Diagnosis

HIV is most commonly diagnosed by testing your blood or saliva for antibodies to the virus. Unfortunately, it takes time for your body to develop these antibodies — usually up to 12 weeks.

A newer type of test that checks for HIV antigen, a protein produced by the virus immediately after infection, can quickly confirm a diagnosis soon after infection. An earlier diagnosis may prompt people to take extra precautions to prevent transmission of the virus to others.

Home test

A Food and Drug Administration-approved home test is available. To do the test, you swab fluid from your upper and lower gums. If the test is positive, you need to see your doctor to confirm the diagnosis and discuss your treatment options. If the test is negative, it needs to be repeated in three months to confirm the results.

Tests to tailor treatment

If you receive a diagnosis of HIV/AIDS, several types of tests can help your doctor determine what stage of the disease you have. These tests include:

  • CD4 count. CD4 cells are a type of white blood cell that's specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 count dips below 200.
  • Viral load. This test measures the amount of virus in your blood. Studies have shown that people with higher viral loads generally fare more poorly than do those with a lower viral load.
  • Drug resistance. This blood test determines whether the strain of HIV you have will be resistant to certain anti-HIV medications.

Tests for complications

Your doctor might also order lab tests to check for other infections or complications, including:

  • Tuberculosis
  • Hepatitis
  • Toxoplasmosis
  • Sexually transmitted infections
  • Liver or kidney damage
  • Urinary tract infection

Treatment

There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each class of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two classes to avoid creating strains of HIV that are immune to single drugs.

The classes of anti-HIV drugs include:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine-tenofovir (Truvada), and lamivudine-zidovudine (Combivir).
  • Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and indinavir (Crixivan).
  • Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
  • Integrase inhibitors. These drugs work by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells. Examples include raltegravir (Isentress), elvitegravir (Vitekta) and dolutegravir (Tivicay).

When to start treatment

Everyone with HIV infection, regardless of CD4 count, should be offered antiviral medication.

HIV therapy is particularly important for the following situations:

  • You have severe symptoms.
  • You have an opportunistic infection.
  • Your CD4 count is under 350.
  • You're pregnant.
  • You have HIV-related kidney disease.
  • You're being treated for hepatitis B or C.

Treatment can be difficult

HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can include:

  • Nausea, vomiting or diarrhea
  • Heart disease
  • Weakened bones or bone loss
  • Breakdown of muscle tissue (rhabdomyolysis)
  • Abnormal cholesterol levels
  • Higher blood sugar levels

Other diseases and treatment

Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV medications. Talk to your doctor about other conditions for which you're taking medication.

Treatment response

Your doctor will monitor your viral load and CD4 counts to determine your response to treatment. Viral load should be tested at the start of treatment and then every three to four months during therapy. CD4 counts should be checked every three to six months.

HIV treatment should reduce your viral load to the point that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it. You can still transmit HIV to others when your viral load is undetectable.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Although it's important to receive medical treatment for HIV/AIDS, it's also essential to take an active role in your own care. The following suggestions may help you stay healthy longer:

  • Eat healthy foods. Emphasize fresh fruits and vegetables, whole grains, and lean protein. Healthy foods help keep you strong, give you more energy and support your immune system.
  • Avoid certain foods. Foodborne illnesses can be especially severe in people who are infected with HIV. Avoid unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi. Cook meat until it's well-done.
  • Get immunizations. These may prevent infections such as pneumonia and the flu. Make sure the vaccines don't contain live viruses, which can be dangerous for people with weakened immune systems.
  • Take care with companion animals. Some animals may carry parasites that can cause infections in people who are HIV-positive. Cat feces can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry the fungus cryptococcus or histoplasmosis. Wash hands thoroughly after handling pets or emptying the litter box.

Alternative medicine

People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or counteract side effects of anti-HIV drugs.

Supplements that may be helpful

  • Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain in people with diabetes. It's possible that acetyl-L-carnitine might help nerve pain linked to HIV. But it may be helpful only if you're already deficient in acetyl-L-carnitine.
  • Whey protein. Preliminary evidence indicates that whey protein, a cheese byproduct, can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase CD4 counts.

Supplements that may be dangerous

  • St. John's wort. Commonly used to combat depression, St. John's wort can reduce the effectiveness of several types of anti-HIV drugs by more than 50 percent.
  • Garlic supplements. Although garlic may help strengthen the immune system, garlic supplements also interact with several anti-HIV drugs — reducing their effectiveness by 50 percent. Occasionally eating garlic in food appears to be safe.

Be sure to discuss the use of any dietary supplement with your doctor before trying it to ensure that it won't adversely interact with any of your medications.

Coping and support

Receiving a diagnosis of any life-threatening illness is devastating. But the emotional, social and financial consequences of HIV/AIDS can make coping with this illness especially difficult — not only for you but also for those closest to you.

Fortunately, numerous services and resources are available to people with HIV. Most HIV/AIDS clinics have social workers, counselors or nurses who can help you with problems directly or put you in touch with people who can. They may be able to arrange transportation to and from doctor appointments, help with housing and child care, deal with employment and legal issues, and see you through financial emergencies.

Coming to terms with your illness may be the hardest thing you've ever done. For some people, having a strong faith or a sense of something greater than themselves makes this process easier. Others seek counseling from someone who understands HIV/AIDS. Still others make a conscious decision to experience their lives as fully and intensely as they can or to help other people who have the disease.

Preparing for your appointment

If you think you might have HIV infection, you're likely to start by seeing your family doctor. You may be referred to an infectious disease specialist.

What you can do

Before your appointment, you might want to write a list answering the following questions:

  • How do you think you were exposed to HIV?
  • What are your symptoms?
  • Do you have risk factors, such as participating in unprotected sex or using intravenous drugs?
  • What prescription drugs or supplements do you take?

What to expect from your doctor

Your doctor will ask you questions about your health and lifestyle. He or she will also conduct a thorough physical exam, checking you for:

  • Swollen lymph nodes
  • Lesions on your skin or in your mouth
  • Neurological problems
  • Abnormal sounds in your lungs
  • Enlarged organs in your abdomen

What you can do in the meantime

If you think you might have HIV infection, there are some precautions you can take to protect yourself and others before your appointment.

  • Have only protected sexual intercourse.
  • Inject drugs with a clean needle only, and don't share it with others.
July 21, 2015
References
  1. Longo DL, et al., eds. Human immunodeficiency virus disease. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: The McGraw-Hill Companies; 2015. http://accessmedicine.com. Accessed June 3, 2015.
  2. What is HIV? AIDS.gov. http://www.aids.gov/hiv-aids-basics/. Accessed June 3, 2015.
  3. Sax PE. Acute and early HIV infection: Clinical manifestations and diagnosis. http://www.uptodate.com/home. Accessed June 3, 2015.
  4. Bartlett JG. The natural history and clinical history of HIV infection in adults and adolescents. http://www.uptodate.com/home. Accessed June 3, 2015.
  5. Ferri FF. Human immunodeficiency virus. In: Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed June 3, 2015.
  6. HIV/AIDS. National Institute of Allergy and Infectious Diseases. http://www.niaid.nih.gov/topics/hivaids/understanding/Pages/Default.aspx. Accessed June 3, 2015.
  7. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. National Institutes of Health. https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/0. Accessed June 5, 2015.
  8. Pollack TM, et al. Primary care of HIV-infected adults. http://www.uptodate.com/home. Accessed June 3, 2015.
  9. Natural medicines in the clinical management of HIV/AIDS. Natural Medicines Comprehensive Database. http://www.naturaldatabase.com. Accessed June 3, 2015.
  10. Pre-exposure prophylaxis (PrEP). AIDS.gov. https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/index.html. Accessed June 3, 2015.
  11. Lower your sexual risk of HIV. AIDS.gov. https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/sexual-risk-factors/. Accessed June 3, 2015.