HIV/AIDS

Diagnosis

HIV can be diagnosed through blood or saliva testing. Several types of tests are available depending on how long it has been since exposure and what needs to be detected.

• Antigen-antibody tests: These tests typically use blood from a vein. Antigens are parts of the HIV virus that appear in the blood within a few weeks after exposure. Antibodies take longer to appear, usually between 2 to 6 weeks.

• Antibody tests: These look for antibodies to HIV in blood or saliva. Most rapid HIV tests, including home self-tests, fall under this category. Antibodies may take 3 to 12 weeks to show up after exposure.

• Nucleic acid tests (NATs): NATs detect the virus itself in the blood, measuring viral load. They can detect infection earlier than other tests and are often used if exposure occurred within the past few weeks.

If an initial test is negative, follow-up testing may be needed weeks or months later for confirmation. Your healthcare professional can help determine which test is right for you.

Tests to stage disease and treatment

After an HIV diagnosis, your healthcare professional will recommend further tests to understand the stage of infection and guide treatment:

• CD4 T cell count: Measures the number of white blood cells targeted by HIV. HIV progresses to AIDS when the CD4 count drops below 200.

• Viral load (HIV RNA): Measures the amount of HIV in the blood. The goal of treatment is an undetectable viral load, meaning the virus is well controlled.

• Medicine resistance testing: Checks if the virus is resistant to certain HIV medicines. This helps guide therapy choices.

Additional tests may also be done to check for complications such as tuberculosis, hepatitis B or C, other sexually transmitted infections (STIs), and organ function.

Treatment

Although there is no cure for HIV/AIDS, treatment can effectively control the virus and prevent complications. Everyone diagnosed with HIV should start antiretroviral therapy (ART), regardless of symptoms or disease stage.

ART combines two or more medicines from different drug classes to lower the amount of HIV in the blood. Many ART regimens are available as single pills taken once daily.

The main classes of HIV medicines include:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): Block a protein the virus uses to make copies of itself.

• Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs): Act as faulty building blocks to stop the virus from replicating.

• Protease inhibitors (PIs): Disable HIV protease, another protein necessary for replication.

• Integrase inhibitors: Prevent the virus from inserting its genetic material into CD4 T cells.

• Entry or fusion inhibitors: Block HIV from entering healthy cells.

A typical regimen includes two medicines from one class plus a third from another class to prevent resistance and improve effectiveness.

Starting and staying on treatment

Everyone with HIV should begin ART as soon as possible. Taking medicines consistently and as prescribed helps keep the viral load undetectable, which:

• Strengthens the immune system.

• Reduces the risk of opportunistic infections.

• Prevents the development of resistant virus strains.

• Lowers the chance of transmitting HIV to others.

If you experience side effects or challenges staying on treatment, talk to your healthcare professional. Regular follow-up visits every few months are important to track viral load and CD4 counts.

Treatment side effects

Possible side effects of HIV treatment include:

• Nausea, vomiting, or diarrhea.

• Heart disease.

• Kidney or liver damage.

• Bone loss or weakened bones.

• Abnormal cholesterol or blood sugar levels.

• Cognitive or sleep problems.

Your healthcare professional can help manage side effects and adjust medicines if needed.

Treatment for age-related diseases

As people with HIV age, other conditions such as heart disease or osteoporosis may require treatment. Some medicines for these conditions can interact with HIV drugs, so it’s important to inform all your healthcare providers about your HIV treatment.

Treatment response

Your healthcare professional will monitor your progress with regular blood tests. After starting ART, the first evaluation is usually done after 4 to 6 weeks, then every 3 to 6 months.

Successful treatment results in an undetectable viral load, meaning the virus cannot be measured in the blood — though it remains in the body. Maintaining this status is key to staying healthy and preventing transmission.