How do you know if you have HIV (Human Immunodeficiency Virus)?

How do you know if you have HIV (Human Immunodeficiency Virus)?

Most people with HIV do not know they are infected because the virus can stay in the body for years without showing symptoms, making HIV diagnosis difficult. Research has shown that about one in every seven persons infected with HIV remains unaware of the infection.

Get an HIV test is the only way to know If you have HIV. However, understanding some early signs and symptoms of HIV and the risk factors that increases your chances of contracting HIV can help you know if you need to get tested immediately.  

Transmission of HIV

One of the first steps to know whether you have contracted HIV or not is to understand the mode of transmission of HIV.

The virus survives in body fluids like breast milk, vagina secretions, semen, and blood. Most people with HIV got infected when exposed to these fluids through the following.

• Anal sex
• Vaginal sex
• Sharing needles and sharp objects

An infected mother can transmit HIV to her child during childbirth, but this is not common, especially in developed countries, due to advances in treatment and preventive measures.  You cannot contract HIV through intact skin because the virus can only enter the body through openings like the rectum or vagina, vulnerable tissues (common during sexual intercourse) or direct inoculation into the body.

To contract HIV, you must have been exposed to a certain amount of the virus, meaning people do not get infected at every point of exposure. However, you can contract HIV through one exposure to the virus, especially when you contact a high-risk individual.  

The virus does not survive in saliva, tears, faeces, or urine. It does not also survive when exposed to environmental conditions and air.

The less common mode of transmissions

The following are theoretical modes of HIV transmission but are unlikely to result in HIV infection.

• Blood transfusion
• Biting
• Dental procedures
• Tabooing and piercings
• Healthcare exposure
• Female-to-female sex
• Oral sex
• Kissing
• Shared utensils

Early symptoms and signs

Within the initial period of HIV infection, some people develop acute symptoms and signs. These symptoms include:

• Chills
• Sore throat
• Fatigue
• Headache
• Fever
• Loss of appetite
• Swollen lymph nodes
• Muscle aches
• Genital, mouth, or anal sores (mostly from co-STD infections)
• Night sweats
• A widespread non-itchy rash

These symptoms are known as an acute retroviral syndrome (ARS). They usually start after five days of exposure to the virus and last for about 14 days. In some cases, they remain for up to six months.

If you recently had exposure to the virus, like engaging in unprotected sex with someone with an unknown HIV status and you notice any of the above symptoms, ensure you get an HIV test as soon as possible.

Some people do not have ARS, while others experience mild and non-specific symptoms, easily mistaken for other common conditions like exhaustion or a common cold. Some people show no symptoms until after several years, and a review in 2016 showed that about 43% of people infected with HIV remain asymptomatic.

However, a few persons develop atypical HIV symptoms a short while after exposure to the virus. Some serious symptoms include:

• Gastric bleeding
• Herpes zoster (shingles)
• Tonsilitis
• Oesophageal thrush
• Meningitis

Some doctors may not diagnose HIV if they fail to identify HIV as the underlying cause of these health problems.  

Risk factors

Anyone can contract HIV, but certain factors put some persons at a high risk of having HIV. Some group of people have a higher risk of contracting HIV due to certain biological vulnerabilities, social and psychological factors.

Certain factors that predispose people to HIV infection are modifiable. This means you can control the factors by changing some behaviours. Other factors are not modifiable, and you cannot manage them.  

Identifying your risk factors for contracting HIV will help you determine whether you need an HIV test or not.  

Sexual risk factors

Sex is the most common means of transmitting HIV. However, the following factors will determine whether you would contract HIV.

• The viral load of the infected partner
• Whether you have vaginal or anal sex
• Whether your male sex partner is circumcised or not
• Whether ejaculation occurs during sex or not
• The number of sex partners you have
• If you are the insertive or receptive sex partner

Anal sex has the highest risk of HIV transmission, with each episode having a risk of 1.43% for the receptive partner and 0.62% for the insertive partner. Tissues in the rectum are more likely to rupture, giving the virus access to vulnerable cells and tissues.  

Vaginal sex has the second-highest risk of HIV transmission, with each episode having the risk of 0.1% for the female partner and 0.1% for the male partner. This explains the higher rate of HIV in women. New infections in women are about 18% and 8% in men.  

You can reduce your risk of contracting HIV by using a condom and engaging in safe sex practices. Limit your number of sex partners and get the HIV pre-exposure prophylaxis (PrEP) to prevent HIV.

Sexually transmitted diseases

Research shows that about one in seven persons infected with HIV contract other sexually transmitted infections. These co-infections increase the vulnerability to HIV and increase the risk of transmission from an infected partner.

STDs increase the risk of HIV transmission in the following ways.

• Ulceration

Syphilis and genital herpes cause open sores that give the virus more access to internal tissues.  

• Inflammation

STDs such as gonorrhoea cause inflammation, increase the number of immune cells at the exposure site. CD4 T-cells are which the HIV targets also accumulates at the site of infection.  

• Genital shedding

Inflammation caused by other STD infections increases HIV in the genital tract (genital shedding). Even when an infected person has an undetectable viral load in the blood, they may still transmit the virus from vaginal fluid, rectal secretion or semen.

Other risk factors that increase the rate of HIV infection include

• Ethnicity and race
• Age
• HIV stigma
• Using intravenous drug

HIV testing

Although certain symptoms and risk factors may spur you to get an HIV test, in some cases, no symptom occur, so you need to get tested often. Different HIV tests are available. Some are more accurate, while others are more convenient, offers confidentiality or gives faster results.  

HIV test may check for antibodies, the proteins that make up the immune system and respond to infection or antigen, a part of the virus which triggers an immune response. Some HIV tests detect both antigen and antibodies, and you can get a nucleic acid test, which detects the virus.  

The different HIV test requires different samples. At-home and mail-in HIV test that gives a result within a short time require a drop of blood or saliva sample, while some in-office HIV test requires a whole blood sample.  

HIV tests requiring a blood sample are usually more accurate. However, new rapid tests have high specificity and sensitivity than past tests.

The table below summarises the available HIV tests.