HIV/AIDS

Diagnosis

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

• Antigen-antibody tests. These tests most often use blood from a vein. Antigens are substances on the HIV virus itself. They most often show up in the blood within a few weeks after being exposed to HIV.

  The immune system makes antibodies when it's exposed to HIV. It can take weeks to months for antibodies to show up in blood. You may not show a positive result on an antigen-antibody test until 2 to 6 weeks after exposure to HIV.

• Antibody tests. These tests look for antibodies to HIV in blood or saliva. Most rapid HIV tests are antibody tests. This includes self-tests done at home. You may not show a positive result on an antibody test until 3 to 12 weeks after you've been exposed to HIV.

• Nucleic acid tests (NATs). These tests look for the virus in your blood, called viral load. They use blood from a vein.

  If you might have been exposed to HIV within the past few weeks, your healthcare professional may suggest NAT. NAT is the first test to become positive after exposure to HIV.

Talk with your healthcare professional about which HIV test is right for you. If any of these tests are negative, you may 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, find a specialist trained in diagnosing and treating HIV to help you:

• Decide whether you need other tests.
• Find which HIV antiretroviral therapy, also called ART, is best for you.
• Watch your progress and work with you to manage your health.

If you get a diagnosis of HIV/AIDS, tests can help your healthcare professional learn the stage of your disease and the best treatment, including:

• CD4 T cell count. CD4 T cells are white blood cells that HIV targets and destroys. Even if you have no symptoms, HIV infection becomes AIDS when your CD4 T cell count dips below 200.
• Viral load, also called HIV RNA. This test measures the amount of virus in your blood. After starting HIV treatment, the goal is to have a viral load so low that it doesn't show up on the test, called undetectable. This greatly reduces your chances of opportunistic infection and other HIV-related complications.
• Medicine resistance. Some strains of HIV are resistant to medicines. This test helps your healthcare professional know if your form of the virus has resistance. This guides treatment decisions.

Tests for complications

Your healthcare professional also might 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

There's no cure for HIV/AIDS. Once you have the infection, your body can't get rid of it. But there are medicines that can control HIV and prevent complications.

Everyone diagnosed with HIV should take antiretroviral therapy medicines, also called ART. This is true no matter what stage the disease is in or what the complications are.

ART is usually a mix of two or more medicines from several classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that mix more than one HIV medicine into a single pill, taken once daily.

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

• Account for medicine resistance, called viral genotype.
• Keep from creating new medicine-resistant strains of HIV.
• Suppress the virus in the blood as much as possible.

Two medicines from one class, plus a third medicine from another class, are most often used.

The classes of anti-HIV medicines include the following:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself.

  Examples include efavirenz, 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). Retrovir is no longer suggested for routine use in the U.S. because of high rates of toxic effects.

  Mixes of medicines also are available, such as emtricitabine-tenofovir disoproxil fumarate (Truvada) and emtricitabine-tenofovir alafenamide fumarate (Descovy).

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

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

• Integrase inhibitors stop the action of a protein called integrase. HIV uses integrase to put 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). Newer medicines include ibalizumab-uiyk (Trogarzo) and fostemsavir (Rukobia).

Starting and staying on treatment

Everyone with HIV infection, no matter what the CD4 T cell count or symptoms are, should be offered antiviral medicine.

Staying on ART that keeps your HIV viral load in the blood from being detected is the best way for you to stay healthy.

For ART to work, you must take the medicines as prescribed. Don't miss or skip doses. Staying on ART with an undetectable viral load helps:

• Keep your immune system strong.
• Lower your chances of getting an infection.
• Lower your chances of getting treatment-resistant HIV.
• Lower your chances of giving HIV to other people.

Staying on HIV therapy can be hard. Talk to your healthcare professional about possible side effects, trouble you have taking medicines, and any mental health or substance use issues that may make it hard for you to stay on ART.

Have regular follow-up appointments with your health professional to check your health and response to treatment. Let your health professional know right away if you have problems with HIV therapy. Then you can work together to find ways to deal with those issues.

Treatment side effects

Treatment side effects can include:

• Nausea, vomiting or diarrhea.
• Heart disease.
• Kidney and liver damage.
• Weakened bones or bone loss.
• Cholesterol levels that are not typical.
• Higher blood sugar.
• Problems with thinking, emotions and sleep.

Treatment for age-related diseases

Some health issues that are a part of aging may be harder to manage if you have HIV. Some medicines that are common for age-related heart, bone or metabolic conditions, for example, may not mix well with anti-HIV medicines. Talk with your healthcare professional about your other health conditions and the medicines you take for them.

If another health professional prescribes a medicine for another condition, let that health professional know about your HIV therapy. Then the health professional can make sure there are no problems with taking the medicines together.

Treatment response

Your healthcare professional will watch your viral load and CD4 T cell counts to see your response to HIV treatment. The first check is at 4 to 6 weeks. After that, you see your health professional every 3 to 6 months.

Treatment should lower your viral load so that can't be found in the blood. That doesn't mean your HIV is gone. Even if it can't be found in the blood, HIV is still in your body.

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

Besides getting medical treatment, you need to take an active role in your own care. The following 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. Eat enough calories to keep your weight stable.
• Avoid raw meat, eggs and more. Foodborne illnesses can be severe in people who are infected with HIV. Cook meat until it's well done. Don't use dairy products that aren't treated for bacteria, called pasteurized. Don't eat raw eggs and raw seafood such as oysters, sushi or sashimi. Don't drink water you don't know is safe.
• Get the right vaccinations. These may prevent common infections such as pneumonia, influenza, COVID-19 and mpox. Your healthcare professional also may suggest other vaccinations, including those for HPV, hepatitis A and hepatitis B. Vaccines that don't have live viruses mostly are safe. But most vaccines with live viruses are not safe because of your weakened immune system.
• Take care with pets. Some animals may carry parasites that can cause infections in people who are HIV positive. Cat stool can cause toxoplasmosis, reptiles can carry salmonella, and birds can carry cryptococcus or histoplasmosis. Wash hands thoroughly after handling pets or emptying litter boxes.

Alternative medicine

People who are infected with HIV sometimes try dietary supplements that claim to boost the immune system or help with side effects of anti-HIV medicines. But there are no studies that show these claims are true. And many supplements can get in the way of other medicines you take.

Always check with your healthcare professional before taking any supplements or alternative therapies to make sure they won't affect the way your medicines work.

Supplements that may be helpful

There's little evidence to show that any supplements for HIV work. Some examples with limited research include:

• Acetyl-L-carnitine. Researchers have used acetyl-L-carnitine to treat nerve pain, numbness or weakness, called neuropathy, in people with diabetes. It may also ease neuropathy linked to HIV for people who don't have enough acetyl-L-carnitine in their bodies.
• 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), also may help with weight gain.
• Probiotics. There is some evidence that the probiotic Saccharomyces boulardii may help with HIV-related diarrhea. Use only as your healthcare professional directs. Bovine colostrum also is being studied for treating diarrhea. But more research is needed.
• Vitamins and minerals. Vitamins A, D, E, C and B and the minerals zinc, iron and selenium may help if you have low levels of them. Talk to your health professional before taking them. Too much of some vitamins and minerals can be harmful.

Supplements that may be dangerous

• St. John's wort. Often used for depression, St. John's wort can reduce how well several types of anti-HIV medicines work by more than half.
• Garlic supplements. Garlic itself may help strengthen the immune system. But garlic supplements can reduce how well some anti-HIV medicines work. Eating some garlic in food seems to be safe.
• Red yeast rice extract. Some people use this to lower cholesterol. Don't take 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

Getting a diagnosis of any life-threatening illness can cause distress. The emotional, social and financial effects of HIV/AIDS can make coping with this illness very hard for you and for those close to you.

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

They may be able to:

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

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

Preparing for your appointment

If you think you might have an HIV infection, you're likely to start by seeing your family healthcare professional. You may be sent to an infectious disease specialist who focuses on treating HIV/AIDS.

What you can do

Before your appointment, think about the answers to 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 having sex without protection or shooting illicit drugs?
• What medicines or supplements do you take?

What to expect from your doctor

Your healthcare professional asks you questions about your health and lifestyle and does a physical exam, checking you for:

• Swollen lymph nodes.
• Sores on your skin or in your mouth.
• Problems with your nervous system.
• Unusual sounds in your lungs.
• Swollen organs in your belly.

What you can do in the meantime

If you think you might have an HIV infection, protect yourself and others before your appointment. Don't have sex without using protection. If you shoot illicit drugs, always use a fresh, clean needle. Don't share needles with others.