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HIV-1 Antibody Test (ELISA and Western Blot)


What is the HIV-1 antibody test?

The HIV-1 antibody test checks your blood for antibodies to the most common type of the human immunodeficiency virus (HIV-1). HIV is the virus that causes AIDS (acquired immunodeficiency syndrome), a life-threatening disease. If you are infected with HIV, your immune system makes a type of protein called an antibody to try to destroy or get rid of the virus.

There are different HIV antibody tests. One test is the ELISA (enzyme-linked immunosorbent assay). If the ELISA test is positive, a second test called a Western blot is done to confirm the result. The Western blot takes longer to perform and is more expensive than the ELISA test, but it is more precise.

There is no way to know, without testing, if you are infected with HIV. Learning whether you are HIV positive will help you care for yourself and protect your loved ones.

Why is this test done?

This test is done to see if you are infected with the virus that causes AIDS. This test is also used to screen donated blood for HIV.

How do I prepare for this test?

It is important to get counseling before you have the HIV test. This can help to identify things you do that may increase your risk for HIV infection.

How is the test done?

Usually a small amount of blood is taken from your finger or your arm. Blood from a finger prick is put in a vial of solution and tested with a dipstick. Blood taken from your arm with a needle will be sent to a lab for testing. In some hospitals and clinics a new, faster test is now available. A sample for testing is obtained by swabbing your gums with a cotton swab rather than drawing blood.

Having the test takes just a few minutes of your time. There is no risk of getting AIDS, hepatitis, or any other blood-borne disease from this test.

Home test kits have become available through the Internet. However, some of these tests have been shown to be inaccurate. The only HIV test approved by the FDA is the Home Access HIV testing kit. When you do this home test, first you register by phone. Then you collect a sample of blood and mail the sample to the lab for testing. Toll-free telephone support is available 24 hours a day for test and result questions. You should see your health care provider to confirm any positive results from a home test.

How will I get the test result?

Ask your heath care provider when and how you will get the result of your test. Results from the finger-prick or gum-swabbing HIV tests may be available in 30 minutes or less. You may get results from other HIV tests in 2 to 10 days.

The test results are confidential. Confidential testing ensures that your results will be guarded with care. Positive results may be reported by name to the health department for 2 reasons. The first reason is to provide help with partner notification and referral to care. The second is to provide reports to the federal government so there can be a count of how many people have HIV. The count helps determine how much money each state needs for HIV care.

Some centers offer anonymous testing. Anonymous testing does not use your name at all. Positive results are reported without any personal identifiers. Some people feel this better protects the confidentiality and civil rights of people who test positive for HIV.

What do the test results mean?

In general, a positive HIV test means that you are infected with HIV, and a negative test means that you are not infected with HIV. The test does not directly measure or identify the HIV virus in the blood, however. Instead it measures antibodies that the body makes in response to the viral infection. Because it takes at least a few weeks for the antibodies to appear in the blood after infection by the virus, it is possible to have a negative test if you have been recently infected (this is called a false negative test). In this case, the test will become positive if it is repeated several weeks or months later. If you have a negative test result but you are in a high-risk group, you may need to have another test in 3 to 6 months. Most people test positive 6 weeks after infection.

Although the HIV tests are very precise, sometimes the test result can be positive even though you do not have HIV infection (this is called a false positive test). For this reason, when a positive result occurs, labs perform a second HIV test (Western blot) to check the result.

What if my test result is positive?

If your first test for HIV is positive, you should have more blood tests to confirm the results. If repeat tests are positive, you should seek medical care, even if you have no symptoms. In some cases you may need to start taking medicine to try to stop the HIV infection from developing into AIDS. You need to discuss the test results with your health care provider or an HIV counselor as soon as possible to protect your health and the health of people you love.

AIDS Case Definition

A person who has tested HIV positive is diagnosed with AIDS when:

• the person’s CD4 cell count falls below 200 cells/ml

OR

• the person is diagnosed with any of the following conditions or diseases:

  1. Candidiasis of bronchi,
  2. trachea or lungs Candidiasis,
  3. esophageal Cervical cancer,
  4. invasive Coccidioidomycosis,
  5. disseminated or extrapulmonary Cryptococcosis,
  6. extrapulmonary Cryptosporidiosis,
  7. chronic intestinal (>1 month duration)
  8. Cytomegalovirus disease (other than liver, spleen, or nodes)
  9. Cytomegalovirus retinitis (with loss of vision)
  10. Encephalopathy,
  11. HIV-related
  12. Herpes simplex: chronic ulcer(s) (>1 month duration) Histoplasmosis,
  13. disseminated Isosporiasis,
  14. chronic intestinal (> 1 month duration) Kaposi’s sarcoma Lymphoid interstitial pneumonitis (in children) Lymphoma,
  15. Burkitt’s (or equivalent term)
  16. Lymphoma,
  17. immunoblastic (or equivalent term) Lymphoma,
  18. disseminated or extrapulmonary Mycobacterium tuberculosis, any site (pulmonary or extrapulmonary) Mycobacterium, other species or unidentified species, disseminated or extrapulmonary Pneumocystis carinii pneumonia Pneumonia,
  19. recurrent Progressive multifocal leukoencephalopathy Salmonella septicemia,
  20. recurrent Toxoplasmosis of brain Wasting syndrome due to HIV A person who is HIV negative or of undetermined serostatus may be diagnosed with AIDS when other causes of immunodeficiency are ruled out and the person is definitively diagnosed with one of the AIDS indicator diseases listed above.

100. Do confidential HIV test results have to be included in a person’s individual medical record?

Yes. New York State Code, Rules and Regulations, Title X, Part 63 requires that confidential HIV-related information be recorded in the medical record and be easily accessible to provide proper care and treatment.

99. Can people with HIV infection or AIDS be denied health, disability, or life insurance?

No. In New York State, health insurance – including hospital, medical, and surgical coverage – cannot be denied and a higher premium cannot be charged simply because the applicant has HIV. However, disability insurance and life insurance companies are allowed to ask applicants if they have been diagnosed or treated for AIDS or HIV-related illnesses; they can deny coverage or charge higher premiums for the policy if the person is infected. Insurance companies can also require an HIV test before issuing a policy. A person with HIV can be determined to have a pre-existing condition and may have to go through a waiting period before their coverage begins. After the waiting period (usually 12 months), all HIV-related expenses should be covered. For more information, call the New York State Insurance Department at 1-800-342-3736.

94. Are there laws in New York State that protect the confidentiality of people with HIV and AIDS?

Yes. Public Health Law, Article 27-F is the section of New York State Public Health Law that protects the confidentiality and privacy of anyone who has:

been tested for HIV;

been exposed to HIV;

HIV infection or HIV/AIDS-related illness; or

been treated for HIV/AIDS-related illness.

In addition, the law requires that anyone who takes a voluntary HIV test must first sign a consent form. This means the person understands what the test means and agrees to take it. The law also requires that information about a person’s HIV status can only be disclosed (shared with others) if the person signs an HIV release form or if the form is signed by the person’s legally appointed guardian or health care proxy. The law applies to individuals and facilities that directly provide health or social services and to anyone who receives HIV-related information about a person pursuant to a properly executed HIV release form. Also, the law Health care workers who refuse to care for a person with HIV infection or AIDS may be fired or disciplined. Ongoing education is required for all health care workers to ensure that they understand the ways in which HIV is spread and follow recommended safety precautions.

93. What happens if a person who tests HIV positive thinks that a partner will react violently if notified?

If a person who tests HIV positive is concerned that notifying a partner may seriously affect their health or safety, or the health and safety of someone close to them, such as a child, the person is referred for domestic violence services. Partner notification is delayed until it is safe to proceed. For information about programs providing domestic violence services, call the New York State Domestic Violence Hotline at 1-800-942-6906.

92. Can doctors notify the partners of a patient with HIV without the patient’s permission?

Yes. If a doctor knows the name of a patient’s partner, the doctor can notify the partner without the patient’s consent. However, the doctor must tell the patient that he or she intends to do this.

91. Are people who test HIV positive required to tell their doctor or counselor the names of their partners?

No. A person who tests HIV positive may be asked about his or her partners but is not legally required to reveal names. People cannot be punished or have treatment denied if they do not disclose the names of their partners to a doctor or public health worker. However, people with HIV should know the options they have for partner notification and understand how vitally important it is for partners to know of their possible exposure to HIV so that they can get tested and get treatment if they are infected.

90. How are partners of people who test HIV positive notified?

Persons who test HIV positive can choose from the following options how they would like to have their partners informed that they have been exposed to HIV:

• A counselor from the New York State Health Department PartNer Assistance Program (PNAP) or the Contact Notification Assistance Program (CNAP) in New York City can tell their partners without revealing the identity of the person.

• People can tell their partners with the help of their doctor or PNAP/CNAP counselor.

• People can tell their partners themselves.

Help from PNAP/CNAP is free. For more information, call the New York State Department of Health HIV/AIDS Hotline (see the Resources section). In New York City, call CNAP at 1-212-693-1419.

89. When the name of a person who tests HIV positive is reported to the New York State Department of Health, is that information shared with other gov

No. Under the law, identifying information about people who have HIV can only be used to help the State Department of Health track the epidemic and for partner notification. Information cannot be shared with other government agencies like the Immigration and Naturalization Service (INS), police, welfare agencies, insurance companies, landlords, or private agencies. The confidentiality of all HIV-related information is protected by New York State Public Health Law.

88. What are the Public Health Law provisions regarding HIV case reporting and partner notification?

In New York State, HIV reporting means that doctors and laboratories must report all cases of HIV infection to the State Department of Health. Public Health Law requires HIV case reporting by name. Additionally, laboratories must report HIV nucleic acid tests (viral load tests), CD4 lymphocyte tests, and drug resistance and subtype tests to the State Department of Health. Reporting helps the State Department of Health to accurately monitor the HIV epidemic, assess how the epidemic is changing, and create programs for HIV prevention and medical care that best serve affected people and communities. All reported information is protected by strict confidentiality laws (see questions 65 and 67).

Partner notification is important so that people can become aware of their HIV risk and receive HIV counseling and testing. Then they can take steps to protect themselves and their loved ones and get medical care sooner if they are infected. Giving doctors or the Health Department the names of partners is voluntary. While doctors are required to report known partners of their HIV-infected patients to the Health Department for the purpose of partner assistance, doctors are also required to talk with their patients about how they would prefer to let sex partners and needle-sharing partners know they may have been exposed to HIV. See question 90 for more information on partner notification options and assistance available through the PartNer Notification Assistance Program (PNAP) or the Contact Notification Assistance Program (CNAP) in New York City.

The national Centers for Disease Control and Prevention has issued guidelines urging all states to collect and report data on HIV cases to track the epidemic on a national basis. Within the next several years, HIV data will become the basis for funding formulas that allocate federal money for HIV care and treatment under the Ryan White CARE Act.

87. If an adolescent gets tested for HIV, will the parents or guardians be told about the test result?

Parents or guardians will not be told the test result if the adolescent being tested shows capacity to consent to the HIV test (see question 37). The laws that protect confidentiality of HIV-related information apply, no matter what the person’s age or

whether the person has parental consent or parental involvement (see question 94).

There are certain times when a parent or guardian of an adolescent who gave

informed consent can be told confidential HIV-related information – for example,

if the adolescent is being abused or needs urgent care. If it is best for the adolescent, HIV-related information should be kept strictly confidential.

86. At what age can a person consent to an HIV test?

According to New York State Public Health Law, individuals may consent to an HIV test without regard to age. Parents or legal guardians generally have the authority to consent to HIV testing for infants and young children who do not have the ability to understand and make an informed decision about testing. Care is taken to assure that young persons seeking HIV testing are able to make informed decisions about the test and are capable of understanding all information provided. Once a person has the capacity to consent – no matter what age – he or she can have an HIV test without parental knowledge or consent

85. Do adolescents/young adults get HIV?

Yes. HIV infection is an important concern for people of all ages, and young adults are no different. The Centers for Disease Control and Prevention estimate that at least half of all new HIV infections in the United States occur among

people under the age of 25.

The same behaviors that put adults at risk for HIV also put adolescents at risk. These activities include:

having vaginal, anal, or oral sex without using a condom; or

sharing drug injection equipment.

Adolescents should also be aware of these high-risk situations:

Drinking or using drugs. Drugs and alcohol can affect your judgment and lead to unplanned and unprotected sex.

Injection drug use, including sharing needles, syringes, cotton, spoons, bottle caps, or any other equipment (“works”).

Experiencing “blackouts” – not being able to remember what happened while using alcohol or drugs.

• Not understanding your own risk of being infected with HIV or your partner’s risk of being infected.

• Having many sex partners, which increases the chances of having sex with someone who has HIV.

• Exchanging sex for money, drugs, food, housing, or other things of value.

• Having sex with older partners, especially partners who use drugs.

• Having sex with partners you do not know well.

• Having a history of sexually transmitted diseases (STDs) or having a partner who has a history of STDs.

• Rape or incest – anyone who has been a victim of rape or incest should seek counseling, including advice about HIV testing.

84. Who should parents and guardians tell about a child’s HIV infection?

The child’s health care providers need to know that the child has HIV in order to provide the best possible care. Providers include doctors, nurses, dentists, and other medical employees.

The law does not require parents and guardians to share HIV-related information with a child’s school. However, it may be in the child’s best interest for some school employees to know about the child’s HIV infection (for example, if the child needs help taking medicines).

Parents and guardians of children with HIV should also think about whether to share their child’s HIV status with people directly involved in the child’s life, such as babysitters, friends, and relatives. They do not have to tell anyone. However, it may be overwhelming to care for a young person with HIV/AIDS without telling

others and getting support.

Parents and guardians should consider:

how disclosure would be helpful to the child;

how disclosure would be helpful to the parents or guardians; and

whether others can be trusted with this confidential information.

It may also be helpful to talk to the child’s doctor, nurse, social worker, and other people who are involved in the child’s care and sensitive to the child’s needs. They can provide advice about whether to reveal this information, how much you should tell, and who should know.

83. Can a child with HIV infect another child through casual contact, fighting, or contact sports?

HIV is not passed through casual contact like hugging, touching, or sharing toys It is highly unlikely that a child could get HIV through fighting or contact sports. The external contact with blood that might occur in a sports injury or through a fight is very different from the direct entry of someone else’s blood into your bloodstream that occurs from sharing needles or drug works.

82. Are children in foster care tested for HIV? Who receives the results?

Foster care agency workers assess all children who enter foster care for their risk of HIV infection. If a child is thought to be at risk for HIV and is not able to make an informed decision about testing, foster care staff get a signed consent from the appropriate guardian and make arrangements to have the child tested for HIV. Children and youth who are at risk for HIV and who are determined by the foster care agency to have the ability to make an informed decision about testing are recommended, but not required, to have an HIV test.

Authorized foster care agencies, foster and adoptive parents, local Departments of Social Services, Family Court, and health care providers have a right to know HIV information about children in foster care. However, they may not disclose HIV-related information to anyone else, unless it is for the care and treatment of the child.

81. Should a child with HIV get regular childhood immunizations?

Yes. Immunizations are important for all children. However, the schedule of immunizations is different for children with HIV, so it is important to tell the health care provider that the child has HIV. Also, vaccines given to an infant or child with HIV may become less effective over time as the child’s immune system gets weaker. So, a child with HIV who is exposed to any childhood disease should receive medical attention, even if the child has been vaccinated.

80. Do health care providers need to know if a child has HIV?

Yes. Health care providers need to know the HIV status of anyone who they treat in order to give the best possible health care. Children with HIV may develop infections and illnesses that require special medical attention. They may need medicines to fight HIV or to prevent HIV-related illnesses. Children with HIV also have a special childhood vaccination schedule .

79. Do children get HIV?

Yes. A woman can pass HIV to her baby during pregnancy, delivery, or breastfeeding (see question 20). However, there are medicines that a pregnant woman can take to greatly reduce the chance of her baby being born with HIV . These medicines have resulted in a large reduction in the number of babies infected with HIV in the United States.

The New York State Department of Health AIDS Institute and the State Office of Children and Family Services have published a manual, Caring for Children with Special Needs. The manual provides parents, foster parents, and other caregivers with information and support to meet the challenges of raising children with HIV. It is available online at http://www.health.state.ny.us/nysdoh/hivaids/child/index.htm.

78. How should parents talk to their children about HIV and AIDS?

Children and Adolescents/Young Adults

Parents should talk with their children about HIV and AIDS for many reasons, including:

• to make sure their children are getting accurate information that is appropriate for their age; and

• to help their children learn skills to reduce the risk of becoming infected

with HIV and protect themselves later in life.

Parents should look for chances to discuss HIV and AIDS directly with their children before their children are sexually active or experiment with drugs. A good way to approach the subject is to ask children what they are learning about HIV and AIDS in school. Or, parents can use news articles or stories on television, radio, or in the newspaper to start a conversation.

Parents should learn the facts about HIV and AIDS before talking with their children. Health departments, school health teachers, clinics, physicians, AIDS-related community organizations, libraries, and the Internet are good resources.

For a listing of HIV/AIDS educational materials written specifically for parents, call the New York State Department of Health AIDS Institute at (518) 474-9866 or

visit the website at http://www.health.state.ny.us/nysdoh/aids/index.htm for an order form; or call the National AIDS Information Clearinghouse at 1-800-458­5231. Parents of children with HIV should refer to question 79 below.

77. How can I learn about experimental treatments for people with HIV?

For information about clinical trials or experimental treatments for HIV in New York State and nearby areas, contact the AIDS Community Research Initiative of America (ACRIA). ACRIA can help locate a specific clinical trial and provide treatment education and information on community services.

For more information, contact ACRIA at (212) 924-3934, ext. 121 or by e-mail:

treatmented@acria.org. The group’s website address is: www.acria.org. ACRIA provides detailed information on many federally and privately sponsored clinical trials. Call 1-800-TRIALS-A.

76. Do prisoners have access to up-to-date HIV treatments?

All people with HIV, including those in prison, should have access to healthcare and appropriate HIV treatment. For more information, speak with the medical staff at the prison or contact the New York State Prison HIV Hotline at (716) 854­5469, Monday – Friday,12pm-8pm; Saturday – Sunday, 10am-6pm; collect calls are accepted from inmates in New York State Correctional Facilities

75. Are people with HIV who receive Medicaid required to join a managed care program?

No. People with HIV/AIDS who are on Medicaid do not have to join a managed care plan and can continue to get health care as they have in the past. However, this may change in the future, and people with HIV/AIDS who are on Medicaid may have to choose between a regular managed care plan or an HIV Special Needs Plan (SNP). SNPs are special health care plans for people with HIV or AIDS who are on Medicaid. People who join an HIV SNP choose a primary care doctor who is an HIV specialist – a doctor with special training and experience in treating people with HIV. SNPs pay for the same services as regular Medicaid, plus special services that are important for people living with HIV/AIDS. For more information about SNPs and managed care choices for people receiving Medicaid, call the New York Medicaid CHOICE HelpLine at 1-800-505-5678 or 1-888-329-1541 TTY/TDD

74. How can people with HIV and AIDS pay for their medical care?


Care for patients with HIV infection and AIDS is generallypaid for in the same way as other forms of medical care:• by the government (Medicaid, Medicare, and theHIV Uninsured Care Program, which includes the AIDS Drug Assistance Program, known as ADAP); or

• by private insurance companies. Most group health insurance plans cover HIV and AIDS medical treatment, although some have a maximum amount they will cover. People with HIV who are on Medicaid can now choose an HIV Special Needs Plan (SNP). SNPs are special Medicaid Managed Care Plans that allow people with HIV to choose HIV specialists as their primary care doctors and give patients access to special services.

The New York State Medicaid Program pays for drugs for persons on Medicaid. In addition, the New York State Department of Health operates the HIV Uninsured Care Program, including ADAP, which offers free drugs, primary care, and home care for people who do not qualify for Medicaid and who meet income requirements. ADAP can help people with no insurance or partial insurance. The program includes these services:

ADAP pays for medicines for the treatment of HIV- and AIDS-related conditions.

ADAP Plus (Primary Care) pays for primary care services at participating clinics and hospital outpatient programs, drug treatment programs, and private doctors’ offices.

• The HIV Home Care Program pays for a person’s home care services that are identified by their doctor. The maximum lifetime Home Care benefit per person is $30,000.

• APIC (ADAP Plus Insurance Continuation) pays for the health insurance of people with HIV who meet certain income and insurance criteria.

• AHIP (AIDS Health Insurance Program), operated by Medicaid, also pays for the health insurance of people with HIV who meet certain employment, income, and insurance criteria. But the criteria are slightly different from those of the APIC program. People who do not qualify for AHIP may qualify for APIC.

73. Where can people with HIV get medical care?

Hospital clinics. The New York State Department of Health has identified some hospitals as Designated AIDS Centers because they have special care programs for people with HIV infection and AIDS. Designated AIDS Centers are required to coordinate the full range of medical services needed by patients with HIV and AIDS, including inpatient and outpatient care, home health care, oral health care, and mental health care. Some Designated AIDS Centers now have special programs for women, children, and adolescents with HIV and AIDS. These hospitals are also generally involved in HIV-related research programs. There are also hospitals that are not Designated AIDS Centers but have experience in treating people with HIV. For more information about Designated AIDS Centers, call the New York State Department of Health AIDS Institute HIV Health Care

Community health centers. Many people with HIV receive their medical care from clinics in the community where they live. There are also special programs for children, adolescents, and substance users. Most HIV clinics also provide case management to help people with HIV get the other services they need. People who need referrals to health care facilities should contact their nearest AIDS

service organization or the HIV Counseling and Testing Hotline: 1-800-872-2777.

Drug treatment programs. For people with HIV who are being treated for drug use, some drug treatment programs also provide HIV medical care on site. To

find one of these sites near you, call 1-800-541-AIDS and ask for a listing of drug

treatment programs that also have HIV medical care services. This call is free and private. Health care in these sites can be accessed by persons enrolled in the drug treatment program.

Private doctors’ offices. People with HIV can get care from private doctors in their community. It is important to see a doctor who is knowledgeable about HIV, sometimes called an HIV specialist. Doctors who take special training and meet certain requirements are called HIV specialists by the New York State Department of Health.

Day treatment programs. There are many adult day treatment programs in New York State that offer medical care, nursing care, and substance use and related health services to people with HIV who meet certain requirements. For more information, call the New York State Department of Health AIDS Institute

Chronic Care Section at (518) 474-8162.

Home care programs. Throughout the state, a number of AIDS home care programs provide nursing and other services in the homes of people who have AIDS-related illnesses. For more information, call the New York State Department of Health AIDS Institute Chronic Care Section at (518) 474-8162.

Skilled nursing facilities. The New York State Department of Health has helped to develop HIV/AIDS nursing homes that provide medical care and special services for severely ill patients. For more information about skilled nursing facilities, call the New York State Department of Health AIDS Institute Chronic Care Section at

(518) 474-8162.

72. What do people with HIV need to know about hepatitis?

.

People with HIV should be tested for hepatitis A, hepatitis B, and hepatitis C. These illnesses can cause severe liver problems, especially in people with HIV. Hepatitis A is commonly spread through contaminated food or water. Hepatitis B and hepatitis C can be spread through unprotected sex or by sharing needles with a person who has either of these viruses. People with HIV should talk to their doctor about their risk for hepatitis, how to avoid infection, and whether they should receive vaccines to prevent hepatitis A and hepatitis B (there is no vaccine for hepatitis C). There are treatments available for hepatitis B and hepatitis C, but they do not work for everyone.

71. What is the connection between HIV and TB?

TB (tuberculosis) is one of many diseases that a healthy immune system can usually keep under control. Only about 10% of people with normal immune systems who have the TB bacteria will get sick with active TB.

However, a person with HIV who has the TB bacteria and a weak immune system is much more likely to develop active TB disease. Untreated active TB can be spread to others by coughing. TB can usually be cured with medicines. Active TB can be prevented by taking medicine before symptoms start. All people with HIV who have not had a positive TB skin test in the past should be tested for TB once a year.

That way, if they are infected, they can take medicine to avoid getting sick with active TB

70. Are there alternative or complementary treatments for HIV?

Many people with HIV are interested in alternative or complementary treatments, including herbs, supplements, acupuncture, and other nontraditional treatments. Some people feel that these treatments reduce their symptoms, such as nausea or pain. Unfortunately, the safety and effectiveness of many of these treatments have not been well studied or are not known. In some cases, these treatments may be harmful. Some commonly used supplements, including St. John’s Wort and milk thistle, have been shown to reduce the effectiveness or increase the side effects of some HIV medicines.

To avoid problems, people with HIV should tell their doctors about all of the treatments they use, including all herbs, vitamins, and other supplements.

69. Can a person who is on methadone maintenance take HIV medicines?

Yes. However, some HIV medicines interact with methadone and may require a change in the dosage of methadone or the HIV medicine. People with HIV should tell their doctors about all the medicines they take, including methadone, so that their doctors can prescribe medicines that will work best. People on methadone should tell their methadone clinic about any HIV medicines they take so that they can get the dose of methadone they need.

68. When should a person with HIV begin taking HIV medicines?

There is no one simple answer to this question. Many factors influence the decision to begin taking HIV medicines, including CD4 cell count, viral load, symptoms, concern about side effects and your ability to deal with them, and your ability to take the medicines correctly. The following recommendations are based on CD4 count, viral load, and symptoms, but people with HIV should keep in mind that personal factors are important, too.

Treatment is strongly recommended if:

symptoms of HIV/AIDS appear; or,

CD4 count falls below 200.

Treatment should be offered if:

there are no symptoms, but CD4 count is between 200 and 350; or,

there are no symptoms, and CD4 count is higher than 350, but viral load is higher than 55,000 copies/mL PCR. Some experts would delay treatment at this point, but would keep checking viral load and CD4 cell counts.

Treatment is not recommended if:

• CD4 count is higher than 350, viral load is less than 55,000 copies/ mL PCR, and there are no symptoms of HIV/AIDS. Most experts would not begin treatment and would continue checking viral load and CD4 cell counts.

67. What is drug resistance?

Drug resistance happens when HIV mutates, or changes itself, so that the HIV medicines a person is taking are no longer effective. People who become resistant to one drug may also become resistant to other drugs, including drugs they have never taken. Tests are available to help find out whether a person is resistant to any HIV medicine.

Drug resistance is much less likely to develop if the amount of HIV in a person’s body is kept as low as possible. That is why it is important that people with HIV take their HIV medicines as prescribed and not skip doses. Case managers, adherence counselors, and treatment educators can help people with HIV figure out strategies for taking their HIV medicines successfully.

66. How is HIV infection treated?

Treatment for HIV infection includes:

Highly Active Anti-Retroviral Treatment (HAART);


preventive treatment to avoid opportunistic infections;

treatments for HIV-related illnesses; and

• healthy living practices.

HAART (Highly Active Anti-Retroviral Therapy) involves taking three or more drugs that fight HIV at the same time. HAART can strengthen the immune system and reduce the amount of HIV in the blood. Many medicines are available, and no one combination is best for everyone. Not everyone with HIV needs HAART, which is usually started only when signs of immune system damage or symptoms of HIV appear.

Drugs that fight HIV are divided into several “classes” or types. The different classes of drugs are used in combinations. Each class of drugs affects HIV in a different way:

NRTIs (nucleoside and nucleotide reverse transcriptase inhibitors) interrupt the first step that HIV takes to “copy” itself inside a cell.

NNRTIs (non-nucleoside reverse transcriptase inhibitors) also interrupt the first step that HIV takes to copy itself, but in a different way than NRTIs.

Protease inhibitors interrupt the last step that HIV takes to copy itself.

Entry inhibitors (including fusion inhibitors) stop HIV from entering a healthy cell.

New medicines in each of these drug classes are being developed. New drug classes, which attack HIV in new ways, are also being researched. Drugs that fight HIV have improved the health of many people, but these treatments are not perfect. HIV medicines can be hard to take and often have side effects, some ofwhich are serious and even life threatening. Missing or delaying just a few doses of medicine can lead to the person developing “resistance” to the drugs, which means that the drugs will stop working.

Opportunistic illnesses like PCP (Pneumocystis carinii pneumonia) and MAC (Mycobacterium avium complex) affect people whose immune systems are severely weakened by HIV. However, many of these illnesses can be prevented by taking certain medicines as soon as the immune system becomes weak. Since the immune system can be severely weakened before symptoms appear, it is important for people with HIV to see their doctors so that they can begin preventive treatment as soon as it is needed. A HAART regimen is the most effective way to strengthen the immune system.

Treatments for AIDS-related illnesses. Treatments for AIDS-related cancers, infections, and other conditions are available. Combining these treatments with HAART, as needed, can help people with AIDS live healthier, longer lives.

People with HIV should ask their doctor, nurse, or case manager for more information about these topics before they make any changes to their treatment plan.

Healthy living. Good health habits can play an important role in the treatment of HIV. Important factors include:

eating healthy foods


preparing and storing food safely


taking vitamins as directed by a doctor or nutritionist


exercise (both aerobic and muscle-building)


getting enough sleep


stress management

avoiding alcohol, cigarettes, street drugs, and other harmful substances. Smoking increases the risk of bacterial pneumonia, thrush, and other oral health problems.



65. What are CD4 cell counts and viral load tests?

CD4 cells are part of the immune system. Over time, HIV kills CD4 cells, making the immune system weaker. A person’s CD4 cell count shows the strength or weakness of the immune system. Viral load is the amount of HIV in a person’s blood. Over time, without treatment, the viral load of a person living with HIV gets higher. HIV treatment with HAART (Highly Active Anti-Retroviral Therapy) usually lowers the viral load. When the amount of HIV in the blood is so low that blood tests cannot find it, it is called an undetectable viral load. A person with an undetectable viral load is less likely to get sick but still has HIV and can pass the virus to others.

CD4 cell count tests and viral load tests give people with HIV and their doctors important information about a person’s HIV infection and immune system strength. These tests help show whether a person should consider taking medicines for opportunistic infections and/or medicines to fight HIV (HAART). They also show how well HAART is working. People with HIV should have a CD4 cell count test and a viral load test done at least every six months. If they are taking HAART, these tests should be done at least every four months.

New York State laboratories automatically give the results of these tests and drug resistance tests to the State Department of Health. The reporting process is very secure and confidential. Getting these test results will help the State Department of Health track the quality of health care for people with HIV; find out about drug-resistant strains of HIV in the community; and better track the epidemic to plan prevention, health care, and support services.

64. Should people with HIV tell their doctor, dentist, physician assistant, nurse practitioner, and other health care providers?

Yes. To provide the best medical care, health care providers need to know the HIV status of their patients. It is against the law for health care providers to deny care to people with HIV because of their HIV status. By law, health care providers must keep your HIV status confidential.

63. Do women with HIV need special medical care?

Yes. Some medical problems are more common in women with HIV. These include:

Cervical cancer. HIV-infected women also have high rates of HPV (human papillomavirus) infection, especially those types that lead to the development of cervical cancer. Treatment with antiretroviral drugs may be able to change the course of HPV infection, but this has not yet been proven.

Vaginal yeast infections, which may be more frequent and need longer treatment in women with HIV. Women with HIV should have yearly pelvic exams and PAP smears to look for cervical cancer. Women with HIV also need to know how to prevent pregnancy (if they do not wish to become pregnant) and how to prevent passing HIV to their babies if they do choose to get pregnant. They should talk to a doctor about family planning, including how birth control pills interact with some HIV medicines. It is especially important for pregnant women with HIV to get medical care, because there are medicines that women with HIV can take to greatly reduce the risk of their babies being born with HIV. Children with HIV infection also need medical care as early as possible.

62. Why is it important for people with HIV to get medical care?

People with HIV should seek early medical care so they can:

find out about medicines that fight HIV; and

receive care for HIV-related conditions.

Treatments that fight HIV help people with HIV live longer, healthier lives. Often, it is best to start treatment before symptoms appear. A doctor can do blood tests to find out how much HIV is in a person’s body and how much damage the virus has done to the immune system. This information helps people with HIV and their
doctors decide when to start treatment and how well treatment is working. Early medical care helps people with HIV take best advantage of treatments for HIV. Certain medicines can also prevent some opportunistic illnesses like PCP (Pneumocystis carinii pneumonia). Testing and treatment for other illnesses, like TB (tuberculosis) and STDs (sexually transmitted diseases), is also important.
These illnesses are more common in people with HIV and can make HIV progress more quickly to AIDS.

It is important to see a doctor who is well informed about HIV. The New York State Department of Health designates doctors who meet certain criteria, like treating HIV-infected patients and taking special courses in HIV-related topics, as HIV specialists.

61. When does a person with HIV infection have AIDS?

According to the Centers for Disease Control and Prevention (CDC), a person with HIV infection has AIDS when:

the person’s CD4 cell count, a way to measure the strength of the immune system, falls below 200 (a normal CD4 cell count is 500 or higher); or

the person develops any of the specific serious conditions – also called AIDS-defining illnesses – linked with HIV infection.

60. What are the symptoms of HIV infection?

Shortly after being infected with HIV, some people – but not all people – have flu-like symptoms (fever, muscle aches, feeling tired) that last a few days and then go away. This is sometimes called seroconversion illness or acute HIV infection. Most people with HIV have no symptoms for many years. However, even without symptoms, people who are newly infected have large amounts of HIV circulating in their blood and are highly infectious at that time.

HIV infection cannot be diagnosed from symptoms alone. The symptoms of worsening HIV infection and AIDS – swollen glands, fever, and skin rashes – can also be caused by other illnesses, many of which are more common than HIV infection. Only an HIV test can show whether a person has HIV .

59. If a person is exposed to HIV outside of the work setting, is there anything he or she can do to prevent infection?

New York State Department of Health guidelines call for postexposure prophylaxis (PEP) at certain times when people are potentially exposed to HIV when a condom breaks or during a sexual assault. PEP involves taking a combination of HIV medicines, usually for four weeks. There is no proof yet that PEP after HIV exposure outside the work setting reduces the risk of HIV infection. However, PEP does reduce the risk of HIV transmission after needle-sticks and helps prevent mother-to-child HIV transmission; so PEP may also be helpful for other types of exposure. PEP should be started as soon as possible, but no longer than 36 hours, after the exposure. PEP is not a “morning after” pill that you take for a day. For PEP to work, every dose of every medicine must be taken, for the full period of time. PEP can have serious side effects and should be taken with guidance from an experienced care provider. PEP is expensive, but payment assistance is available for sexual assault victims.

58. How can health care workers and others at risk of on-the-job exposure reduce the risk of HIV infection?

Health care workers and others who come in contact with potentially infectious blood and/or other body fluids on the job can reduce their risk by following strict safety guidelines, such as the Universal Precautions. These guidelines include wearing latex gloves when taking blood samples or injecting medicine and vaccines and washing hands before and after all procedures.

While these guidelines have helped to reduce the frequency of exposure to HIV, needle-sticks and other direct contact with blood and body fluids sometimes occur. For some exposures, the New York State Department of Health recommends that the health care worker or other workers take medicines to reduce the risk of HIV infection. This form of treatment – postexposure prophylaxis (PEP) – works best when it is started within a few hours, and no more than 36 hours, after HIV exposure. Although PEP can decrease the risk of HIV transmission to a person who has been exposed on the job, some people using PEP may still become infected with HIV. A health care worker who has a needle-stick injury or other direct contact with blood or body fluids should be evaluated right away to determine whether PEP is needed.

57. Does using alcohol or other non-injected drugs increase my risk of HIV infection?

Yes. Using non-injected drugs like alcohol, marijuana, crystal methamphetamine, ecstasy, or crack reduces your ability to make good decisions about safe sex and using clean needles and works. If you are drunk or high, you are less likely to think about protecting yourself and others from HIV. Cocaine tends to increase a person’s sex drive and to decrease sexual inhibitions, which can make him or her less likelyto use condoms and to avoid high-risk sex activities. Crystal methamphetamine (“crystal meth”) – whether non-injected or injected – has effects similar to cocaine, but it lasts even longer. Crystal meth has become popular among men who have sex with men and other groups. Its use appears to be leading to increased unprotected sex and greater potential risk of HIV transmission.

People who are addicted to drugs may also trade sex for money or drugs, which further increases their HIV risk. Evidence shows that treatment programs for any kind of substance use can reduce high-risk sex and drug-using behavior.

56. How do I dispose of needles and syringes?

Put used needles and syringes in a “sharps” container or a puncture-resistant plastic bottle. Bleach or laundry detergent bottles are good choices.

Close the screw-on top tightly. You may want to tape it as well. Label the bottle: “Contains Sharps.”

Do not put sharps in soda cans, milk cartons, glass bottles, or any container that is not puncture resistant. Coffee cans are not recommended because the lids come off too easily.

To dispose of your sharps container:

• In New York State, all hospitals and nursing homes must have a place and time that they accept household sharps (including needles, syringes, and lancets) for disposal. You can also call (518) 473-7542 to get a directory of sharps disposal sites.

• In several regions in New York State, sharps may be disposed of in collection kiosks located in pharmacies and health care clinics. Call (518) 473-7542 to find out where these sites are located.

• Ask your pharmacist about the best methods and locations for safely disposing of used sharps. He or she may be able to accept used sharps for safe disposal or tell you about other convenient sites for safe disposal. You may also be able to purchase personal sharps disposal containers at your pharmacy.

• In many areas, including New York City, it is legal to put your sealed sharps container in the trash. Call your local sanitation department to find out if this is allowed in your community. Do not put sharps containers in with recycled household items.

New HIV/AIDS drug treatments have lowered the number of AIDS-related deaths in the United States.

If you are HIV positive and pregnant, there are medicines you can take that can greatly decrease the chances of your baby having HIV.