Opportunistic infections (OIs) are infections that occur more frequently and are more severe in people with weakened immune systems, including people with HIV. Many OIs are considered AIDS-defining conditions. That means if a person with HIV has one of these conditions, they are diagnosed with AIDS, the most serious stage of HIV infection.
AIDS is the late stage of HIV infection that occurs when the body’s immune system is badly damaged because of the virus. In the U.S., most people with HIV do not develop AIDS because taking HIV medicine every day as prescribed stops the progression of the disease. A person with HIV is considered to have progressed to AIDS when: the number of their CD4 cells falls below 200 cells per cubic millimeter of blood (200 cells/mm3). (In someone with a healthy immune system, CD4 counts are between 500 and 1,600 cells/mm3.) OR they develop one or more opportunistic infections regardless of their CD4 count. Without HIV medicine, people with AIDS typically survive about 3 years. Once someone has a dangerous opportunistic illness, life expectancy without treatment falls to about 1 year. HIV medicine can still help people at this stage of HIV infection, and it can even be lifesaving. But people who start ART soon after they get HIV experience more benefits—that’s why HIV testing is so important.
OIs are caused by a variety of germs (viruses, bacteria, fungi, and parasites). These germs spread in different ways, such as in the air, in body fluids, or in contaminated food or water. They can cause health problems when a person’s immune system is weakened by HIV disease.
People living with HIV are at greatest risk for OIs when their CD4 count falls below 200. However, some OIs can occur when a person’s CD4 count is below 500. That’s because weakened immune system makes it harder for the body to fight off HIV-related OIs.
OIs are less common now than in the early days of HIV and AIDS when there was no treatment. Today’s HIV medicines (called antiretroviral therapy or ART) reduce the amount of HIV in a person’s body and keep the immune system stronger and better able to fight off infections.
However, some people with HIV still develop OIs for reasons such as:
they do not know they have HIV and so they are not on treatment
they know they have HIV but are not taking ART
they were living with HIV for a long time before they were diagnosed and so have a weakened immune system
they are taking ART, but their drug combination is not working as expected and is not keeping their HIV levels low enough for their immune system to fight off infections
The best way to prevent OIs is to take HIV medication daily as prescribed so that you can get and keep an undetectable viral load and keep your immune system strong.
It is also important to stay in HIV medical care and get lab tests done. This will allow you and your health care provider to know when you might be at risk for OIs and discuss ways to prevent them.
Some of the ways people living with HIV can reduce their risk of getting an OI include:
avoiding exposure to contaminated water and food
taking medicines to prevent certain OIs
getting vaccinated against some preventable infections
If you develop an OI, there are treatments available such as antiviral, antibiotic, and antifungal drugs. The type of medicine used depends on the OI. Once an OI is successfully treated, a person may continue to use the same medicine or an additional medicine to prevent the OI from coming back. Having an OI may be a very serious medical situation and its treatment can be challenging. For more information about specific OIs, visit CDC’s Opportunistic Infections.
Some groups of people in the United States are more likely to get HIV than others because of many factors, including the status of their sex partners, their risk behaviors, and where they live. When you live in a community where many people have HIV infection, the chances of having sex or sharing needles or other injection equipment with someone who has HIV are higher. You can use CDC’s HIV, STD, hepatitis, and tuberculosis Atlas Plus to see the percentage of people with HIV (“prevalence”) in different US communities. Within any community, the prevalence of HIV can vary among different populations. Gay and bisexual men have the largest number of new diagnoses in the United States. Blacks/African Americans and Hispanics/Latinos are disproportionately affected by HIV compared to other racial and ethnic groups. Also, transgender women who have sex with men are among the groups at highest risk for HIV infection, and injection drug users remain at significant risk for getting HIV. Risky behaviors, like having anal or vaginal sex without using a condom or taking medicines to prevent or treat HIV, and sharing needles or syringes play a big role in HIV transmission. Anal sex is the highest-risk sexual behavior. If you don’t have HIV, being a receptive partner (or bottom) for anal sex is the highest-risk sexual activity for getting HIV. If you do have HIV, being the insertive partner (or top) for anal sex is the highest-risk sexual activity for transmitting HIV. But there are more tools available today to prevent HIV than ever before. Choosing less risky sexual behaviors, taking medicines to prevent and treat HIV, and using condoms with lubricants are all highly effective ways to reduce the risk of getting or transmitting HIV. Learn more about these and other strategies to prevent HIV.
The only way to know for sure if you have HIV is to get tested. You can’t rely on symptoms to tell whether you have HIV.
Knowing your HIV status gives you powerful information so you can take steps to keep yourself and your partner(s) healthy:
If you test positive, you can take medicine to treat HIV. People with HIV who take HIV medicine daily as prescribed can live a long and healthy life and prevent transmission to others. Without HIV medicine (called antiretroviral therapy or ART), the virus replicates in the body and damages the immune system. This is why people need to start treatment as soon as possible after testing positive.
If you test negative, there are several ways to prevent getting HIV.
If you are pregnant, you should be tested for HIV so that you can begin treatment if you're HIV-positive. If an HIV-positive woman is treated for HIV early in her pregnancy, the risk of transmitting HIV to her baby can be very low.
There are several symptoms of HIV. Not everyone will have the same symptoms. It depends on the person and what stage of the disease they are in.
Below are the three stages of HIV and some of the symptoms people may experience.
Stage 1: Acute HIV Infection
Within 2 to 4 weeks after infection with HIV, about two-thirds of people will have a flu-like illness. This is the body’s natural response to HIV infection.
Flu-like symptoms can include:
Swollen lymph nodes
Mouth ulcers These symptoms can last anywhere from a few days to several weeks. But some people do not have any symptoms at all during this early stage of HIV. Don’t assume you have HIV just because you have any of these symptoms—they can be similar to those caused by other illnesses. But if you think you may have been exposed to HIV, get an HIV test.
Request an HIV test for recent infection—Most HIV tests detect antibodies (proteins your body makes as a reaction to HIV), not HIV itself. But it can take a few weeks after you’re infected for your body to produce them. There are other types of tests that can detect HIV infection sooner. Tell your doctor or clinic if you think you were recently exposed to HIV, and ask if their tests can detect early infection.
Know your status—After you get tested, be sure to learn your test results. If you’re HIV-positive, see a doctor as soon as possible so you can start treatment with HIV medicine. And be aware: when you are in the early stage of infection, you are at very high risk of transmitting HIV to others. It is important to take steps to reduce your risk of transmission. If you are HIV-negative, there are prevention options like pre-exposure prophylaxis (PrEP) that can help you stay negative.
Stage 2: Clinical Latency
In this stage, the virus still multiplies, but at very low levels. People in this stage may not feel sick or have any symptoms. This stage is also called chronic HIV infection. Without HIV treatment, people can stay in this stage for 10 or 15 years, but some move through this stage faster. If you take HIV treatment every day, exactly as prescribed and get and keep an undetectable viral load, you can protect your health and prevent transmission to others. But if your viral load is detectable, you can transmit HIV during this stage, even when you have no symptoms. It’s important to see your health care provider regularly to get your level checked.
Stage 3: AIDS
If you have HIV and you are not on HIV treatment, eventually the virus will weaken your body’s immune system and you will progress to AIDS (acquired immunodeficiency syndrome). This is the late stage of HIV infection. Symptoms of AIDS can include:
Rapid weight loss
Recurring fever or profuse night sweats
Extreme and unexplained tiredness
Prolonged swelling of the lymph glands in the armpits, groin, or neck
Diarrhea that lasts for more than a week
Sores of the mouth, anus, or genitals
Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
Memory loss, depression, and other neurologic disorders Each of these symptoms can also be related to other illnesses. The only way to know for sure if you have HIV is to get tested. Many of the severe symptoms and illnesses of HIV disease come from the opportunistic infections that occur because your body’s immune system has been damaged. See your health care provider if you are experiencing any of these symptoms.
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