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 quicker test checks for HIV antigen, a protein produced by the virus immediately after infection. It can confirm a diagnosis soon after infection and allow the person to take swifter steps to prevent the spread of the virus to others.

Home testing

At least two Food and Drug Administration-approved home test kits for HIV are available. Depending on which you choose, you'll need a drop of dried blood or sample of saliva. If the test is positive, you'll 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 a few months to confirm the results.

Tests to stage disease and treatment

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

  • CD4 T cell count. CD4 T cells are white blood cells that are specifically targeted and destroyed by HIV. Even if you have no symptoms, HIV infection progresses to AIDS when your CD4 T cell count dips below 200.
  • Viral load (HIV RNA). This test measures the amount of virus in your blood. A higher viral load has been linked to a worse outcome.
  • Drug resistance. Some strains of HIV are resistant to medications. This test helps your doctor determine if your specific form of the virus has resistance and guides treatment decisions.

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 many different drugs are available to control the virus. Such treatment is called antiretroviral therapy, or ART. Each class of drug blocks the virus in different ways. ART is now recommended for everyone, regardless of CD4 T cell counts. It's recommended to combine three drugs from two classes to avoid creating drug-resistant strains of HIV.

The classes of anti-HIV drugs include:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off 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) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine/tenofovir (Truvada), Descovy (tenofovir alafenamide/emtricitabine), and lamivudine-zidovudine (Combivir).
  • Protease inhibitors (PIs) inactivate HIV 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 Tblock HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
  • Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include raltegravir (Isentress) and dolutegravir (Tivicay).

When to start treatment

Everyone with HIV infection, regardless of CD4 T cell 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 T cell 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 plans may involve taking several pills at specific times every day for the rest of your life. Each medication comes with its own unique set of side effects. It's critical to have regular follow-up appointments with your doctor to monitor your health and treatment.

Some of the treatment side effects are:

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

Treatment for age-related diseases

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 heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It's important to talk to your doctor about your other health conditions and the medications you are taking.

Treatment response

Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. CD4 T cell counts should be checked every three to six months.

Viral load should be tested at the start of treatment and then every three to four months during therapy. Treatment should lower your viral load so 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.

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

Along with receiving medical treatment, it's essential to take an active role in your own care. The following suggestions may help you stay healthy longer:

  • Eat healthy foods. Fresh fruits and vegetables, whole grains, and lean protein help keep you strong, give you more energy and support your immune system.
  • Avoid raw meat, eggs and more. Foodborne illnesses can be especially severe in people who are infected with HIV. Cook meat until it's well-done. Avoid unpasteurized dairy products, raw eggs and raw seafood such as oysters, sushi or sashimi.
  • Get the right 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 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. However, there is no scientific evidence that any nutritional supplement improves immunity, and many may interfere with other medications you are taking.

Supplements that may be helpful

  • Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain in people with diabetes. It may also ease nerve pain linked to HIV if you're lacking in the substance.
  • Whey protein. Early evidence suggests that whey protein, a cheese byproduct, can help some people with HIV gain weight. Whey protein also appears to reduce diarrhea and increase CD4 T cell counts.

Supplements that may be dangerous

  • St. John's wort. A common depression remedy, St. John's wort can reduce the effectiveness of several types of anti-HIV drugs by more than half.
  • Garlic supplements. Although garlic itself may help strengthen the immune system, garlic supplements interact with several anti-HIV drugs and reduce their ability to work. 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. 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.

But today, there are many services and resources available to people with HIV. Most HIV/AIDS clinics have social workers, counselors or nurses who can help you directly or put you in touch with people who can.

Services they may provide:

  • Arrange transportation to and from doctor appointments
  • Help with housing and child care
  • Assist with employment and legal issues
  • Provide support during financial emergencies

It's important to have a support system. Many people with HIV/AIDS find that talking to someone who understands their disease provides comfort.

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, consider answering these questions and take them to your doctor's visit:

  • 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. Your doctor will perform a complete physical exam, checking you for:

  • Swollen lymph nodes
  • Lesions on your skin or in your mouth
  • Problems with your nervous system
  • Abnormal sounds in your lungs
  • Swollen organs in your abdomen

What you can do in the meantime

If you think you might have HIV infection, take steps to protect yourself and others before your appointment. Don't have unprotected sex. If you use injectable drugs, always use a fresh, clean needle. Don't share needles with others.

Jan. 19, 2018
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