Frequent Asked Questions

HIV Basics

What is HIV?

HIV stands for Human Immunodeficiency Virus. It is the virus that causes AIDS. It can only affect humans. It is a member of a group of viruses called retroviruses. It attacks the human immune system specifically and destroys it gradually.

What is AIDS?

AIDS is the abbreviation for Acquired Immune Deficiency Syndrome.

Acquired means you can get infected with it.
Immune Deficiency means a weakness in the body’s system that fights diseases.
Syndrome means a group of health problems that make up a disease.

Being HIV-positive, or having HIV disease, is not the same as having AIDS.

Many people are HIV-positive but don’t get sick for many years. As HIV disease continues, it slowly wears down the immune system and progresses to AIDS. AIDS is a condition in which the body’s immune system breaks down and is unable to fight off certain infections, known as opportunistic infections and other illnesses that take advantage of a weakened immune system.

How does HIV cause AIDS?

When a person is infected with HIV, the virus enters the body and lives and multiplies primarily in the T lymphocytes, a type of white blood cells. These are the immune cells that normally protect us from diseases.

The hallmark of HIV infection is the progressive loss of a specific type of immune cell called T-helper or CD4+ cells. As the virus grows, it damages or kills these cells, weakening the immune system and leaving the individual vulnerable to various opportunistic infections and other illnesses, ranging from pneumonia to cancer.

HIV Symptoms and Signs

What are the first symptoms of HIV infection?

The symptoms of initial HIV infection are not very specific. Initial symptoms include fever, headache, sore muscles and joints, stomach ache, swollen lymph glands, or a skin rash. Most people think it’s the flu. During this period of infection (acute infection) only about half the people experience symptoms mentioned above and an only small number of people experience serious enough symptoms that require a doctor’s attention.

What is a window period?

Once you are infected with HIV, the virus will multiply in your body for a few weeks or even months before your immune system responds. During this time, you won’t test positive for HIV, but you can infect other people. When your immune system responds, it starts to make antibodies. When this happens, you will test positive for HIV. This is called window period. This window period is roughly about 3 weeks to 6 months from the time of infection to the time when you will show antibodies against HIV.

What happens after an acute HIV infection?

After acute infection, whether you experience the first flu-like symptoms or not, the virus will continue to multiply in your body and damaging your immune system. During this period, most people will remain asymptomatic but you can infect other people.

How quickly do people infected with HIV develop AIDS?

In some people, the CD4 cell decline and opportunistic infections that signal AIDS develop soon after initial infection with HIV. Most people remain asymptomatic for 10 to 12 years, and a few for much longer. As with most diseases, early medical care can help prolong a person’s life.

What are opportunistic infections?

Opportunistic infections (OIs) are infections that take the opportunity of a person’s weakened immune system to manifest itself and cause grievous effects on that person. Common opportunistic infections were seen in patients at late stage HIV disease ie. AIDS stage includes:

  • Candidiasis (oral, oesophagal or vaginal)
  • Disseminated Tuberculosis
  • Pneumocystis pneumonia (PCP)
  • Cerebral toxoplasmosis
  • Cryptococcal meningitis
  • Cytomegalovirus (CMV) retinitis
  • Kaposi’s sarcoma

Many people are HIV-positive but don’t get sick for many years. As HIV disease continues, it slowly wears down the immune system and progresses to AIDS. AIDS is a condition in which the body’s immune system breaks down and is unable to fight off certain infections, known as opportunistic infections and other illnesses that take advantage of a weakened immune system.

How long can I live if I am HIV positive?

The vast majority of people infected with HIV will progress to AIDS stage in an average of 7-10 years after infection. If you were to live without treatment, you may not be able to live longer than 1-3 years after that.

With the introduction of Highly Active Antiretroviral Therapy (HAART) in 1996, anti-HIV medications have since been found to be able to suppress individuals’ viral load to an undetectable level and thus improve their survival. There is every reason to assume that increasing numbers of people will be living longer, and living well with HIV, and outliving the prognosis.

However there are many factors that may affect your life span, here are few that worth your attention:

The vast majority of people infected with HIV will progress to AIDS stage in an average of 7-10 years after infection. If you were to live without treatment, you may not be able to live longer than 1-3 years after that.

With the introduction of Highly Active Antiretroviral Therapy (HAART) in 1996, anti-HIV medications have since been found to be able to suppress individuals’ viral load to an undetectable level and thus improve their survival. There is every reason to assume that increasing numbers of people will be living longer, and living well with HIV, and outliving the prognosis.

However there are many factors that may affect your life span, here are few that worth your attention:

1) How well the person takes care of themselves medically
People who live a healthy lifestyle (diet, exercise, etc.) tend to live longer. People who have other medical problems, and/or those with a history of substance abuse, may not live as long. If you take care of yourself and adhere well to your medications, there is no reason you should not live a full life. Besides that, it is recommended to get tested for Hepatitis A, B, and C and get vaccinated for A and B if you have not been exposed yet.

2) How well the person takes care of themselves emotionally
People with a positive mental attitude tend to live longer than those with a pessimistic or negative mental attitude. Go to support groups to talk to others that have gone through what you are going through. Do not isolate yourself. HIV can be a wake-up call to live life to the fullness.

3) The virulence of the strain of HIV
Some strains of HIV may be more virulent than others. We have already found cases where a person was infected with a rare genetically defective strain of HIV, and that strain was not causing any significant illness (so far).

4) Drug-resistant strains of HIV
People who have drug-resistant strains of HIV may not live as long, if the drugs that are available are no longer effective. But if a person is responding well to their medications, they are expected to live longer.

5) The genetic make-up of the person
A few people have genetic mutations in their white blood cells (including mutations in the CCR-5 receptor and other receptors), that can slow down the progression of the disease.

It is very hard to know what is the longest time that one can live with HIV/AIDS. Often, it is difficult to predict exactly how long a person has been infected with the virus, since people progress from HIV to AIDS at different rates. Some people progress to AIDS very quickly, and others progress very slowly. But we do know that there are some infected individuals that can live for many years with the virus.

HIV Transmission and Prevention

How is HIV transmitted?

You can get infected with HIV from anyone who is infected, even if they don’t look sick, and even if they haven’t tested HIV-positive yet. The blood, vaginal fluid, semen, and breast milk of people infected with HIV have enough of the virus in it to infect other people. Most people get the HIV virus through these actions:

1. Unprotected sexual intercourse (vaginal, anal or oral) with someone who is HIV-infected.
Women are at greater risk of HIV infection through vaginal sex than men, although the virus can also be transmitted from women to men.

Anal sex (whether male-male or male-female) poses a higher risk to the receptive partner, because the lining of the anus and rectum are extremely thin and filled with small blood vessels that can be easily injured during intercourse.

There are far fewer cases of HIV transmission attributed to oral sex than to either vaginal or anal intercourse, but oral-genital contact poses a clear risk of HIV-infection, particularly when ejaculation occurs in the mouth. This risk is increased when either partner has cuts or sores, such as those caused by sexually transmitted diseases (STDs), recent tooth-brushing, or canker sores, which can allow the virus to enter the bloodstream.

2. The sharing of needles or syringes with someone who is HIV-infected.
Laboratory studies show that infectious HIV can survive in used needles for some time. Therefore, one should never reuse or share syringes, or drug preparation equipment. This includes needles or syringes used to inject illegal drugs such as heroin, as well as steroids.
Other types of needles, such as those used for body piercing and tattoos, can also carry HIV if not sterilized properly.

3. Infection during pregnancy, childbirth, or breastfeeding (mother-to-infant or vertical transmission).

Any woman who is pregnant or considering to become pregnant and thinks she may have been exposed to HIV even if the exposure occurred years ago should seek testing and counselling.
Mother-to-infant transmission carries a 30% risk of HIV infection but has been reduced with the use of medications.
Pregnant women are presently tested for HIV routinely in Malaysia, and those who are tested positive are provided with drugs to prevent transmission and counselled not to breast-feed.

4. Other ways.
Getting a transfusion of infected blood used to be a way people got AIDS, but now the blood supply is screened very carefully and the risk is extremely low. Other ways HIV can be transmitted include organ or tissue transplant and needle-prick injuries

These are much less common ways of transmission and are mainly due to human error or negligence.

How HIV is NOT transmitted?

HIV is not transmitted through food or air (for instance, by coughing or sneezing). There has never been a case where a person was infected by a household member, relative, co-worker, or friend through casual or everyday contact such as sharing eating utensils and bathroom facilities or hugging and kissing.

Most scientists agree that while HIV transmission through deep or prolonged “French” kissing may be possible, it would be extremely unlikely.

In Malaysia, one cannot get HIV from giving blood at a blood bank or other established blood collection centre because sterile and brand new needles are being used each time blood is taken.

Sweat, tears, vomit, faeces, and urine do contain HIV, but have not been reported to transmit the disease due to the low concentrations of the virus in these body fluids.

Mosquitoes, fleas, and other insects also do not transmit HIV.

Who is at risk?

You are at high risk:

  • If you have sex without condoms.
  • If you have many sex partners and do not use condoms.
  • If your sex partner/s has/have sex with other persons without using condoms.
  • If you have shared unsterilised needles for intravenous drug use.If you have sex with only one partner who is HIV positive.

Is oral sex safe?

It is possible to become infected with HIV through oral sex. However, the risk of becoming infected with HIV through unprotected oral sex is lower than that of unprotected anal or vaginal sex. The risk of HIV transmission for unprotected oral sex increases:

  • If the person performing oral sex has bleeding gums, ulcers, gum disease, cuts or sores around or in their mouth or throat;
  • If the person receiving oral sex ejaculated in the mouth of the person performing oral sex;
  • Or if the person receiving oral sex has another sexually transmitted disease (STD) ecent tooth-brushing which may cause some minor gum bleeding.

What are the chances of becoming infected with HIV if he doesn’t come inside me?

Research suggests that high concentrations of HIV can sometimes be detected in pre-cum (pre-ejaculate), it is possible that HIV infection can occur.

To guard against the possibility of infection with HIV or any other STI it is best to practice safer sex i.e. sex with a condom from start to finish.

Is deep kissing a route of HIV transmission?

Deep or open-mouth kissing is a very low-risk activity in terms of HIV transmission.

There has been only one documented case someone becoming infected with HIV through kissing; a result of exposure to infected blood during open mouthed-kissing.

If you and partner have open wounds in your mouth, you should avoid kissing until the wound has healed.

Can I become infected with HIV through normal social contact or activities such as shaking hands, kissing, using toilet seats and swimming pools, sharing cutlery, or exposure to sneezes and coughs?

No. this is because HIV is not an airborne, water-borne or food-borne virus.

Therefore ordinary social contact such as kissing, shaking hands, coughing and sharing cutlery does not result in the virus being passed from one person to another.

How long can HIV survive outside the human body?

Generally, the fragile nature of the virus prevents it from surviving for a substantial amount of time in the open air. The length of time HIV can survive outside the body is dependent on the amount of HIV present in the body fluid and the conditions the fluid is subjected to.

Many common substances such as hot liquid, soap, bleach, alcohol, and the gastric juices found within your stomach can destroy the virus.

The only studies on the survival of HIV outside the body have been conducted in the laboratory under controlled scientific conditions. These studies found HIV is not affected by extreme cold, but it is inactivated by heat and is destroyed after 30 minutes at 60°C.

Scientific studies have found that HIV can sometimes survive in dried blood at room temperature for up to 6 days.

It is extremely difficult to assess exactly the length of survival of HIV outside the body in a non-laboratory setting.

Is there a risk of HIV transmission when having a tattoo, acupuncture, during body piercing or at the barber or hairdresser?

At the barber, there is no risk of infection unless the skin is cut (which may occur if the barber accidentally cuts you) and if there is a transfer of infected blood.

If the instruments are contaminated with infected blood and are not sterilized between clients there is a risk of HIV transmission.

To reduce the risk of blood-borne infections such as hepatitis and HIV, ensure that the razor/instruments used are new or have been properly sterilized.

However, people who carry out body piercing, tattoos, acupuncture or hairdressing should follow procedures called “universal precautions”, which are designed to prevent the transmission of blood-borne infections such as HIV and hepatitis B.

What are universal precautions?

These are a set of guidelines that were designed to protect both workers and their customers from HIV and other blood-borne illnesses such as hepatitis.

The guideline state that any instrument designed to penetrate the skin such as tattoo or acupuncture needles wither should be used only once and discarded, or should be thoroughly cleaned and sterilized after each use.

Am I at risk of becoming infected with HIV when visiting the doctor or dentist?

Transmission of HIV in a health care setting is extremely rare.

All health professionals are required to follow infection control procedures when caring for any patient.

These procedures are called universal precautions for infection control.

They are designed to protect both patients and health care workers from the transmission of blood-borne diseases such as hepatitis B and HIV.

Am I at high risk if I have sex with a member of the same sex?

HIV is transmitted sexually regardless of your sexual preference.

By following safe sexual practices you can reduce your chances of becoming infected.

Can I infect my unborn child if I am HIV positive?

Women with HIV can transmit the virus to their fetus. The use of antiretroviral drugs, during pregnancy and at birth, can now help to prevent the transmission of HIV from mother to child.

Can mosquito bite transmit HIV?

No, it is not possible to get HIV from mosquitoes bite or other biting and sucking insects
.
Studies conducted by the CDC and elsewhere have shown no evidence of HIV transmission through mosquitoes or any other insects — even in areas where there are many cases of AIDS and large populations of mosquitoes

The results of experiments and observations of insect biting behaviour indicate that when an insect bites a person, it does not inject its own or a previously bitten person’s or animal’s blood into the next person bitten.

Rather, it injects saliva, which acts as a lubricant so the insect can feed efficiently. HIV lives for only a short time inside an insect and HIV does not reproduce (and does not survive) in insects.

Thus, even if the virus enters a mosquito or another insect, the insect does not become infected and cannot transmit HIV to the next human it bites.

Additional information:

  • Besides, that infected people do not have constantly high levels of HIV in their bloodstreams.
  • Second, insect mouthparts retain only very small amounts of blood on their surfaces.
  • Finally, scientists who study insects have determined that biting insects normally do not travel from one person to the next immediately after ingesting blood. Rather, they fly to a resting place to digest the blood meal.

Can the virus be transmitted through breastfeeding?

Yes, HIV is present in infectious amounts in breast milk. HIV can be passed from an infected mother to her baby through breastfeeding. This can be prevented when an HIV infected mother does not breastfeed her baby and uses alternate milk recommended by her doctor.