# HIV infection and AIDS
What is it
HIV (human immunodeficiency virus) is a virus that attacks and destroys cells of the immune system. The virus spreads through blood and certain body fluids between people.
AIDS (acquired immunodeficiency syndrome) is the final stage of untreated HIV infection. It occurs when the immune system becomes so weakened that the body can no longer resist serious infections and certain types of cancer that healthy people do not normally get.
HIV is not the same as AIDS. Many people with HIV live healthy lives for years and never develop AIDS, especially since medicines now exist that can keep the virus under control. These medicines can make the amount of virus in the blood so low that the virus is no longer transmissible to others.
Causes
HIV spreads through contact with blood or certain body fluids of someone who has the virus. This usually happens through:
- Unprotected sexual intercourse (without a condom)
- Sharing needles when using drugs
- From mother to child during pregnancy, childbirth or breastfeeding (this can be prevented with medicine)
- Blood or organ transplantation (very rare in Western countries due to screening)
The virus cannot spread through saliva, sweat droplets, hugs or sharing eating utensils. You cannot get HIV from someone on antiretroviral therapy who has an undetectable viral load.
How the disease progresses
After infection, HIV goes through different stages:
**Acute infection (first 2-4 weeks)**
The virus multiplies rapidly. Many people have flu-like symptoms, but not everyone. The virus is highly contagious in this phase.
**Asymptomatic phase (sometimes for years)**
The virus continues to grow slowly. The amount of virus in the blood and the number of immune cells can remain stable. Many people feel completely healthy, but can still transmit the virus. Without treatment, immunity gradually declines.
**AIDS (advanced immunosuppression)**
The immune system is so weak that serious infections and certain cancers develop. This usually only happens years after infection, and can be prevented with treatment.
With modern medicines, most people remain in the first stage and never reach the asymptomatic phase without treatment. With regular check-ups and treatment, someone's life expectancy can be virtually the same as that of people without HIV.
Symptoms by phase
**Acute infection**
- Fever, chills
- Fatigue
- Muscle and joint pain
- Headache
- Swollen lymph nodes
- Skin rash (usually mild)
- Sore throat
- Nausea or diarrhea
These symptoms resemble flu or another virus. They usually disappear on their own after a few weeks, even without treatment.
**Asymptomatic phase**
- No symptoms, or very mild
- Possibly recurrent infections (fungal infections, herpes)
- Enlarged lymph nodes
**AIDS (without treatment)**
- Serious infections: pneumonia (pneumocystis), tuberculosis, brain inflammation (meningitis)
- Fungal infections in the mouth, esophagus or elsewhere
- Types of cancer that are normally rare
- Severe weight loss
- Chronic diarrhea
- Memory problems, concentration difficulties
- Skin conditions
What it means for daily life
**With treatment:**
Most people with HIV feel normal and can live a full life. They can work, study, exercise and have relationships. The medications are usually simple to take (often one tablet a day). Side effects are usually mild or absent nowadays.
**Care and monitoring:**
Regular visits to the HIV specialist for blood tests. This happens less often if the disease is well controlled. The doctor monitors the amount of virus and immune cells.
**Relationships and intimacy:**
You can be safely intimate with partners. With medications that work well, the virus is not transmissible ('U = U': undetectable = not contagious). Condom use provides extra certainty.
**Pregnancy:**
Pregnancies are possible and safe, for both mother and child, if the disease is well treated. The risk of transmission to the child is very low.
**Mental wellbeing:**
An HIV diagnosis can feel heavy. Many hospitals have support programs, counseling and peer contact. Stigma can still occur, but has decreased.
**Without treatment:**
The situation is more serious. Without medication, the immune system becomes weaker. The risk of serious infections increases. Also, someone is contagious to others.
Outlook
**With treatment:**
For most people, HIV has now become a chronic disease, comparable to diabetes or high blood pressure. With regular medication use and monitoring, people have a normal or near-normal life expectancy. Many people with HIV are now fifty, sixty years old or older.
**Research shows:**
Worldwide, more than 39 million people have HIV, of which about 30 million are on treatment. In about 95% of these people, the virus has been made undetectable, meaning it is no longer transmissible and their health remains stable.
**Gender-specific differences:**
Some research suggests that women and LGBTQ+ people sometimes have different experiences with diagnosis and care. This depends on acceptance, access to care and social factors in their own environment.
**Long-term issues:**
With long-term treatment, doctors monitor side effects, heart health and bone strength, because HIV and some medications can have an impact on these. Also, people with HIV can more often get other infections (such as tuberculosis or hepatitis) and these require special attention.
**Prognosis per person:**
General figures say nothing about YOUR situation. Your prognosis depends on when your diagnosis was made, how quickly you were treated, how well you stick to your medication, your age, other illnesses and your overall health. Discuss this with your own doctor.
Frequently asked questions
**Can I get HIV from someone who uses medication?**
No, if someone's viral load is undetectable (which doctors monitor regularly). With modern medications, the virus can multiply so little that it is not transmissible. This is called 'U = U': undetectable = not contagious. This applies to sexual intercourse and mother-to-child transmission.
**How long before AIDS develops?**
This varies greatly. Without treatment, it can take 8-12 years for AIDS to develop, but this can be faster or slower. With treatment, most people never reach the AIDS stage. This is why early diagnosis and treatment is so important.
**What happens if I become resistant to medication?**
This means the virus no longer responds to certain medications. Doctors monitor this with blood tests. If this happens, doctors can try other medication combinations. Nowadays there are many options, so a well-working regimen is usually found.
**Can I have children with HIV?**
Yes. Women and men with HIV can have healthy children. With good treatment of the mother, the risk of transmission to the child is very small (less than 1%). In men, the virus is harmless to the child if the viral load is undetectable.
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_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._