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Human immunodeficiency virus infection (HIV and AIDS) - including symptoms, treatment and prevention

Without treatment, human immunodeficiency virus (HIV) infection will usually result in acquired immune deficiency syndrome (AIDS). However, HIV antiretroviral therapies introduced in the mid-1990s, which are available to all Australians living with HIV, have resulted in the virtual elimination of AIDS in Australia.

With treatment, people living with HIV in Australia can live a long and healthy life without the risk of transmitting HIV to their sexual partners. HIV in Australia is now considered a chronic manageable condition. Whilst a vaccine or cure is yet to be found for HIV, most people living with HIV in Australia can achieve an undetectable viral load and long-term suppression of symptoms by taking effective treatment.

Human immunodeficiency virus is a notifiable condition1

How HIV is spread

HIV infection occurs when certain body fluids (blood, semen, vaginal fluid and breast milk) containing the virus come into contact with another person’s tissues beneath the skin (for example, through needle puncture or broken skin), or mucous membranes (the thin moist lining of many parts of the body such as the nose, mouth, throat and genitals).

In Australia, most infections now result from unprotected sex (anal or vaginal intercourse without a condom) and/or the sharing of injecting equipment.

Mother-to-baby transmission during pregnancy, birth or breastfeeding is now rare in Australia and is only a risk where the mother has untreated HIV infection.

Routine social or community contact with a person living with HIV carries no risk of infection. There is no evidence of the spread of HIV through social contact in schools, at home or in the work place. HIV has not been transmitted through:

  • air or water
  • swimming pools or toilets
  • sharing of plates, cups or cutlery
  • kissing
  • coughing
  • sneezing or spitting.

In addition, there is no evidence HIV can be spread by mosquitoes or other biting insects.

In Australia, receiving blood, blood products or an organ transplant is not a risk for HIV infection as screening for HIV occurs.

Signs and symptoms

Acute infection

A few weeks after infection with HIV, the infected person may develop a flu-like illness (seroconversion illness) consisting of:

  • muscle aches
  • low-grade fever
  • headaches
  • sometimes a rash
  • swelling of the lymph glands may also occur.

This flu-like illness may be so mild it goes unnoticed or, in some people, it may be quite severe and last for a few weeks before there is a return to seemingly normal health. Either way, this illness at the beginning of the infection is so similar to many other viral infections that the diagnosis of HIV infection may not be made at this time.

In Australia it is now recommended that HIV treatment starts as soon as possible after diagnosis. Whilst it is not a cure, treatment is known to slow or even halt the disease progression that may otherwise lead to AIDS.

Longer term, untreated HIV infection

The length of time that a person with untreated HIV infection may live without symptoms varies widely, but usually severe disease develops in adults within 10 years of infection.

When symptoms develop in untreated HIV, they may not be specific and can include:

  • chronic loss of appetite
  • diarrhoea
  • weight loss
  • fever
  • lethargy
  • fatigue.

Untreated HIV destroys certain cells within the immune system (CD4+ or helper T cells) from the time of infection onwards, causing more and more damage. AIDS occurs when the damage to the immune system is so great the body can no longer stop some infections or cancers it normally fights successfully. Infections not usually seen in healthy people (opportunistic infections) and certain unusual tumours such as Kaposi’s sarcoma may occur.

Women with untreated HIV infection are at increased risk of developing cervical cancer and both men and women are at increased risk of anal cancer. Untreated HIV can also cause infection in the brain, which can lead to nervous system disorders or dementia in some people with HIV infection.

Diagnosis

Diagnosis of HIV infection is made using blood tests. A positive blood test indicates the development of antibodies to HIV and therefore the presence of the virus. Antibodies to HIV usually develop within a few weeks to three months. Even though the blood test for antibodies may not be positive during the early stage of infection, the virus will be present in certain body fluids (blood, semen, vaginal fluid and breast milk), making the person infectious to other people. Polymerase chain reaction (PCR) tests in a pathology laboratory can be used for the early detection of HIV genetic material in the blood.

Blood tests to diagnose HIV infection can be ordered by your general practitioner or conducted at a sexual health clinic such as :

SHINE SA also offers HIV point of care testing at their Rapido Clinic.

Incubation period

(time between becoming infected and developing symptoms)

While illness may not occur for months or years after becoming infected with HIV, without treatment, most adults will develop severe disease within 10 years of infection.

Infectious period

(time during which an infected person can infect others)

Once a person has been infected with HIV they remain infected for life and may be able to transmit the virus to others. The risk of transmitting the infection to another person is dependent on the level of virus (viral load) in the body fluids (blood, semen, vaginal fluid and breast milk) of the infected person.

The risk of transmitting the virus to others is higher when the viral load is higher, in particular, in early infection (when a person may not be aware they have HIV) and late in untreated infection (when the immune system is failing). Research demonstrates that having a consistently low (undetectable) viral load dramatically reduces infectiousness and that together with consistent condom use and/or safe injecting practices, lowers the risk of transmission to almost zero. However, certain factors, including poor treatment adherence or the presence of other sexually transmitted infections (STI) may increase the risk of transmission.

Treatment

Although there is no cure for, or vaccine against, HIV infection, significant advances in HIV treatment have been made over recent years that are known to slow or even halt the disease progression that would otherwise have led to AIDS. This means HIV is no longer a terminal illness and is now considered a chronic manageable health condition.

Multiple treatment options are available for people living with HIV. Treatments vary from person to person depending on disease progression, drug resistance and other health conditions. For most people, treatment is as simple as taking a single pill everyday with little to no side-effects experienced. In Australia it is recommended that treatment for HIV starts as soon as possible after diagnosis.

Whilst HIV treatment outcomes over a whole lifetime are not yet known, the majority of people on effective HIV treatment in countries like Australia will achieve long-term suppression of symptoms and an undetectable viral load, meaning they can live a long and healthy life without the risk of transmitting HIV to their sexual partners.

Regular measurement of the viral load and the levels of CD4+ cells assists in indicating the effectiveness of treatments. It is recommended that an infectious diseases specialist or general practitioner with expertise in HIV medicine undertake these assessments.

When HIV infection is advanced, either through treatment failure or in untreated infection, and has caused immune system destruction, secondary infections (opportunistic infections) can occur. Using other antiviral drugs and antibiotics to prevent secondary infection may prevent severe illness and premature (early) death.

Prevention

Exclusion from childcare, preschool, school and work is not necessary. Children living with HIV may be advised to stay away from school during outbreaks of infectious disease (for example, chickenpox) to prevent them getting the infection.

Health Care Workers living with HIV must comply with the requirements of their professional boards.

HIV infection can be prevented by:

  • Using condoms and water based lubricants for penetrative sex. These reduce the risk of getting HIV, as well as other STIs. Having any STI increases the risk of getting an HIV infection.
  • The effective use of pre-exposure prophylaxis (PrEP) – see below
  • Utilising treatment as prevention (TasP). When people with HIV effectively adhere to their treatment regime their viral load is suppressed to undetectable, and therefore untransmissible, levels.
  • Not sharing any injecting equipment (including needles, syringes, filters, spoons, swabs, tourniquets).
  • Safely disposing of found or used needles and syringes in a sharp safe, or other sealable and puncture-proof container.
  • Always using standard precautions when handling blood and other substances. This will minimise and generally eliminate the risk of transmission of HIV.
  • Covering any open sores, cuts or abrasions with waterproof dressings.
  • Understanding the risk of body tattooing or any body piercing. The risk of being infected with HIV through these practices is lower than for hepatitis B or hepatitis C, but there is still a risk if there is use of unsterile equipment or re-used dyes.

In Australia, all donated blood and body organs are screened for HIV infection.

Post-exposure Prophylaxis for HIV

Post exposure prophylaxis (PEP) for HIV is a four week treatment that may prevent you from becoming infected if you have been exposed to HIV.

PEP needs to begin as soon as possible, within 72 hours after exposure, to be effective.

Prevention of mother-to-child transmission of HIV

The administration of HIV treatment to HIV-positive women during pregnancy, labour and after delivery, as well as to the newborn baby, reduces the risk of mother-to-baby transmission of HIV.

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1 – In South Australia the law requires doctors and laboratories to report some infections or diseases to SA Health. These infections or diseases are commonly referred to as 'notifiable conditions'.

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