Sexually Transmitted Infections Diseases

Thanks To U=U, HIV-positive People Can Live Long, Happy, Healthy Lives

Let's face it. Receiving the news that you are HIV-positive is not what anyone really wants to hear. But fortunately, with today's many highly effective treatment options, people living with HIV can now enjoy just as long, happy, healthy lives as those living without the virus — including having safe and active sex lives!

Here, we answer some of the most asked questions by people who have just received an HIV diagnosis:

What are the first symptoms of HIV?Initial symptoms of HIV are much like the flu: fatigue, fever, sore throat, body aches, headache, and swollen lymph nodes.

How did I get HIV?You likely acquired the virus by coming into contact with the blood or sexual fluids of someone who is HIV-positive. The most common modes of transmission include unprotected anal or vaginal sex and sharing of IV drug needles.

My partner's test was negative — are they in the clear?Not necessarily. It takes time for what's known as seroconversion to occur, the period after exposure when your body begins to produce the antigens and antibodies HIV tests are looking for. According to the Johns Hopkins Bloomberg School of Public Health, the period between exposure to HIV and seroconversion is variable, but most people will test positive within several weeks of exposure. Still, someone with a just-diagnosed partner should retest in three months to confirm their results.

Is it possible to transmit HIV to my family and friends?No. A lot of fear and misunderstanding still surrounds HIV, even though treatments have advanced in the past decades to the point where it is simply a chronic, treatable illness like diabetes. You, your family, friends, and even casual acquaintances may fear you'll pass HIV to them. But the virus is transmitted via the kind of contact with sexual fluids and blood that you don't generally have with family members and friends. The Centers for Disease Control and Prevention is clear in stating that HIV is not transmitted via saliva (spitting or kissing) or by sharing a toilet, drinks, or eating utensils.

Is it my fault?No. HIV isn't some kind of divine retribution. It is a virus that is communicable and therefore travels between people. Certain types of activities may increase your risks, but these don't make you responsible for getting sick. We don't blame diabetics for their diabetes even though Type 2 diabetes is preventable, so we needn't assign blame for HIV either.

I thought "tops" couldn't get HIV?Although the receptive partner or "bottom" in anal sex is 13 times more likely to acquire HIV than the "top" or insertive partner, according to the CDC, tops still can and do get HIV from having unprotected sex.

Does being HIV-positive mean I also have AIDS?No. Confusing HIV with AIDS or using the terms interchangeably are some of the most frequent mistakes made by ordinary people and even media outlets. In the U.S., the majority of people living with HIV will never develop AIDS, the most advanced stage. HIV is the virus that causes AIDS, but for most people, proper treatment and regular medical care keep their immune system strong enough to prevent stage 3 HIV and associated illnesses. An AIDS diagnosis only occurs if your CD4 cell count plummets below 200 and your immune system is so damaged that you are susceptible to life-threatening illnesses. Getting on and staying on treatment is the best way to ensure your HIV never develops into AIDS.

Am I going to die?Probably not from HIV. A person diagnosed today has roughly the same life expectancy as a person who is HIV-negative. However, your virus does make you more susceptible to other health problems that you need to be aware of, including cardiovascular disease, kidney problems, and bone density loss. But these can be prevented with lifestyle changes and the right medications.

Why are health outcomes worse for some HIV-positive people?People of color, transgender women, and those living in Southern states continue to have higher mortality rates from HIV-related complications. Some of those disparities have to do with barriers to health care, racial inequalities, discrimination, poverty, substance abuse, and untreated mental health issues. But getting and staying on treatment is the first step in altering those disparities and there are government programs that can help you afford it.

Is there a cure for HIV?Not yet. Although Timothy Brown (or "The Berlin Patient") has continued to live HIV-free for over a decade, he remains the only person to have been functionally cured for such a long period of time. At the 2018 International AIDS Conference in Amsterdam, researchers announced three major strategies scientists are focusing on in seeking a cure for HIV. The first involves reversing HIV latency — making it so the immune system can recognize HIV-infected cells that were previously invisible in reservoirs. This is called "blocking and locking" due to its goal of permanently stopping the virus from reproducing. The second has to do with using a variety of agents, such as neutralizing antibodies, to strengthen the immune system; it would probably require a combination of substances. The third involves genetically engineering cells to make them resistant to HIV or improve their ability to clear HIV-infected cells.

Do I have to take antiretrovirals every day? Forever?Yes and no. Staying on your meds is hugely important, and combining early treatment with continuous adherence is the best way to maintain your long-term health. But doctors and pharmaceutical companies alike realized that maintaining a daily regimen can be a real struggle, so there are now long-acting injectable options as well. Talk to your doctor about which regimen might be best for you, especially if you are having issues adhering to you current one.

What is an undetectable viral load?Those on antiretroviral therapy can see their viral load (the amount of blood detectable in a blood test) reach undetectable levels. Also called viral suppression and defined as reducing the amount of HIV to less than 200 copies/ml, or becoming undetectable, has been proven to prevent HIV transmission.

What does U=U mean?Undetectable equals untransmittable. The global medical community has endorsed research findings that those who are undetectable are no longer able to transmit HIV. The CDC states that "across three different studies, including thousands of couples and many thousand acts of sex without a condom or pre-exposure prophylaxis (PrEP), no HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed. This means that people who take [antiretroviral therapy] daily as prescribed and achieve and maintain an undetectable viral load have effectively no risk of transmitting the virus to an HIV-negative partner."

So, I can throw away my condoms?You probably shouldn't. Even if you are virally suppressed and/or your sexual partners are on PrEP and you aren't concerned about HIV transmission, you are still at risk for contracting other sexually transmitted infections. Getting gonorrhea or syphilis can lead to serious health complications, and new, antibiotic-resistant strains are threatening to heighten their potential to do lasting damage.

Can I still have kids?Yes, you can still have kids if you are HIV-positive. The great news is that if you have your viral load suppressed to undetectable levels you likely won't have to do anything special, as you can no longer transmit the virus. Still, if you are planning to make a baby the old-fashioned way, you should speak with a specialist first. For those whose viral load isn't suppressed, there are specialists who deal with HIV, fertility, and insemination. If you're a woman who is living with unsuppressed HIV, additional medications can also decrease your chance of transmission to your child. If you're a man with detectable HIV, your sperm may need to be "washed" of HIV and then inseminated into your partner, wife, or surrogate. If you want to adopt, there are protections for HIV-positive parents-to-be that ensure you can't be discriminated against by agencies.

Can I still breastfeed?Federal guidelines still currently recommend HIV-positive women not breastfeed and instead rely exclusively on formula. However, according to the CDC "mothers on ART with a sustained undetectable HIV viral load during and after pregnancy, the risk of transmission through breastfeeding is less than 1%, but not zero."

This article originally appeared on HIVplusMag: Thanks to U=U, HIV-positive people can live long, happy, healthy lives

RELATED

First-ever Injectable HIV Prevention Drug Approved By FDA

The U.S. Food and Drug Administration (FDA) has approved the first-ever long-acting injectable drug for HIV prevention.

Until this week, the only FDA-licensed and approved medications for HIV pre-exposure prophylaxis, most commonly known as PrEP, were daily oral pills containing the HIV treatment drugs tenofovir and emtricitabine, which slow the progression of an HIV infection in the body.

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PrEP is taken daily so that it builds up in your system, to the point that if there is an HIV infection, it prevents the virus from replicating and spreading throughout the body.

When taken as prescribed, PrEP services reduce the risk of getting HIV from sex by about 99%, according to new data from the CDC. Now, individuals who feel at-risk of HIV infection have the option of taking the daily pill, or the new shot every two months, after two initiation injections administered one month apart.

"This injection, given every two months, will be critical to addressing the HIV epidemic in the U.S., including helping high-risk individuals and certain groups where adherence to daily medication has been a major challenge or not a realistic option," the FDA said in a statement.

According to Dr. Darien Sutton, Emergency Medicine Physician, in an interview with "Good Morning America," "This is a game-changer in the world of HIV prevention."

"Patients often have difficulty complying with any oral medication, so a bi-monthly injection can truly change the landscape in terms of HIV prevention. Having a bi-monthly treatment also serves as an opportunity to interact with a patient, share risk reduction sexual health education and complete necessary screenings."

"Patients on PrEP can often feel stigmatized with taking daily medication," he told "GMA." "Some have shared with me that they fear simple actions, like picking up their medications from the pharmacy due to fear of stigmatization. This stigma unfortunately doesn't stop at the pharmacy, as many also fear being seen carrying their preventative medications in public."

Sutton added, "The study was also inclusive, including transgender women, which allows better applicability with diverse patient populations."

CDC data shows that an estimated 34,800 people in the United States acquired HIV in 2019, the most recent year for which data are available.

HIV By the Numbers in the U.S.

ABC News Photo Illustration

Men who have sex with men, transgender women who have sex with men, and Black cisgender women are among those disproportionately affected by HIV in the U.S.

Heterosexual people made up 23% of all HIV diagnoses in the U.S. And six dependent areas in 2019. Specifically, heterosexual men accounted for 7% of new HIV diagnoses and heterosexual women accounted for 16%.

The FDA approval comes on the heels of a CDC recommendation this month that there be an expansion of HIV prevention medication to close the gap on PrEP implementation.

In a release, the National Institute of Allergy and Infectious Diseases (NIHAID) also made a nod to the FDA approval, saying in part, "These medications are highly effective at preventing HIV when taken daily as prescribed, however, taking a pill daily while feeling healthy can be challenging." Adding, "Long-acting injectable cabotegravir PrEP is a less frequent, more discreet HIV prevention option that may be more desirable for some people."

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