Preventing HIV Infections

When HIV infects the body, the immune system produces antibodies.  Antibodies are gluey proteins that stick to the virus particles trying to stop some of them from infecting more cells. HIV Antibody tests look for antibodies made to fight HIV. Since the body takes 6 weeks to 3 months to produce anti-HIV antibodies, an HIV antibody test typically will not detect HIV infection for 6 weeks to 3 months after it occurs. HIV antibody tests are widely used because they are inexpensive and easy to administer as rapid tests in a clinic or in an outreach situation. However, they are much slower to detect HIV than HIV antigen testing.
 

When HIV infects the body, the virus inserts its genetic instructions into human cells and forces the cells to make billions of copies of the virus. HIV Antigen tests look for HIV particle surface proteins that reach detectable levels much sooner than HIV antibodies form, typically in about 2 weeks. So antigen tests can identify quite recent HIV infections that antibody tests would not detect for several more weeks.  Because they detect HIV so much faster after infection, HIV antigen tests are becoming more widely used. However, they do require a blood sample from either a finger stick or a venous blood draw. And only programs with certified laboratories can offer the rapid antigen test, so not all programs can offer same-day results for this type of test. 
 

During HIV infection, HIV seizes control of human cells by injecting a molecule called Ribonucleic Acid (RNA) into the cell. Viral RNA contains the genetic instructions, which force the cell to manufacture billions of copies of the virus until the cell actually explodes, releasing viral particles throughout the body to begin the cycle again. HIV Nucleic Acid Testing looks for HIV RNA that reaches detectable levels sooner than HIV antibodies or even HIV antigens (surface proteins) form. So HIV Nucleic Acid tests can identify quite recent HIV infections that neither antigen nor antibody tests would yet detect. Because they are much more expensive than HIV antibody and antigen tests, HIV Nucleic Acid testing is used for specialized needs, sometimes to confirm preliminary positive tests identified by more affordable screening tests.
 

Rapid HIV tests typically process a sample of oral fluid or fingerstick blood at the testing location, producing a result in about 20 minutes. Most commonly, these rapid tests will be antibody tests (which will not detect HIV in its first few weeks of infection because the body has not yet produced antibodies to fight HIV). However, programs with certified laboratories can currently offer a rapid test with combined antibody/antigen detection capability, which will detect HIV sooner after infection than an antibody test alone could. 
 
While remarkably accurate as screening tools, rapid tests do have their limitations. They can miss a very recent infection. And they will sometimes give a reactive result when HIV infection has not actually occurred, a result known as a “False Positive.” For this reason, reactive rapid test results are called “Preliminary Positives” and must be confirmed by one or more supplemental laboratory tests.
 

Because rapid HIV tests will sometimes give a “False Positive,” a reactive result when HIV infection has not actually occurred, a rapid test “Preliminary Positive” must always be confirmed by 1 or more supplemental laboratory tests.  Your healthcare provider or HIV testing program will collect a follow-up sample for testing whenever a rapid test comes gives a reactive result. 
 

To locate the HIV Testing program nearest you, call the IDPH HIV/AIDS and STD Hotline at 800-243-2437.

For a list of funded counseling and testing providers in Illinois, see Resources in the right-hand column and click on HIV/AIDS Counseling and Testing Sites.
 

The CDC recommends that Healthcare Providers routinely screen their patients for HIV. Many clinics, hospitals, and state facilities have adopted this recommendation, and routinely run HIV screens on all their patients except those who specifically opt out of testing. The routine HIV testing format does not require risk assessment or risk reduction counseling for all patients, only for those who are confirmed to be HIV positive.

The CDC recommends that all pregnant women receive an HIV test in both their first and third trimester of pregnancy.
 
The CDC recommends that all pregnant women receive an HIV test in both their first and third trimester of pregnancy.
The Illinois Perinatal HIV Prevention Act (410 ILCS 335) was enacted in 2003 to ensure that women are screened for HIV as early in pregnancy as possible. HIV testing protocols for pregnant women should include the following according to the Illinois Perinatal HIV Prevention act:

• Opt-out HIV testing upon entry into prenatal care for ALL pregnant women
• Opt-out repeat HIV testing in the 3^rd trimester (<36 weeks) for ALL pregnant women
  
  1. Since 2006, the U.S. Centers for Disease Control and Prevention (CDC) has recommended a second HIV test for pregnant women for HIV in their 3rd trimester, preferably at 32-36 weeks of gestation. This 3rd trimester HIV test is particularly recommended for women who:
     
     1. Receive healthcare in jurisdictions, such as Illinois, with an elevated incidence of HIV or AIDS
     2. Receive healthcare in facilities in which prenatal screening identifies at least one HIV infected pregnant women per 1000 women screened
     3. Are known to be at high risk for acquiring HIV that are injection drug users and their sex partners, who exchange sex for money or drugs, who are sex partners of HIV infected persons, who have been diagnosed with another sexually transmitted disease within the last year, and women have had a new or more than 1 sex partner during their pregnancy
     4. Have signs or symptoms consistent with acute HIV infection
  2. The American College of Obstetricians and Gynecologists (ACOG) also recommends repeat third trimester testing for women and states that, “Women who are candidates for third trimester testing, including those who declined testing earlier in pregnancy, should be given a conventional or rapid HIV test rather than waiting to receive a rapid test at labor and delivery”
• Rapid HIV testing for any woman who presents to labor and delivery without a documented third trimester HIV test
• Mandatory HIV testing of newborn if no maternal documentation of HIV status is available prior to delivery
• Mandatory reporting of all preliminary positive rapid HIV test results within 24 hours to the State of Illinois’ 24/7 Perinatal HIV Hotline at 800-439-4079 in order to ensure access to care and treatment services

The 24/7 Illinois Perinatal HIV Hotline serves as a resource for clinicians and medical and social service providers to assist with medical and social services for pregnant, HIV-positive women, to help ensure healthy outcomes for both mothers and their babies.
 

HIV Counseling and Testing is recommended for HIV testing programs targeting persons at increased risk for HIV infection.  These programs are expected to identify confirmed HIV-positive persons at a rate of 1% or higher of persons tested.  This rate is approximately ten times higher than, for example, the rate of confirmed HIV found in routine testing for all pregnant women in Illinois.    In addition to testing, HIV Counseling and Testing includes an individual risk assessment to, identify HIV exposure risk behaviors and the circumstances that typically enhance or reduce risk, safer behavior goals and action steps to help reduce risk, and referrals to support risk reduction.
 
For a list of funded counseling and testing providers in Illinois, see Resources in the right-hand column and click on HIV/AIDS Counseling and Testing Sites.
 

Linkage to Treatment and Care Services:  When a series of tests confirms that a person is in fact HIV-infected, the person should be encouraged and supported to get treatment for HIV as soon as possible.  Prompt treatment will protect the person’s immune system to help them lead a long and healthy life.  Treatment can also greatly reduce the amount of HIV in a person’s body lowering (but not eliminating) the chance that they can pass the virus to someone else through having sex or sharing injection equipment.

Partner Services:  When a series of tests confirms that a person is in fact HIV-infected, the person will be encouraged to ensure that all their sex and injection partners are notified of their possible exposure to HIV.

Linkage to Prevention for Positive Services:  Following an HIV diagnosis, prevention counseling can help a person work through powerful emotions to reach an understanding that a fulfilling, responsible romantic and sexual life is possible.  Prevention counseling may be provided one-on-one between client and counselor.   However, some newly diagnosed people find it very helpful at some point to connect with an HIV support group to learn from others living with HIV how they approach living and loving with HIV.   Topic may include learning how to accept one’s own diagnosis, how to disclose HIV status to a potential partner, a variety of methods for protecting a partner, and how to present these options to a partner.  For people with injection histories, prevention counseling should include a continuum of options to reduce or eliminate injection related harms including HIV or other viral transmission.  Prevention counseling may also provide safer options for HIV-impacted couples interested in having children.
 

People living with HIV benefit their own health and that of their loved ones and community by accessing HIV treatment as soon as possible after their diagnosis and by remaining in care. Prompt treatment will protect the person’s immune system to help them lead a long and healthy life. Treatment can also greatly reduce the amount of HIV in a person’s body lessening (but not eliminating) the chance that they can pass the virus to someone else through having sex or sharing injection equipment.

As HIV replicates billions of copies of itself in the body, the copying process is not precise. Many tiny changes in the virus’ genetic code (the RNA sequences) occur in each generation of virus particles, and occasionally a change will occur that makes that virus resistant to medication. The best way to keep the HIV viral load in the body very low and to prevent HIV from developing resistance to HIV medication is to take a “cocktail” made of several HIV medications as prescribed by a physician and to take those very consistently at the right times every single day. Research has proven that missing medications even as little as once per month can increase the rate of viral resistance. So consistency counts!

Prevention of Perinatal HIV Transmission from mother to child involves a number of steps. It is important for HIV positive pregnant women to be offered, accept, and adhere to HIV antiretroviral medications during pregnancy and at labor and delivery. If pregnant women seek and adhere to early treatment, the chance of transmitting HIV to the infant is 1% or less. If pregnant women receive no treatment, the chances of perinatal HIV transmission increase to 25%.

HIV positive women must avoid breastfeeding their infants.  CDC recommends that HIV positive women refrain from breastfeeding to avoid postnatal transmission of HIV to their infants through breast milk.  HIV positive mothers should also make sure they offered, accept and adhere to anti-retroviral therapy for the infant from birth until the infant’s HIV status is confirmed negative.

Consistent, correct condom use is the “gold standard” in preventing HIV and several other sexually transmitted infections. Condoms come in many varieties. Some condom qualities such as the material, form, lubrication, and size may seriously impact their performance. Other differences such as colors or flavors are mostly for fun and will not seriously impact their performance.
 
Condoms are produced from a variety of materials, including latex, polyurethane, nitrile, and non-synthetic material such as “lambskin.” Latex condoms are inexpensive and highly effective in prevention HIV transmission if they are used with a water-based or silicone-based lubricant. Latex condoms should not be used with oil-based lubricants such as hand lotion, petroleum jelly, or baby oil, as oil dissolves latex, making the condom leak and break.  Latex condoms are not recommended for people allergic to latex and may break out in a rash from contact with latex. Though polyurethane and nitrile condoms are more expensive than latex condoms, they provide excellent alternatives for people who are allergic to latex. And these materials are safe with oil-based lubricants as well. Condoms made of animal tissue such as so-called “lambskin” condoms are not effective against HIV and are not recommended for HIV or STI prevention.
 
For help finding a way to talk with your partner about condom use, call the counselors at the Illinois Department of Public Health (IDPH) HIV/AIDS and STD Hotline at 800-243-2437.
 

Sharing syringes, works, drug solutions, or rinse water with others when injecting street drugs can very efficiently transmit HIV and other viruses and bacteria. Learn more about ways to reduce the harms associated with injection. See Resources in the right-hand column and click on Any Positive Change.  
 

While no vaccine against HIV has yet been FDA-licensed, scientists are currently studying 2 types of HIV vaccines: preventive and therapeutic. Preventative vaccines use non-infectious, killed-virus or synthetic virus-like fragments to safely stimulate the body’s immunity against a specific infection so that infection may be prevented in the case of an actual exposure. Therapeutic vaccines are provided to people already living with a viral infection in to train the immune system to control the virus naturally without the need for additional medications.  
 
Though no vaccine is yet approved for clinical use, progress is being made. In 2009, a large-scale vaccine study conducted in Thailand showed that a 2-vaccine combination could reduce new infections by nearly one third.
 
Vaccines for other viruses have been used for decades around the world. When manufactured and used properly, they are safe and cost-effective. Vaccines have often been the most effective, affordable, and practical means to eliminate an infectious disease. Vaccines have eradicated smallpox on a worldwide scale; soon the same will be true of polio. We hope one day to be able to add a HIV to the list of diseases preventable by a vaccine.
 

While no Microbicides to prevent HIV has yet been FDA-licensed, research is advancing on both vaginal and anal microbicides. Microbicides are gels inserted into the vagina or anus, which will hopefully someday soon be able to protect that person from HIV-infection. Some microbicides are intended to provide a protective seal to protect vulnerable bodily membranes while others have incorporated anti-HIV medications in an effort to stop infection. No study has yet identified a highly effective microbicide, but this is an exciting branch of prevention research.