people avoid getting tested because they\u2019re afraid of the possibility of being HIV-positive. Others may feel embarrassed or uncomfortable talking about sexual issues, and so they don\u2019t get tested. But the earlier HIV is diagnosed and treated, the better the outcome.
\n\u201cThe stigma associated with HIV infection makes it difficult for some people who are at risk to come forward and either be counseled about how to avoid infection, or if they are infected, to get into a health care system and stay in the health care system,\u201d Fauci says. But studies show that open communication can help people treat and prevent HIV.
\n\u201cThe stigma problem can only be solved one person or one family at a time, because each person\u2019s situation is unique,\u201d Dieffenbach says. \u201cIt\u2019s about continuing a conversation with openness and acceptance in communities. As hard as that is, it does really matter.\u201d
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References:
\nHIV reservoirs as obstacles and opportunities for an HIV cure. Chun TW, Moir S, Fauci AS. Nat Immunol. 2015 May 19;16(6):584-9. doi: 10.1038/ni.3152. PMID: 25990814.
\nNIH research: think globally. Fauci AS, Collins FS. Science. 2015 Apr 10;348(6231):159. doi: 10.1126/science.aab2733. PMID: 25859018.
\nImmunology. Immune activation with HIV vaccines. Fauci AS, Marovich MA, Dieffenbach CW, Hunter E, Buchbinder SP. Science. 2014 Apr 4;344(6179):49-51. doi: 10.1126/science.1250672. PMID: 24700849.
\nFocusing to achieve a world without AIDS. Fauci AS, Marston HD. JAMA. 2015 Jan 27;313(4):357-8. doi: 10.1001/jama.2014.17454. PMID: 25626032.
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