What Does It Mean to Be HIV-Positive?

Being HIV-positive means that there is evidence of the human immunodeficiency virus (HIV) in your body. Depending on the type of HIV test done, this may be detectable amounts of the virus itself or, more commonly, substances that are only spotted or produced by the immune system when the virus is present.

An HIV-positive status is only confirmed after two HIV tests have been done.

This article explains what it means to be HIV-positive, how people become positive, what to expect from testing, and how treatment can impact life with HIV.

What Makes Someone HIV-Positive

HIV is a virus that attacks cells in the immune system, killing them and leaving the body defenseless against infection. It is transmitted through contact with infected blood, semen, or vaginal fluids.

Once HIV enters the body, it introduces an antigen called p24. This is a viral protein that prompts the immune system to activate white blood cells. On alert that the virus is present, the immune system then starts producing antibodies, proteins that help fight off infection.

The presence of HIV antigens or antibodies in blood, saliva, or urine confirms that someone is HIV-positive. This is detected through an HIV test.

Two Tests Required

Two HIV tests are required to confirm someone's HIV status. This helps ensure that the diagnosis is correct.

False positives—when a test incorrectly says you are infected—are rare. However, they can occur because of a lab issues (like a specimen mix-up or improper handling) or misinterpretation of a result. They can also occur in people with certain health conditions, like autoimmune diseases.

This is why confirmation tests are essential. A positive result is only considered valid when replicated by a second positive result.

While getting a negative result from your initial test is undoubtedly a relief, it's possible that you could still be positive. As such, you'll also need a second test to confirm your result.

False negatives—when test results indicate you're not infected when you really are—are more common than false positives. They are usually the result of testing for a marker of infection within the "window period," which is the time between when someone contracts HIV and when a test can correctly detect it.

The window period depends on the type of HIV test done. For example, it can take 18 to 45 days after exposure for an antigen/antibody test done on a blood sample taken from a vein to detect HIV.

Recap

You are HIV positive when you test positive on both a first test and a confirmation test. A positive HIV test means that HIV antibodies or antigens were found in your blood. False positives are rare but can occur. False negatives are more common and occur from testing too soon.

How Someone Becomes HIV-Positive

Anyone can get HIV. The virus is spread through sexual contact, sharing drug equipment, or general exposure to infected bodily fluids. It can also be transmitted from parent to child during pregnancy and through breast milk.

The following can put someone at higher risk of becoming infected with HIV:

  • Unprotected sex
  • Anal sex
  • Sharing drug needles and syringes
  • Having other sexually transmitted diseases like syphilis, chlamydia, and gonorrhea
  • Accidental needle-stick injuries (more common among healthcare workers)

While it is possible to acquire HIV during a blood transfusion, it is extremely rare. That's because all donor blood in the United States is tested for HIV. However, theoretically, if blood is collected when a person is infected but has not yet acquired enough antibodies for detection, HIV transmission could occur.

HIV Stages: Severity of Infection

Being HIV-positive only says that the virus is in your body. This status does not reveal how advanced the infection is.

HIV is categorized by severity. The three stages differentiate between early infection and progression to acquired immunodeficiency syndrome (AIDS).

Stage 1: Acute HIV Infection

Stage 1 of the HIV infection is known as acute HIV infection. At this stage, the immune system attempts to attack the virus by producing HIV antibodies. This process is called seroconversion, and it usually takes place within a few weeks of infection.

In this stage, those with HIV may experience:

  • Fever
  • Night sweats
  • Joint pain
  • Headache
  • Sore throat
  • Muscle aches
  • Fatigue
  • Swollen lymph nodes
  • Mouth ulcers

Symptoms may be absent in some people, however.

Of note, antibodies will stick around and remain detectable for many years. As a result, someone who is living with HIV will usually continue to test positive on HIV tests. That is true even if their viral load (the amount of HIV in the blood) is undetectable—a possibility thanks to modern treatments.

Stage 2: Clinical Latency

When the body enters stage 2, it is called clinical latency. At this stage, the virus still multiplies but at very low levels.

Infected individuals begin to feel better with little to no symptoms. HIV can still be transmitted to other people during this stage, however.

Stage 3: AIDS

If an HIV infection is left untreated, it will progress to stage 3, acquired immunodeficiency syndrome (AIDS). This is the point at which the virus has now resulted in a condition.

At this late stage of HIV infection, the body's immune system is badly damaged and becomes vulnerable to other infections as well.

Someone with AIDS may experience recurrent fever, extreme fatigue, chronic diarrhea, depression, and memory loss. Other symptoms of AIDS include: 

Fortunately, today, most people with HIV do not develop AIDS. Taking HIV medicine as prescribed stops the progression of the disease so that it does not reach this stage. However, without early detection and access to healthcare, some people still do progress to stage 3.

Without HIV medicine, people with AIDS typically survive about three years.

However, once an untreated individual has an opportunistic infection, their life expectancy falls to about one year. These are infections that are more likely to occur and are usually more severe in someone with HIV/AIDS due to their compromised immune system.

Recap

HIV is staged by severity and includes acute, latent, and AIDS. Symptoms vary, depending on the stage. Some people never develop symptoms at all.

HIV Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Man

Testing After You've Been Diagnosed

After confirming a positive HIV test, your healthcare provider will do further tests to determine the stage of your infection and monitor your case over time.

Besides testing for HIV antibodies and antigens, healthcare providers also look at how a person's immune system functions and examine the level of HIV in the body. One measure they look at is the CD4 test counts. This is the number of CD4 immune cells in the blood.

These cells are vital to the proper functioning of the immune system. A healthy CD4 count is between 500 and 1,600 cells per cubic millimeter. The more CD4 cells a person has, the healthier they are.

A viral load test is the other key measure and it looks at how much virus is found in a blood sample. Viral load can range from undetectable (below the detection levels of current testing) to more than 1 million.

A low CD4 count, defined as 200 or fewer cells per cubic millimeter, indicates AIDS. In addition, it can indicate a higher risk of life-threatening opportunistic infections for those who also have a high viral load.

An undetectable viral load, known as viral suppression, is the goal of therapies.

Starting Antiretroviral Therapy

Unlike when HIV was first discovered, the virus can be effectively managed today thanks to antiretroviral therapy (ART).

ART is a combination of medications that block the HIV virus from replicating in infected people. There are eight classes of ART and dozens of different antiretroviral drugs.

Doctors recommend that people start ART immediately once an HIV-positive diagnosis is confirmed. While ART is not a cure, it can stop the progression of HIV and keep the infected individual healthy for many years.

ART has two major benefits that have redefined the HIV-positive experience:

  • Protects the immune system: When a person has less than 200 copies of HIV per milliliter of blood, the virus is considered suppressed. This can help protect the immune system, which the virus attacks, and make it less likely for the infected individual to become sick.
  • Reduces transmission risk: ART can keep the amount of HIV in someone's blood very low and dramatically lower risk. Studies of serodiscordant couples—those made up of one person who has HIV and another partner who does not—have shown that when individuals with HIV took ART and had a viral load that was effectively suppressed (undetectable viral load), there was zero transmission to their partners.

People who have undetectable viral loads within a year of therapy are more likely to have a normal life expectancy compared with those who failed to achieve viral suppression.

HIV medicine can still help people who have developed AIDS, but it is more effective if taken before the virus reaches this stage.

Recap

ART is a standard HIV treatment that combines medications to keep the virus from replicating. While not a cure, it can keep you healthier and lower the risk of transmitting the virus to someone else.

Taking Care of Yourself

Other ways to keep yourself healthy after an HIV-positive result include: 

  • Staying up-to-date on vaccines
  • Quitting smoking
  • Lowering alcohol intake
  • Maintaining regular doctor's visits
  • Seeing a therapist

An HIV diagnosis often makes people feel distressed and anxious. It’s so important to have a support system that can help you cope with a new HIV-positive diagnosis as well.

If you feel alienated or confused, join an HIV support group.

Summary

Testing positive for HIV means that a blood test and confirmation test found HIV antibodies or antigens in your blood. False negatives occur when you test too soon after exposure. False positives are rare, but can occur as a result of technical mishaps or with some health conditions.

While testing can tell you if you have HIV, it can not tell you how advanced the disease is. If you test positive, you will receive further blood tests that will help a healthcare provider determine the stage of the illness.

ART treatment can suppress the virus, keep you healthier, and lower the risk of transmission.

A Word From Verywell

Getting an HIV-positive diagnosis can be overwhelming. But finding out early can allow you to access treatment and prevent the infection from getting worse.

If you’ve been diagnosed with HIV, locate your HIV care service, your state’s HIV hotline, an HIV health provider, and an HIV specialist. In addition, the Centers for Disease Control and Prevention (CDC) offers a large list of resources for housing, mental health care, traveling, and combating the stigma surrounding HIV. 

Fortunately, advancements in HIV treatment means that most people with HIV are still able to live a long and healthy life.

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16 Sources
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