HIV/AIDS – Diagnosis and Treatment
Diagnosis
Tests to Understand Disease Level and Plan Treatment
Healthcare workers diagnose HIV using blood or saliva tests. The first step often involves an antigen-antibody test, which can detect infection earlier than antibody tests alone.
This test finds HIV antigens (like the p24 antigen) and antibodies the body makes after encountering the virus. Antigen-antibody tests usually show results about 2 to 6 weeks after exposure.
Antibody tests look only for antibodies to HIV in the blood or saliva. Many at-home and rapid HIV tests use this method.
These tests might not turn positive until 3 to 12 weeks after exposure. The timing of each test is important because of the “window period”—the days or weeks after infection but before tests can detect the virus or the body’s response.
A nucleic acid test (NAT) is even more sensitive. NAT looks for the actual virus in the blood, measuring the viral load.
NATs can detect HIV before other tests, even during acute infection when flu-like symptoms such as fever, rash, and headache may appear.
After confirming HIV infection, doctors run follow-up tests to see how advanced the disease is and plan care. Key tests include:
- CD4 Count: This test measures the number of CD4 T cells (a type of white blood cell) in the blood. HIV attacks these cells.
- Viral Load (HIV RNA): This test checks how much HIV is in the blood. Lower viral load means the virus is less active.
- Drug Resistance Test: This test checks if the virus is resistant to certain medicines. Testing for resistance helps guide the choice of medicines.
The chart below summarizes key tests:
| Test Name | What It Measures | When Used |
|---|---|---|
| Antigen-antibody | Virus and antibodies | 2–6 weeks after exposure |
| Antibody | Antibodies | 3–12 weeks after exposure |
| Nucleic acid (NAT) | HIV RNA/Viral load | 1–4 weeks after exposure |
| CD4 count | Immune cells | After confirmed HIV |
| Drug resistance | Virus strain changes | After diagnosis |
Checking for Other Health Problems
Doctors also check for other illnesses or problems linked to HIV or its treatment, such as:
- Other infections (tuberculosis, hepatitis B, hepatitis C)
- Other sexually transmitted infections (STIs)
- Liver or kidney problems
- Infections that happen more often when the immune system is weak, such as cytomegalovirus or toxoplasmosis
- Certain cancers (like cervical or anal cancer)
- Urinary tract infections
Regular checks help find these problems early and guide ongoing treatment. Doctors use blood tests, urine tests, and sometimes scans or biopsies to look for these complications.
Treatments Available
Beginning and Staying Consistent with Therapy
Doctors recommend that people with HIV start antiretroviral therapy (ART) as soon as possible, no matter how strong their immune system is or if they have symptoms.
Early and regular use of ART helps keep the immune system healthy and lowers the risk of developing acquired immunodeficiency syndrome (AIDS) or serious infections.
Taking ART as prescribed is essential. Missing doses, skipping pills, or stopping treatment lets HIV multiply and increases the risk of drug resistance.
Consistent treatment protects the person taking it and reduces the chance of passing HIV to others. If the viral load drops so low it can’t be detected by routine tests, this is called an undetectable viral load.
People may face challenges with daily HIV medications. These can include forgetting doses, side effects, or emotional and mental health struggles.
Regular check-ins with healthcare teams help address these issues. Healthcare providers can suggest reminders for daily pills, counseling, or changes in medicines if needed.
Benefits of ART adherence:
- Keeps immune response strong
- Reduces risk of drug resistance
- Helps avoid opportunistic infections
- Prevents HIV transmission to others
Tip: Creating a daily routine, using pill boxes or alarms, and staying connected with a healthcare team can help maintain adherence.
Managing Effects from Medicines
HIV medicines can cause side effects. Most side effects improve after the first few weeks or months, but some may last longer.
Side effects may include digestive problems like nausea or diarrhea, heart issues, high cholesterol, high blood sugar, liver or kidney problems, bone weakness, and trouble with mood or thinking.
Each person’s experience with ART can be different. Some medicines may raise cholesterol or blood sugar, increasing the risk of diseases common in older adults.
Bone thinning and liver or kidney damage are also possible with certain drugs.
A table below lists some possible side effects:
| Side Effect | Possible Medicine Causes | Ways to Manage |
|---|---|---|
| Nausea, vomiting, diarrhea | Some NRTIs, PIs, or others | Adjust meal timing, other meds |
| High cholesterol or sugar | Some PIs, certain NRTIs | Regular checks, dietary changes |
| Liver or kidney injury | Tenofovir, others | Regular blood tests, fluid intake |
| Bone loss | Tenofovir | Calcium, vitamin D, exercise |
| Trouble sleeping or thinking | Across several ART classes | Dose timing, talk to provider |
People should tell their health provider about any side effects as soon as they appear. Doctors can often adjust medicines or add treatments to reduce side effects.
Providers may recommend regular blood tests or scans to watch for kidney, liver, heart, or bone problems.
Addressing Conditions Related to Aging
Aging with HIV brings new challenges. Conditions like high blood pressure, heart disease, diabetes, or bone thinning become more common as people get older.
Medicines for these issues can sometimes react with ART, causing unwanted problems. For example, some heart or bone medicines may not mix well with certain antiretroviral medications.
People with HIV should tell each healthcare provider about all the medicines they use, including those for HIV and other issues. This helps prevent harmful interactions.
Some key points for managing age-related issues with HIV:
- Review Medicines Regularly: Healthcare teams should frequently check all prescriptions and over-the-counter products to spot possible problems.
- Watch for New Symptoms: Fatigue, muscle pain, or changes in mood may signal an interaction or a new medical condition.
- Frequent Labs May Be Needed: Blood tests, urine samples, and other screenings help monitor heart, kidney, bone, and liver health in older adults with HIV.
- Lifestyle Measures: Eating healthy, staying active, and not smoking support the immune system and reduce risks.
The healthcare team, including specialists if needed, supports ongoing health management for people with complex needs.
Monitoring How Treatment is Working
Doctors use lab tests to check if HIV treatment is working. Two main tests are used:
- Viral Load Test: Measures how much HIV is in the blood. The goal is to lower it so much that standard tests can’t find it.
- CD4 T Cell Count: Measures how strong the immune system is.
Doctors monitor these tests about 4 to 6 weeks after starting or changing ART, and then every 3 to 6 months.
If the viral load stays high after a few months on treatment, or if the CD4 count goes down, doctors check for drug resistance. If resistance is found, doctors may change medicines.
A simplified table of goals:
| Test | Desired Outcome | How Often |
|---|---|---|
| Viral load | Undetectable (cannot find) | Every 3-6 months |
| CD4 T cell count | Stable or increasing | Every 3-6 months |
Staying in regular contact with the healthcare team helps track treatment, catch problems early, and make changes if needed.
Healthy Living and Self-Care Tips
People living with HIV can take many steps at home to support their health. Making smart choices every day lowers the risk of complications.
A balanced diet gives the body strength. Fresh fruits, vegetables, lean proteins, and whole grains provide vitamins and energy. Eating enough calories helps maintain a healthy weight and supports the immune system.
To prevent foodborne illness, avoid raw or undercooked meat, eggs, and seafood. Use only pasteurized dairy products.
Drink only clean, safe water. These steps lower the chance of infections, which can be harder to treat for people with HIV.
Staying up-to-date with vaccines is important. Recommended shots help prevent pneumonia, flu, COVID-19, mpox, and more. Vaccines without live viruses are usually safe, but live-virus vaccines can be risky.
Staying safe with pets also matters. Common pets, like cats or reptiles, can carry germs that pose a risk. Always wash hands after touching pets or cleaning litter boxes.
Other helpful actions for self-care include:
| Action | Why It’s Important |
|---|---|
| Use condoms | Helps prevent HIV from spreading. |
| Don’t share needles | Reduces risk of new infections. |
| Practice safer sex | Lowers HIV transmission risk. |
| Consider pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) | Medication options to prevent HIV. |
| Seek HIV education | Learn how to protect yourself and others. |
Alternative medicine
Dietary Additions That Could Offer Benefits
Some people try supplements to ease symptoms or side effects linked to HIV or its treatment. The current evidence is limited, but a few options may help when used carefully.
| Supplement | May Help With | Remarks |
|---|---|---|
| Acetyl-L-carnitine | Neuropathy | Only if levels are low |
| Whey protein, amino acids | Weight gain | Use with caution |
| Probiotics | Diarrhea | Follow doctor’s advice |
| Vitamins/minerals | Deficiencies | Avoid high doses |
- Acetyl-L-carnitine: This supplement may help with nerve issues like pain, numbness, or weakness (neuropathy), especially if levels are low.
- Whey protein and certain amino acids: Protein from whey and amino acids like L-glutamine, L-arginine, and HMB might help with weight gain in people struggling to maintain their weight.
- Probiotics: Certain probiotics, such as Saccharomyces boulardii, could help manage diarrhea linked with HIV. Bovine colostrum is also being studied for this purpose.
- Vitamins and minerals: If blood tests show low levels, vitamins A, C, D, E, and B group vitamins, along with minerals like zinc, iron, or selenium, may be helpful. Avoid taking high amounts without a doctor’s advice.
Additions to Avoid Due to Safety Risks
Not all supplements are safe, especially for people with HIV. Some supplements interfere with important medications or cause harm in other ways.
| Supplement | Risk |
|---|---|
| St. John’s wort | Lowers anti-HIV drug levels |
| Garlic supplements | Lowers medicine effectiveness |
| Red yeast rice extract | Not safe with key medicines |
- St. John’s wort reduces the strength of some anti-HIV drugs by more than half.
- Garlic supplements lower the effectiveness of certain HIV medicines. Eating garlic in food does not seem to cause this problem.
- Red yeast rice extract can reduce cholesterol, but it is unsafe with HIV protease inhibitors or statins.
Practices That Support Body and Mind
Mind-body approaches help people with HIV manage stress and improve quality of life. When combined with medical care, these practices may be useful.
- Yoga and meditation can provide stress relief.
- Massage therapy helps with relaxation.
These approaches do not cure HIV, but they may help people feel better day to day. Always ask a health professional before trying new supplements or alternative practices, especially when taking HIV treatments.
Coping and Finding Support
People living with HIV often face emotional, social, and financial challenges. Managing stress and building a strong support system can improve mental health.
Talking with someone about feelings can make things easier.
Ways support can help:
| Type of Support | How It Helps |
|---|---|
| Medical care | Helps manage health and treatment. |
| Support groups | Offers a safe space to share experiences. |
| Social services | Assists with housing, transport, and jobs. |
| Counseling | Provides mental health and emotional care. |
In many places, including sub-Saharan Africa, support groups connect people going through similar experiences.
Accessing these resources and talking with trained professionals or others who understand HIV can help people feel less alone and more prepared to cope.
Getting Ready for Your Visit
Steps You Can Take
Write down key information before your visit:
- Note any symptoms you have noticed and when they started.
- List situations where you might have come in contact with HIV, such as unprotected sex, body fluid exposure, or sharing needles.
- Include any medications, supplements, or herbs you are taking.
- Bring questions for your healthcare provider.
A simple table can help organize details:
| Possible HIV Exposure | Symptoms | Current Medicines |
|---|---|---|
| Sexual contact | Fatigue | Pain relievers |
| Needle use | Sores | Vitamins |
| Contact with body fluids | Swollen glands | Herbal supplements |
What Your Healthcare Provider May Do
- Your provider will ask about your health history and lifestyle, including recent sexual activity, blood donation, or contact with bodily fluids.
- Your provider will perform a physical exam to check for swollen lymph nodes, skin or mouth sores, changes in the nervous system, and unusual lung or belly findings.
Your provider will also discuss the next steps for testing.
Protecting Yourself and Others While You Wait
- Use protection if you have sex before seeing your healthcare team.
- Always use clean, unused needles if you inject drugs.
- Cover any open wounds or sores to lower the risk of spreading infection.
- Wait to donate blood until you know your HIV status.
