HIV/AIDS - Diagnosis and treatment (2024)

Diagnosis

HIV can be diagnosed through blood or saliva testing. Available tests include:

• Antigen/antibody tests. These tests usually involve drawing blood from a vein. Antigens are substances on the HIV virus itself and are usually detectable — a positive test — in the blood within a few weeks after exposure to HIV.

  Antibodies are produced by your immune system when it's exposed to HIV. It can take weeks to months for antibodies to become detectable. The combination antigen/antibody tests can take 2 to 6 weeks after exposure to become positive.

• Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most rapid HIV tests, including self-tests done at home, are antibody tests. Antibody tests can take 3 to 12 weeks after you're exposed to become positive.
• Nucleic acid tests (NATs). These tests look for the actual virus in your blood (viral load). They also involve blood drawn from a vein. If you might have been exposed to HIV within the past few weeks, your health care provider may recommend NAT. NAT will be the first test to become positive after exposure to HIV.

Talk to your health care provider about which HIV test is right for you. If any of these tests are negative, you may still need a follow-up test weeks to months later to confirm the results.

Tests to stage disease and treatment

If you've been diagnosed with HIV, it's important to find a specialist trained in diagnosing and treating HIV to help you:

• Determine whether you need additional testing
• Determine which HIV antiretroviral therapy (ART) will be best for you
• Monitor your progress and work with you to manage your health

If you receive a diagnosis of HIV/AIDS, several tests can help your health care provider determine the stage of your disease and the best treatment, including:

• 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. After starting HIV treatment, the goal is to have an undetectable viral load. This significantly reduces your chances of opportunistic infection and other HIV-related complications.
• Drug resistance. Some strains of HIV are resistant to medications. This test helps your health care provider determine if your specific form of the virus has resistance and guides treatment decisions.

Tests for complications

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

• Tuberculosis
• Hepatitis B or hepatitis C virus infection
• STIs
• Liver or kidney damage
• Urinary tract infection
• Cervical and anal cancer
• Cytomegalovirus
• Toxoplasmosis

Treatment

Currently, there's no cure for HIV/AIDS. Once you have the infection, your body can't get rid of it. However, there are many medications that can control HIV and prevent complications. These medications are called antiretroviral therapy (ART). Everyone diagnosed with HIV should be started on ART, regardless of their stage of infection or complications.

ART is usually a combination of two or more medications from several different drug classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that combine multiple HIV medications into one pill, taken once daily.

Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from different classes to:

• Account for individual drug resistance (viral genotype)
• Avoid creating new drug-resistant strains of HIV
• Maximize suppression of virus in the blood

Two drugs from one class, plus a third drug from a second class, are typically used.

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), rilpivirine (Edurant) and doravirine (Pifeltro).

• 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), tenofovir disoproxil fumarate (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir).

  Combination drugs also are available, such as emtricitabine/tenofovir disoproxil fumarate (Truvada) and emtricitabine/tenofovir alafenamide fumarate (Descovy).

• Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself.

  Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).

• Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells.

  Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumarate (Biktarvy), raltegravir (Isentress), dolutegravir (Tivicay) and cabotegravir (Vocabria).

• Entry or fusion inhibitors block HIV's entry into CD4 T cells.

  Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).

Starting and maintaining treatment

Everyone with HIV infection, regardless of the CD4 T cell count or symptoms, should be offered antiviral medication.

Remaining on effective ART with an undetectable HIV viral load in the blood is the best way for you to stay healthy.

For ART to be effective, it's important that you take the medications as prescribed, without missing or skipping any doses. Staying on ART with an undetectable viral load helps:

• Keep your immune system strong
• Reduce your chances of getting an infection
• Reduce your chances of developing treatment-resistant HIV
• Reduce your chances of transmitting HIV to other people

Staying on HIV therapy can be challenging. It's important to talk to your health care provider about possible side effects, difficulty taking medications, and any mental health or substance use issues that may make it difficult for you to maintain ART.

Having regular follow-up appointments with your health care provider to monitor your health and response to treatment is also important. Let your provider know right away if you're having problems with HIV therapy so that you can work together to find ways to address those challenges.

Treatment side effects

Treatment side effects can include:

• Nausea, vomiting or diarrhea
• Heart disease
• Kidney and liver damage
• Weakened bones or bone loss
• Abnormal cholesterol levels
• Higher blood sugar
• Cognitive and emotional problems, as well as sleep problems

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 health care provider about your other health conditions and the medications you're taking.

If you are started on medications by another health care provider, it's important to let the provider know about your HIV therapy. This will allow the provider to make sure there are no interactions between the medications.

Treatment response

Your health care provider will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. These will be initially checked at 4 to 6 weeks, and then every 3 to 6 months.

Treatment should lower your viral load so that it's undetectable in the blood. That doesn't mean your HIV is gone. Even if it can't be found in the blood, HIV is still present in other places in your body, such as in lymph nodes and internal organs.

Clinical trials

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

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. Make sure you get enough nourishment. 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 vaccinations. These may prevent typical infections such as pneumonia and influenza. Your health care provider may also recommend other vaccinations, including for HPV, hepatitis A and hepatitis B. Inactivated vaccines are generally safe, but most vaccines with live viruses are not, due to your weakened immune system.
• 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're taking. Always check with your health care provider before taking any supplements or alternative therapies to ensure there are no medication interactions.

Supplements that may be helpful

There's little evidence on the effectiveness and benefits of supplements for HIV. Some examples with limited research include:

• Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain, numbness or weakness (neuropathy) in people with diabetes. It may also ease neuropathy linked to HIV if you're lacking in the substance.
• Whey protein and certain amino acids. Early evidence suggests that whey protein, a cheese byproduct, can help some people with HIV gain weight. The amino acids L-glutamine, L-arginine and hydroxymethylbutyrate (HMB) may also help with weight gain.
• Probiotics. There is some evidence that the probiotic Saccharomyces boulardii may help with HIV-related diarrhea, but use only as directed by your health care provider. Bovine colostrum is also being studied for treating diarrhea. But more research is needed.
• Vitamins and minerals. Vitamins A, D, E, C and B — as well as the minerals zinc, iron and selenium — may be helpful if you have low levels of them. Talk to your health care provider first, as too much of some vitamins and minerals can be harmful.

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 may interact with some anti-HIV drugs and reduce their ability to work. Occasionally eating garlic in food appears to be safe.
• Red yeast rice extract. Some people use this to lower cholesterol, but avoid it if you take a protease inhibitor or a statin.

Mind-body practices

Practices such as yoga, meditation and massage have been shown to reduce stress, as well as provide relaxation and improve quality of life. While they need more study, these practices may be helpful if you're living with HIV/AIDS.

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 health care provider 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 health care provider. You may be referred to an infectious disease specialist — who additionally specializes in treating HIV/AIDS.

What you can do

Before your appointment, consider answering these questions and take them to your appointment:

• 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 illicit injection drugs?
• What medications or supplements do you take?

What to expect from your doctor

Your health care provider will ask you questions about your health and lifestyle and 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 illicit injection drugs, always use a fresh, clean needle. Don't share needles with others.