Hiv

Back

Introduction

HIV And AIDS

HIV (human immunodeficiency virus) is a virus that damages the cells in your immune system and weakens your ability to fight everyday infections and disease. 

AIDS (acquired immune deficiency syndrome) is the name used to describe a number of potentially life-threatening infections and illnesses that happen when your immune system has been severely damaged by the HIV virus.

While AIDS can't be transmitted from one person to another, the HIV virus can.

There's currently no cure for HIV, but there are very effective drug treatments that enable most people with the virus to live a long and healthy life. 

With an early diagnosis and effective treatments, most people with HIV won't develop any AIDS-related illnesses and will live a near-normal lifespan.

These pages cover:

Symptoms

Causes

Diagnosis

Treatment

Living with

Prevention

Symptoms of HIV infection

Most people experience a short, flu-like illness 2-6 weeks after HIV infection, which lasts for a week or two.

After these symptoms disappear, HIV may not cause any symptoms for many years, although the virus continues to damage your immune system. This means many people with HIV don't know they're infected.

Anyone who thinks they could have HIV should get tested. Certain groups of people are advised to have regular tests as they're at particularly high risk, including:

  • men who have sex with men
  • Black African heterosexuals
  • people who share needles, syringes or other injecting equipment

Read about symptoms of HIV.

Causes of HIV infection

HIV is found in the body fluids of an infected person. This includes semen, vaginal and anal fluids, blood, and breast milk.

It's a fragile virus and doesn't survive outside the body for long. HIV can't be transmitted through sweat, urine or saliva.

The most common way of getting HIV in the UK is through having anal or vaginal sex without a condom.

Other ways of getting HIV include:

  • sharing needles, syringes or other injecting equipment
  • transmission from mother to baby during pregnancy, birth or breastfeeding

The chance of getting HIV through oral sex is very low and will be dependent on many things, such as whether you receive or give oral sex and the oral hygiene of the person giving the oral sex.

Read about what causes HIV.

Diagnosing HIV

Seek medical advice as soon as possible if you think you might have been exposed to HIV. 

You can get tested in a number of places, including at your GP surgery, sexual health clinics, and clinics run by charities.

Find HIV testing services near you 

The only way to find out if you have HIV is to have an HIV test. This involves testing a sample of your blood or saliva for signs of the infection.

It's important to be aware that:

  • emergency anti-HIV medication called post-exposure prophylaxis (PEP) may stop you becoming infected if started within three days of possible exposure to the virus; starting it as soon as possible is recommended
  • an early diagnosis means you can start treatment sooner, which can improve your chances of controlling the virus and reduce the chance of passing the virus on to others
  • HIV tests may need to be repeated 1-3 months after potential exposure to HIV infection (this is known as the window period), but you shouldn't wait this long to seek help
  • clinics may offer a finger prick blood test, which can give you a result in minutes, but it may take up to a few days to get the results of a more detailed HIV test
  • home testing or home sampling kits are available to buy online or from pharmacies - depending on the type of test you use, your result will be available in a few minutes or a few days

If your first test suggests you have HIV, a further blood test will need to be carried out to confirm the result.

If this is positive, you'll be referred to a specialist HIV clinic for some more tests and a discussion about your treatment options.

Read about diagnosing HIV.

Treatment for HIV

Antiretroviral medications are used to treat HIV. They work by stopping the virus replicating in the body, allowing the immune system to repair itself and preventing further damage.

These come in the form of tablets, which need to be taken every day.

HIV is able to develop resistance to a single HIV drug very easily, but taking a combination of different drugs makes this much less likely.

Most people with HIV take a combination of drugs - it's vital these are taken every day as recommended by your doctor.

The goal of HIV treatment is to have an undetectable viral load. This means the level of HIV virus in your body is low enough to not be detected by a test.

Read about treating HIV

Living with HIV

If you're living with HIV, taking effective HIV treatment and being undetectable significantly reduces your risk of passing HIV on to others.

You'll also be encouraged to:

  • take regular exercise
  • eat a healthy diet
  • stop smoking
  • have yearly flu jabs to minimise the risk of getting serious illnesses

Without treatment, the immune system will become severely damaged, and life-threatening illnesses such as cancer and severe infections can occur.

It's rare for a pregnant woman living with HIV to transmit it to her baby, provided she receives timely and effective HIV treatment and medical care.

Read about living with HIV.

Preventing HIV

Anyone who has sex without a condom or shares needles is at risk of HIV infection.

The best way to prevent HIV is to use a condom for sex and never share needles or other injecting equipment, including syringes, spoons and swabs.

Knowing your HIV status and that of your partner is also important.

For people with HIV, taking effective HIV treatment and being undetectable significantly reduces the risk of passing HIV on to others.

Read about preventing HIV.

Symptomspg

Symptoms

Most people infected with HIV experience a short, flu-like illness that occurs 2-6 weeks after infection. After this, HIV may not cause any symptoms for several years.

It's estimated up to 80% of people who are infected with HIV experience this flu-like illness.

The most common symptoms are:

  • raised temperature (fever)
  • sore throat
  • body rash

Other symptoms can include:

  • tiredness
  • joint pain
  • muscle pain
  • swollen glands

The symptoms usually last 1-2 weeks, but can be longer. They're a sign that your immune system is putting up a fight against the virus. 

But having these symptoms doesn't necessarily mean you have the HIV virus. Remember: they're commonly caused by conditions other than HIV.

If you have several of these symptoms and think you've been at risk of HIV infection within the past few weeks, you should get an HIV test.

After the initial symptoms disappear, HIV may not cause any further symptoms for many years.

During this time, the virus continues to be active and causes progressive damage to your immune system.

This process can vary from person to person, but may take up to 10 years, during which you'll feel and appear well.

Once the immune system becomes severely damaged, symptoms can include:

  • weight loss
  • chronic diarrhoea
  • night sweats
  • skin problems
  • recurrent infections
  • serious life-threatening illnesses

Earlier diagnosis and treatment of HIV can prevent these problems.

Read more about treating HIV.

You should still take an HIV test if you may have been at risk at any time in the past, even if you don't experience any symptoms.

Want to know more?

Causes

Causes

In the UK, most cases of HIV are caused by having sex with a person who has HIV without using a condom.

A person with HIV can pass the virus on to others even if they don't have any symptoms. People with HIV can pass the virus on more easily in the weeks following infection.

HIV treatment significantly reduces the risk of someone with HIV passing it on.

Sexual contact

Most people diagnosed with HIV in the UK acquire the virus through unprotected vaginal or anal sex.

It may also be possible to catch HIV through unprotected oral sex, but the risk is much lower.

The risk is higher if:

  • the person giving oral sex has mouth ulcers, sores or bleeding gums
  • the person receiving oral sex has recently been infected with HIV and has a lot of the virus in their body, or another sexually transmitted infection

Other risk behaviours

Other ways of getting HIV include:

  • sharing needles, syringes and other injecting equipment 
  • from mother to baby before or during birth or by breastfeeding
  • sharing sex toys with someone infected with HIV
  • healthcare workers accidentally pricking themselves with an infected needle, but this risk is extremely low
  • blood transfusion - now very rare in the UK, but still a problem in developing countries

Who's most at risk?

People who are at higher risk of becoming infected with HIV include:

  • men who have unprotected sex with men
  • people who engage in chemsex (using drugs to help or enhance sex) - chemsex among men who have sex with men is an increasing concern as it can be associated with risky sexual behaviours, such as having lots of different sexual partners and not using condoms
  • women who have unprotected sex with men who have sex with men
  • people who have unprotected sex with a person who has lived or travelled in Africa
  • people who inject drugs and share equipment
  • people who have unprotected sex with somebody who has injected drugs and shared equipment
  • people with another sexually transmitted infection
  • people who have received a blood transfusion while in Africa, eastern Europe, the countries of the former Soviet Union, Asia or central and southern America

How HIV is transmitted

HIV isn't passed on easily from one person to another. The virus doesn't spread through the air like cold and flu viruses.

HIV lives in the blood and in some body fluids. To get HIV, one of these fluids from someone with HIV has to get into your blood.

The body fluids that contain enough HIV to infect someone are:

  • semen
  • vaginal fluids, including menstrual blood
  • breast milk
  • blood
  • lining inside the anus

Other body fluids, like saliva, sweat or urine, don't contain enough of the virus to infect another person.

The main ways the virus enters the bloodstream are: 

  • by injecting into the bloodstream with needles or injecting equipment that's been shared with other people
  • through the thin lining on or inside the anus, vagina and genitals
  • through the thin lining of the mouth and eyes
  • through cuts and sores in the skin

HIV isn't passed on through:

  • spitting
  • kissing
  • being bitten
  • contact with unbroken, healthy skin
  • being sneezed on
  • sharing baths, towels or cutlery
  • using the same toilets or swimming pools
  • mouth-to-mouth resuscitation
  • contact with animals or insects like mosquitoes

How HIV infects the body

HIV infects the immune system, causing progressive damage and eventually making it unable to fight off infections.

The virus attaches itself to immune system cells called CD4 lymphocyte cells, which protect the body against various bacteria, viruses and other germs.

Once attached, it enters the CD4 cells and uses it to make thousands of copies of itself. These copies then leave the CD4 cells, killing them in the process.

This process continues until eventually the number of CD4 cells, also called your CD4 count, drops so low that your immune system stops working.

This process may take up to 10 years, during which time you'll feel and appear well. 

Read about the symptoms of HIV.

Diagnosispg

Diagnosis

The only way to find out if you have HIV is to have an HIV test, as symptoms of HIV may not appear for many years. Anyone who thinks they could have HIV should get tested.

HIV testing is provided to anyone free of charge on the NHS. Many clinics can give you the result on the same day. Home testing and home sampling kits are also available.

Certain groups of people are at particularly high risk and are advised to have regular tests:

  • Men who have sex with men are advised to have an HIV test at least once a year, or every three months if they're having unprotected sex with new or casual partners.
  • Black African men and women are advised to have an HIV test, and a regular HIV and STI screen, if they're having unprotected sex with new or casual partners.

Other people at an increased risk of infection include those who share needles, syringes or other injecting equipment.

Read more about how you get HIV.

When to get tested

Seek medical advice immediately if you think there's a chance you could have HIV. The earlier it's diagnosed, the earlier you can start treatment and avoid becoming seriously ill.

Some HIV tests may need to be repeated 1-3 months after exposure to HIV infection, but you shouldn't wait this long to seek help.

Your GP or a sexual health professional can talk to you about having a test and discuss whether you should take emergency HIV medication.

Anti-HIV medication called post-exposure prophylaxis (PEP) may stop you becoming infected if taken within 72 hours of being exposed to the virus. 

Read more about treating HIV.

Where to get an HIV test

There are various places you can go to for an HIV test, including:

  • sexual health or genitourinary medicine (GUM) clinics 
  • clinics run by charities like the Terrence Higgins Trust 
  • some GP surgeries
  • some contraception and young people's clinics
  • local drug dependency services
  • an antenatal clinic, if you're pregnant
  • a private clinic, where you will have to pay

Find HIV testing services near you

There are also home sampling and home testing kits you can use if you don't want to visit any of these places.

Types of HIV test

There are four main types of HIV test:

  • blood test - where a sample of blood is taken in a clinic and sent for testing in a laboratory. Results are usually available on the same day or within a few days.
  • point of care test - where a sample of saliva from your mouth or a small spot of blood from your finger is taken in a clinic. This sample doesn't need to be sent to a laboratory and the result is available within a few minutes.
  • home sampling kit - where you collect a saliva sample or small spot of blood at home and send it off in the post for testing. You'll be contacted by phone or text with your result in a few days. Visit test.hiv to check if you're eligible for a free test. If not, you can buy them online or from some pharmacies.
  • home testing kit - where you collect a saliva sample or small spot of blood yourself and test it at home. The result is available within minutes. It's important to check that any test you buy has a CE quality assurance mark and is licensed for sale in the UK, as HIV self-tests available from overseas can be poor quality.

If the test finds no sign of infection, your result is "negative". If signs of infection are found, the result is "positive".

The blood test is the most accurate test and can normally give reliable results from one month after infection.

The other tests tend to be less accurate and may not give a reliable result for a longer period after exposure to the infection. This is known as the window period.

For all these tests, a blood test should be carried out to confirm the result if the first test is positive.

If this test is also positive, you'll be referred to a specialist HIV clinic for some more tests and a discussion about your treatment options.

Read more about coping with a positive HIV test.

Screening for HIV in pregnancy

All pregnant woman are offered a blood test to check if they have HIV as part of routine antenatal screening.

If untreated, HIV can be passed from a pregnant woman to her baby during pregnancy, birth or breastfeeding. Treatment in pregnancy greatly reduces the risk of passing HIV on to the baby.

Read more about screening for HIV during pregnancy.

Treatmentpg

Treatment

While there's no cure for HIV, there are very effective treatments that enable most people with the virus to live a long and healthy life.

Emergency HIV drugs

If you think you've been exposed to the virus, post-exposure prophylaxis (PEP) medication may stop you becoming infected.

PEP must be started within 72 hours of coming into contact with the virus for it to be effective. It's only recommended following higher risk exposure, particularly where the sexual partner is known to be positive.

PEP involves taking HIV treatment every day for one month. It may cause some side effects.

You should be able to get PEP from:

  • sexual health clinics or genitourinary medicine (GUM) clinics
  • hospitals - usually accident and emergency (A&E) departments

If you already have HIV, try your HIV clinic if the PEP is for someone you've had sex with.

Want to know more?

If you test positive

If you're diagnosed with HIV, you'll have regular blood tests to monitor the progress of the HIV infection before starting treatment.

Two important blood tests are:

  • HIV viral load test - a blood test that monitors the amount of HIV virus in your blood
  • CD4 lymphocyte cell count - which measures how the HIV has affected your immune system

Treatment can be started at any point following your diagnosis, depending on your circumstances and in consultation with your HIV doctor.

Want to know more?

Antiretroviral drugs

HIV is treated with antiretroviral medications, which work by stopping the virus replicating in the body. This allows the immune system to repair itself and prevent further damage.

A combination of HIV drugs is used because HIV can quickly adapt and become resistant.

Some HIV treatments have been combined into one pill, known as a fixed dose combination, although these often cost more to prescribe.

Usually, people who have just been diagnosed with HIV take between one and four pills a day.

Different combinations of HIV medicines work for different people, so the medicine you take will be individual to you.

Many of the medicines used to treat HIV can interact with other medications prescribed by your GP or bought over-the-counter.

These include herbal remedies like St John's Wort, as well as some recreational drugs. Always check with your HIV clinic staff or your GP before taking any other medicines.

Want to know more?

Missing a dose

Once treatment is started, you'll probably need to take medication for the rest of your life. For the treatment to be continuously effective, it needs to be taken regularly at the same time every day.

Missing even a few doses increases the risk of your treatment not working and developing resistance to your HIV medicines.

You'll need to develop a daily routine to fit your treatment plan around your lifestyle.

Want to know more?

Side effects

HIV treatment can have side effects. If you get serious side effects, which is uncommon, you may need to try a different combination of drugs.

Common side effects include:

  • nausea
  • diarrhoea
  • skin rashes
  • sleep difficulties

Want to know more?

living-with

Living with

Psychological impact of HIV

Getting support

As HIV is a long-term condition, you'll be in regular contact with your healthcare team, who will review your treatment on an ongoing basis.

Developing a good relationship with your healthcare team means you can easily discuss your symptoms or concerns. The more the team knows, the more they can help you.

People with HIV are seen at a specialist HIV clinic, which is usually part of a sexual health or infectious diseases clinic at your local hospital.

Find local HIV support services

Psychological support

Being diagnosed with HIV can be extremely distressing, and feelings of anxiety or depression are common.

Your healthcare team can provide you with counselling so you can fully discuss your condition and concerns.

You may find it helpful to talk to a trained counsellor or psychologist, or someone at a specialist helpline. Your HIV clinic will have information about these.

Some people find it helpful to talk to other people who have HIV, either at a local support group or on an internet chatroom.

Want to know more?

Telling people about your HIV

Telling your partner and former partners

If you have HIV, it's important your current sexual partner and any sexual partners you've had since becoming infected are tested and treated.

Some people can feel angry, upset or embarrassed about discussing HIV with their current or former partners. Discuss your concerns with your GP or the clinic staff.

They'll be able to advise you about who should be contacted and the best way to contact them, or they may be able to contact them on your behalf.

They'll also advise you about disclosing your status to future partners and how you can reduce the risk of transmitting the virus to someone else.

Nobody can force you to tell any of your partners you have HIV, but it's strongly recommended that you do.

Left untested and untreated, HIV can have devastating consequences, and eventually lead to serious illness and death.

Telling your employer

People with HIV are protected under the Equality Act (2010)

There's no legal obligation to tell your employer you have HIV, unless you have a frontline job in the armed forces or work in a healthcare role where you perform invasive procedures.

If you work in a healthcare role, you'll need to be monitored by your occupational health team and HIV doctor to ensure you're not putting yourself and patients at risk of infection.

The Equality Act 2010 also places restrictions on the health questions employers can ask during a job application process.

Employers are allowed to ask health questions only after an offer of employment has been made to help them decide whether you can carry out tasks essential for the job.

If you're asked a question you think isn't allowed under the Equality Act 2010, you can tell the employer or the Equality and Human Rights Commission. The GOV.UK website has more information about questions an employer can ask about health and disability.

If you're an employee with HIV, you may worry that your HIV status will become public knowledge or you'll be discriminated against if you tell your employer.

On the other hand, if your boss is supportive, telling them may make it easier for adjustments to be made to your workload or for you to have time off.

The organisations listed below have lots of information, and can advise you on these and other work-related issues.

Want to know more?

Pregnancy and HIV

Advice for pregnant women

HIV treatment is available to prevent a pregnant woman passing HIV to her child.

Without treatment, there's a one in four chance your baby will become infected with HIV. With treatment, the risk is less than 1 in 100 (<1%).

Advances in treatment mean there's no increased risk of passing the virus to your baby with a normal delivery.

But for some women, a caesarean section may still be recommended, often for reasons not related to your HIV.

Discuss the risks and benefits of each delivery method with the staff at your HIV clinic. The final decision about how your baby is delivered is yours, and staff will respect that decision.

If you have HIV, don't breastfeed your baby as the virus can be transmitted through breast milk.

Conception

If you or your partner has HIV, options may be available that allow you to conceive a child safely. You should ask your HIV doctor for advice.

If you have HIV and become pregnant, contact your HIV clinic.

This is important because:

  • some HIV treatments can be harmful to your unborn baby, so your treatment plan will need to be reviewed
  • additional medicines may be needed to prevent your baby contracting HIV

Want to know more?

Opportunistic infections

Infection risk

You'll be at risk of developing infections you wouldn't normally be at risk of if your immune system has been damaged by the HIV virus.

These opportunistic infections, as they're called, happen when you have a very weak immune system.

But if you take your HIV treatment, the likelihood of developing these is low.

The four main types of opportunistic infections are:

People with advanced HIV also have a higher risk of developing some forms of cancer, such as cancer of the lymphatic system (lymphoma).

Pneumonia

Bacterial pneumonia can develop as a complication of other infections, such as flu. It can be treated with antibiotics. Left untreated, pneumonia can be fatal.

Everyone with a long-term condition such as HIV is encouraged to get a flu jab each autumn to protect against seasonal flu.

It's also recommended they have a pneumoccocal vaccination, which protects against a serious chest infection called pneumococcal pneumonia.

Pneumocystis pneumonia (PCP)

Pneumocystis pneumonia (PCP) is a fungal infection of the lungs, which can be life threatening if not treated promptly.

Before advances in HIV treatment, PCP was the leading cause of death among those with HIV in the developed world.

Symptoms of PCP include:

  • a persistent dry cough
  • shortness of breath 
  • difficulty breathing
  • fever (in some cases)

Report any symptoms of PCP straight away as the condition can suddenly worsen without warning.

PCP can be treated with antibiotics. If your CD4 count drops below 200, you may be given antibiotics to take every day until your CD4 count rises above 200.

Tuberculosis (TB)

Tuberculosis (TB) is another bacterial infection. Globally, it's one of the leading causes of death for people who are HIV positive.

The bacteria responsible for causing TB can sometimes pass from one person to another through the air. But many people who have TB aren't infectious.

TB can be treated using antibiotics, but some strains of bacteria have developed antibiotic resistance and these can be more difficult to treat.

Candidiasis (thrush)

Candidiasis is a fungal infection that's common in people living with HIV. It causes a thick, white coating to appear on the inside of the mouth, tongue, throat or vagina.

Candidiasis is rarely serious, but it can be both embarrassing and painful. It can be treated with antifungal creams and tablets.

Tell the staff at your HIV clinic if you have repeated bouts of candidiasis as it could be a sign of a low CD4 count.

Cancer

People with advanced HIV have an increased risk of developing some types of cancer.

It's estimated someone with untreated late-stage HIV infection is 100 times more likely to develop certain cancers compared with someone without the condition.

The two most common cancers to affect people with HIV are:

  • lymphoma - cancer of the lymphatic system, a network of glands that makes up part of our immune system
  • Kaposi's sarcoma - this causes lesions to grow on your skin, and can also affect your internal organs

HIV treatment is important in reducing your risk of cancer and long-term conditions, such as cardiovascular and respiratory disease. If you smoke, giving up is also important in reducing this risk.

Money and financial support

Money

If you have to stop work or work part time because of HIV, you may find it difficult to cope financially.

But you may be entitled to one or more of the following types of financial support:

Want to know more?

Preventionpg

Prevention

The best way to prevent HIV is to use a condom for sex and never share needles or other injecting equipment, including syringes, spoons and swabs.

Condoms

Both male condoms and female condoms are available. They come in a variety of colours, textures, materials, and flavours.

A condom is the most effective form of protection against HIV and other STIs. It can be used for vaginal and anal sex, and for oral sex performed on men.

HIV can be passed on before ejaculation through pre-come and vaginal secretions, and from the anus.

It's very important condoms are put on before any sexual contact occurs between the penis, vagina, mouth or anus.

Lubricant

Lubricant, or lube, is often used to enhance sexual pleasure and safety by adding moisture to either the vagina or anus during sex.

Lubricant can make sex safer by reducing the risk of vaginal or anal tears caused by dryness or friction, and can also prevent a condom tearing.

Only water-based lubricant (such as K-Y Jelly) rather than an oil-based lubricant (such as Vaseline or massage and baby oil) should be used with condoms.

Oil-based lubricants weaken the latex in condoms and can cause them to break or tear.

Sharing needles and injecting equipment

If you inject drugs, this could expose you to HIV and other viruses found in blood, such as hepatitis C.

It's important not to share needles, syringes or other injecting equipment, such as spoons and swabs.

Many local authorities and pharmacies offer needle exchange programmes, where used needles can be exchanged for clean ones.

If you're a heroin user, consider enrolling in a methadone programme. Methadone can be taken as a liquid, so it reduces your risk of getting HIV.

A GP or drug counsellor should be able to advise you about both needle exchange programmes and methadone programmes.

If you're having a tattoo or piercing, it's important that a clean, sterilised needle is always used.

HIV prevention medication

If you're HIV negative, you may be able to take pre-exposure prophylaxis (PrEP) medication to reduce your risk of getting the virus.

PrEP is available for some people who are at high risk of HIV infection - for example, those whose partner is HIV positive.

It's available as a tablet, and is to be taken before you have sex and are exposed to HIV. You'll be able to get the medication from sexual health clinics across England.

Read more about the PrEP trial to prevent against HIV infection

Screening for HIV in pregnancy

All pregnant women are offered a blood test to check if they have HIV as part of routine antenatal screening.

If untreated, HIV can be passed from a pregnant woman to her baby during pregnancy, birth or breastfeeding.

Read more about screening for HIV during pregnancy.

'Many HIV-positive women assume they'll pass it on to their baby'

'Many HIV-positive women assume they'll pass it on to their baby'

Sarah has HIV. She describes her pregnancy and the steps she had to take to make sure she'd have a healthy baby.

And an expert explains what HIV is and how to avoid passing it on to your unborn child.

More real stories from NAT