Which actions transmit the human immunodeficiency virus (HIV select all that apply Quizlet)

Human immunodeficiency virus (HIV) infection is a viral infection that progressively destroys certain white blood cells and can cause acquired immunodeficiency syndrome (AIDS).

• HIV is transmitted through close contact with a body fluid that contains the virus or cells infected with the virus (such as blood, semen, or vaginal fluids).

• HIV destroys certain types of white blood cells, weakening the body’s defenses against infections and cancers.

• When people are first infected, symptoms of fever, rashes, swollen lymph nodes, and fatigue may last a few days to several weeks.

• Many infected people remain well for more than a decade.

• About half of untreated people become ill and develop AIDS, defined by the presence of serious infections and cancers, within about 10 years.

• Eventually, most untreated people develop AIDS.

• Blood tests to check for HIV antibody and to measure the amount of HIV virus can confirm the diagnosis.

• HIV drugs (antiretroviral drugs)—two, three, or more taken together—can stop HIV from reproducing, strengthen the immune system, and thus make people less susceptible to infection, but the drugs cannot eliminate HIV, which persists in an inactive form.

HIV infections may be caused by one of two retroviruses, HIV-1 or HIV-2. HIV-1 causes most HIV infections worldwide, but HIV-2 causes many HIV infections in West Africa.

HIV-1 originated in Central Africa during the first half of the 20th century when a closely related chimpanzee virus first infected people. The global spread of HIV-1 began in the late 1970s, and AIDS was first recognized in 1981.

In 2019, about 38 million people, including 1.8 million children under age 15, were living with HIV infection worldwide. In 2019, about 690,000 people died from AIDS-related illnesses worldwide, compared to 1.9 million in 2004 and 1.4 million in 2010. In 2019, about 1.7 million people, including 150,000 children, were newly infected with HIV, compared to 3.4 million new infections in 1996.

Most (86%) new infections occur in the developing world; over half are in women in sub-Saharan Africa. However, in many sub-Saharan African countries, the number of new HIV infections has greatly decreased, partly because of international efforts to provide treatment and strategies for prevention.

In the United States in 2018, over 1.21 million people aged 13 years or older were estimated to have HIV infection. About 14% of them do not know they have HIV infection. There were 22% fewer cases in 2018 than 2008 and 7% fewer than in 2014. Over two thirds of these new infections occurred in men who have sex with men. Among these men, most infections occurred in black/African-American men (9,400), followed by Hispanic/Latino men (8,000) and white men (5,700).

AIDS is the most severe form of HIV infection. HIV infection is considered to be AIDS when at least one serious complicating illness develops or the number (count) of CD4+ lymphocytes decreases substantially.

When people who are infected with HIV develop certain illnesses, AIDS is diagnosed. These illnesses, called AIDS-defining illnesses, include

• Dysfunction of the nervous system

• A substantial loss of weight due to HIV infection (AIDS wasting)

The transmission of HIV requires contact with a body fluid that contains the virus or cells infected with the virus. HIV can appear in nearly any body fluid, but transmission occurs mainly through blood, semen, vaginal fluids, and breast milk. Although tears, urine, and saliva may contain low concentrations of HIV, transmission through these fluids is extremely rare, if it occurs at all.

HIV is not transmitted by casual contact (such as touching, holding, or dry kissing) or by close, nonsexual contact at work, school, or home. No case of HIV transmission has been traced to the coughing or sneezing of an infected person or to a mosquito bite. Transmission from an infected doctor or dentist to a patient is extremely rare.

HIV is usually transmitted in the following ways:

• Sexual contact with an infected person, when the mucous membrane lining the mouth, vagina, penis, or rectum is exposed to body fluids such as semen or vaginal fluids that contain HIV, as occurs during unprotected sexual intercourse

• Injection of contaminated blood, as can occur when needles are shared or a health care worker is accidentally pricked with an HIV-contaminated needle

• Transfer from an infected mother to a child before birth, during birth, or after birth through the mother’s milk

HIV is more likely to be transmitted if skin or a mucous membrane is torn or damaged—even if minimally.

In the United States, Europe, and Australia, HIV has been transmitted mainly through men who have sex with men and the sharing of needles among people who inject drugs, but transmission through heterosexual contact accounts for about one fourth of cases. HIV transmission in Africa, the Caribbean, and Asia occurs primarily between heterosexuals, and HIV infection occurs equally among men and women. In the United States, fewer than 25% of adults who have HIV infection are women. Before 1992, most American women with HIV were infected by injecting drugs with contaminated needles, but now most are infected through heterosexual contact.

Risk of transmitting HIV is highest during vaginal or anal sex when a condom is not used or is used incorrectly. HIV transmission can also occur during oral sex, although transmission is less likely than during vaginal or anal sex.

Risk of HIV infection is increased when semen or vaginal fluids contain a large amount of HIV and/or when there are tears or sores, even small ones, in the skin or membranes lining the genitals, mouth, or rectum. Thus, transmission is much more likely during the following:

• The first weeks after people are infected because at that time, the blood and body fluids contain very large amounts of HIV

• Vigorous sexual activities that damage the skin or membranes lining the genitals, mouth, or rectum

HIV (antiretroviral) drugs can reduce the amount of HIV in semen and vaginal fluids. Thus, treatment of HIV infection with these drugs can dramatically reduce the likelihood of transmission.

Sexual activities that can damage the membranes lining the genitals, mouth, or rectum include fisting (inserting most or all of the hand into the rectum or vagina) and using sex toys.

The risk of being infected with HIV during heterosexual intercourse is higher for young people partly because they have less control over their impulses and thus are more likely to engage in risky sexual behavior, such as having several sex partners and not using condoms.

Recent evidence shows that HIV infected people in whom antiretroviral therapy has reduced their viral load below the current detectable level (virally suppressed) do not sexually transmit the virus to their partners.

Health care workers who are accidentally pricked with an HIV-contaminated needle have about a 1 in 300 chance of contracting HIV unless they are treated as soon as possible after exposure. Such treatment reduces the chance of infection to less than 1 in 1,500. The risk increases if the needle penetrates deeply or if the needle is hollow and contains HIV-contaminated blood (as with a needle used to draw blood or to inject street drugs) rather than simply being coated with blood (as with a needle used to stitch a cut).

Infected fluid splashing into the mouth or eyes has less than a 1 in 1,000 chance of causing infection.

HIV infection can be transmitted from an infected mother to her child in the following ways:

• To the fetus through the placenta

• To the baby during passage through the birth canal

• To the baby after birth through breast milk

If infected mothers are not treated, about 25 to 35% of their babies are likely to be infected at birth, and if they breastfeed, about another 10 to 15% of the babies are likely to be infected.

Treating infected women with HIV drugs can dramatically reduce the risk of transmission. Infected pregnant women should be treated during the 2nd and 3rd trimesters of pregnancy, during delivery, and during breastfeeding. Doing a cesarean delivery and treating the baby for several weeks after birth also reduce the risk.

Infected mothers should not breastfeed if they live in countries where formula feeding is safe and affordable. However, in countries where infectious diseases and undernutrition are common causes of infant death and where safe, affordable infant formula is not available, the World Health Organization recommends that mothers breastfeed. In such cases, the protection provided by breastfeeding from potentially fatal infections may counterbalance the risk of HIV transmission.

Currently, HIV infection is rarely transmitted through blood transfusions or organ transplants.

Since 1985 in most developed countries, all blood collected for transfusion is tested for HIV, and when possible, some blood products are treated with heat to eliminate the risk of HIV infection. The current risk of HIV infection from a single blood transfusion (which is carefully screened for HIV and other bloodborne viruses) is estimated to be less than 1 in about 2 million in the United States. However, in many developing countries, blood and blood products are not screened for HIV or are not screened as stringently. There, the risk remains substantial.

HIV has been transmitted when organs (kidneys, livers, hearts, pancreases, bone, and skin) from infected donors were unknowingly used as transplants. HIV transmission is unlikely to occur when corneas or certain specially treated tissues (such as bone) are transplanted.

HIV transmission is also possible when sperm from an infected donor is used to inseminate a woman. In the United States, measures have been taken to reduce this risk. Fresh semen samples are no longer used. Sperm from donors is frozen for 6 months or more. Then the donors are retested for HIV infection before the sperm is used.

If a sperm donor is known to have HIV infection, washing sperm is an effective way to remove HIV from sperm.

The HIV DNA copy is incorporated into the DNA of the infected lymphocyte. The lymphocyte’s own genetic machinery then reproduces (replicates) the HIV. Eventually, the lymphocyte is destroyed. Each infected lymphocyte produces thousands of new viruses, which infect other lymphocytes and destroy them as well. Within a few days or weeks, the blood and genital fluids contain a very large amount of HIV, and the number of CD4+ lymphocytes may be reduced substantially. Because the amount of HIV in blood and genital fluids is so large so soon after HIV infection, newly infected people transmit HIV to other people very easily.

Simplified Life Cycle of the Human Immunodeficiency Virus

Like all viruses, human immunodeficiency virus (HIV) reproduces (replicates) using the genetic machinery of the cell it infects, usually a CD4+ lymphocyte.

• HIV first attaches to and penetrates its target cell.

• HIV releases RNA, the genetic code of the virus, into the cell. For the virus to replicate, its RNA must be converted to DNA. The RNA is converted by an enzyme called reverse transcriptase (produced by HIV). HIV mutates easily at this point because reverse transcriptase is prone to errors during the conversion of viral RNA to DNA.

• The viral DNA enters the cell’s nucleus.

• With the help of an enzyme called integrase (also produced by HIV), the viral DNA becomes integrated with the cell’s DNA.

• The DNA of the infected cell now produces viral RNA as well as proteins that are needed to assemble a new HIV.

• A new virus is assembled from RNA and short pieces of protein.

• The virus pushes (buds) through the membrane of the cell, wrapping itself in a fragment of the cell membrane and pinching off from the infected cell.

• To be able to infect other cells, the budded virus must mature. It becomes mature when another HIV enzyme (HIV protease) cuts structural proteins in the virus, causing them to rearrange.

Drugs used to treat HIV infection were developed based on the life cycle of HIV. These drugs inhibit the three enzymes (reverse transcriptase, integrase, and protease) that the virus uses to replicate or to attach to and enter cells.

When HIV infection destroys CD4+ lymphocytes, it weakens the body’s immune system, which protects against many infections and cancers. This weakening is part of the reason that the body is unable to eliminate HIV infection once it has started. However, the immune system is able to mount some response. Within a month or two after infection, the body produces lymphocytes and antibodies that help lower the amount of HIV in the blood and keep the infection under control. For this reason, untreated HIV infection may cause no symptoms or only a few mild symptoms for an average of about 10 years (ranging from 2 to more than 15 years).

HIV also infects other cells, such as cells in the skin, brain, genital tract, heart, and kidneys, causing disease in those organs.

The number of CD4+ lymphocytes in blood (the CD4 count) helps determine the following:

• How well the immune system can protect the body from infections

• How severe the damage done by the HIV is

Most healthy people have a CD4 count of 500 to 1,000 cells per microliter of blood. Typically, the number of CD4+ lymphocytes is reduced during the first few months of infection. After about 3 to 6 months, the CD4 count stabilizes, but without treatment, it usually continues to decline at rates that vary from slow to rapid.

If the CD4 count falls below about 200 cells per microliter of blood, the immune system becomes less able to fight certain infections (such as Pneumocystis jirovecii pneumonia Causes ). Most of these infections are rare in healthy people. However, they are common among people with a weakened immune system. Such infections are called opportunistic infections because they take advantage of a weakened immune system.

A count below about 50 cells per microliter of blood is particularly dangerous because additional opportunistic infections that can rapidly cause severe weight loss, blindness, or death commonly occur. These infections include

The amount of HIV in the blood (specifically the number of copies of HIV RNA) is called the viral load.

Viral load represents how quickly HIV is replicating. When people are first infected, the viral load increases rapidly. Then, after about 3 to 6 months, even without treatment, it drops to a lower level, which remains constant, called the set point. This level varies widely from person to person—from as little as a few hundred to over a million copies per microliter of blood.

Viral load also indicates

• How contagious the infection is

• How fast the CD4 count is likely to decrease

• How fast symptoms are likely to appear

The higher the set point of the viral load, the more quickly the CD4 count decreases to the low levels (less than 200) that increase risk of opportunistic infections, even in people without symptoms.

During successful treatment, the viral load decreases to very low or undetectable levels (less than about 20 to 40 copies per microliter of blood). However, inactive (latent) HIV is still present within cells, and if treatment is stopped, HIV starts replicating and the viral load increases.

An increase in the viral load during treatment may indicate the following:

• The HIV has developed resistance to drug treatment.

• The person is not taking the prescribed drugs.

• Both

When initially infected, many people have no noticeable symptoms, but within 1 to 4 weeks, fever, rashes, sore throat, swollen lymph nodes, fatigue, and a variety of less common symptoms develop in some people. Symptoms of initial (primary) HIV infection usually last from 3 to 14 days.

After the first symptoms disappear, most people, even without treatment, have no symptoms or only occasionally have a few mild symptoms. This interval of few or no symptoms may last from 2 to 15 years. The symptoms that most commonly occur during this interval include the following:

• Swollen lymph nodes, felt as small, painless lumps in the neck, under the arms, or in the groin

• White patches in the mouth (thrush Symptoms

  
  ) due to candidiasis (a yeast infection)

• Diarrhea

• Fatigue

• Fever sometimes with sweating

• Progressive loss of weight

• Anemia

Some people progressively lose weight and have a mild fever or diarrhea.

These symptoms may result from HIV infection or from opportunistic infections that develop because HIV has weakened the immune system.

For some people, the first symptoms are those of AIDS.

AIDS is defined as the development of very serious opportunistic infections or cancer—the ones that usually develop only in people with a CD4 count of less than 200 cells per microliter of blood.

More serious opportunistic infections may cause various symptoms depending on the organ affected:

• Lungs: Fever, cough, or shortness of breath

• Brain: Headache, weakness, loss of coordination, or deterioration of mental function

• Digestive tract: Pain, diarrhea, or bleeding

HIV can also cause symptoms when it directly infects and damages organs such as the following:

• Brain: Brain damage with memory loss, difficulty thinking and concentrating, or both, eventually resulting in dementia if HIV infection is not treated, as well as weakness, tremor, or difficulty walking

• Kidneys: Kidney failure with swelling in the legs and face, fatigue, and changes in urination (more common in blacks than in whites), but often not until the infection is severe

• Heart: Heart failure with shortness of breath, cough, wheezing, and fatigue (uncommon)

• Genital organs: Decreased levels of sex hormones, which may cause fatigue and sexual dysfunction in men

HIV is probably directly responsible for a substantial loss of weight (AIDS wasting) in some people. Wasting in people with AIDS may also be caused by a series of infections or by an untreated, persistent digestive tract infection.

Usually, death is caused by the cumulative effects of opportunistic infections or cancers, wasting, and/or dementia.

• Tests to detect antibodies to the HIV virus in a sample of blood or saliva

• Tests to detect HIV RNA in a sample of blood

Early diagnosis of HIV infection is important because it makes early treatment possible. Early treatment enables infected people to live longer, be healthier, and be less likely to transmit HIV to other people.

Doctors also do a complete physical examination to check for signs of opportunistic infections, such as swollen lymph nodes and white patches inside the mouth (indicating thrush), and for signs of Kaposi sarcoma of the skin or mouth.

If doctors suspect exposure to HIV infection, they do a screening test for HIV. Doctors also recommend that all adults and adolescents, particularly pregnant women, have a screening test regardless of what their risk appears to be. Anyone who is concerned about being infected with HIV can request to be tested. Such testing is confidential and often free of charge.

The current (4th-generation) combination screening test tests for two things that suggest HIV infection:

• HIV antigens (p24 antigen)

Antibodies are proteins produced by the immune system to help defend the body against a particular attack, such as that by HIV. Antigens are foreign substances that can trigger an immune response.

The body takes several weeks to produce enough antibodies to be detected by the test, so results of the antibody test are negative during the first few weeks after the virus enters the body (known as the "window period" of acute HIV infection). However, results of the p24 antigen test can be positive as early as 2 weeks after the initial infection. The combination tests can be done quickly by a laboratory. Also, a version of these tests can be done in a doctor's office or clinic (called bedside testing). If results are positive, doctors do a test to distinguish HIV-1 from HIV-2 and a test to detect the amount of HIV RNA in the blood (the viral load).

The newer combination screening test is quicker and less complex than older screening tests, which use enzyme-linked immunosorbent assay (ELISA) to detect HIV antibodies and then confirm positive results using a separate, more accurate, specific test such as the Western blot test.

Other, older rapid bedside tests are also available. These tests can be done using a sample of blood or saliva. If results of these rapid screening tests are positive, they are confirmed by ELISA (with or without Western blot) or by repetition of one or more other rapid tests.

If people at low risk have a negative test result, the screening test is not repeated unless their risk status changes. If people at the highest risk have a negative test result (especially if they are sexually active, have several sex partners, or do not practice safe sex), testing should be repeated every 6 to 12 months.

HIV RNA tests can confirm positive results of an antibody test or detect evidence of HIV infection when antibody test results are negative. HIV RNA tests often use techniques to produce many copies of an organism's genetic material (called nucleic acid amplification). These tests can detect very small amounts of HIV RNA in blood and are very accurate.

If HIV infection is diagnosed, blood tests should be done regularly to measure the following:

• CD4 count

• Viral load

If the CD4 count is low, people are more likely to develop serious infections and other complications of HIV such as certain cancers. Viral load helps predict how fast the CD4 count is likely to decrease over the next few years.

These two measurements help doctors determine

• How soon to start antiretroviral drugs

• What effects treatment is likely to have

• Whether other drugs may be needed to prevent complicating infections

With successful treatment, the viral load falls to very low levels within weeks, and the CD4 count begins a slow recovery toward normal levels.

AIDS is diagnosed when the CD4 count falls below 200 cells per microliter of blood or when extreme wasting or certain serious opportunistic infections or cancers develop.

Various tests may be done to check for conditions that can accompany HIV infection. These tests include the following:

• Bone marrow aspiration and biopsy: To check for low blood cell counts (including anemia), which may be due to lymphomas, cancers, and opportunistic infections

• Computed tomography (CT) with a contrast agent or magnetic resonance imaging (MRI): To check for damage to the brain or spinal cord

At present, there is no effective HIV vaccine to prevent HIV infection or slow the progression of AIDS in people who are already infected. However, treating people who have HIV infection reduces the risk of their transmitting the infection to other people.

Condoms made of latex provide good protection against HIV (as well as other common sexually transmitted infections), but they are not foolproof. Oil-based lubricants (such as petroleum jelly) should not be used because they may dissolve latex, reducing the condom's effectiveness.

Other measures can help. For men, circumcision, an inexpensive, safe procedure, reduces the risk of becoming infected during vaginal intercourse with an infected woman by about half. Whether circumcision reduces the risk of HIV infection in other circumstances is unclear. Because circumcision provides only partial protection against HIV infection, people should also use other measures to prevent HIV infection. For example, if either partner has a sexually transmitted infection or HIV infection, it should be treated, and condoms should be used correctly and consistently.

People who are likely to come into contact with blood or other body fluids at their job should wear protective latex gloves, masks, and eye shields. These precautions apply to body fluids from all people, not just those from people with HIV, and are thus called universal precautions. Universal precautions are taken for two reasons:

• People with HIV may not know that they are infected.

• Viruses that cause other serious disorders (such as hepatitis B and C) can be transmitted by body fluids.

Surfaces contaminated with HIV can easily be cleaned and disinfected because HIV is inactivated by heat and by common disinfectants such as hydrogen peroxide and alcohol.

Because HIV is not transmitted through the air or by casual contact (such as touching, holding, or dry kissing), hospitals and clinics do not isolate HIV-infected people unless they have another contagious infection.

In the United States, the following have almost eliminated transmission of HIV infection by organ transplantation or blood transfusion:

• Screening donors of organs or blood for risk factors for HIV infection

• Screening donated blood for HIV

Risk is reduced further by asking people with risk factors for HIV infection, regardless of their test results for HIV, not to donate blood or organs for transplantation.

However, developing countries have not consistently used sensitive HIV screening tests and have not restricted donors. Consequently, transmission by these routes is still a problem in these countries.

Pregnant women infected with HIV can transmit the virus to the newborn.

• Testing pregnant women to determine whether they are infected with HIV

• If they are infected, treating them with antiretroviral drugs during pregnancy and labor (treatment during labor is especially important)

• Delivering the baby by cesarean rather than by vaginal delivery

• After birth, treating the newborn with zidovudine, given intravenously, for 6 weeks

• If possible, using formula instead of breastfeeding (HIV can be transmitted in breast milk)

Taking an antiretroviral drug before being exposed to HIV can reduce the risk of HIV infection. Such preventive treatment is called preexposure prophylaxis (PrEP). However, PrEP is expensive and is effective only if people take the drug every day. Thus, PrEP is recommended only for people who have a very high risk of becoming infected, such as people who have a partner who is infected with HIV.

PrEP may also be recommended for people who engage in high-risk sexual activities, such as the following:

• Men who have anal sex with men without using a condom

• Heterosexual men and women who do not regularly use condoms during sex with partners whose HIV status is unknown and who are at increased risk of HIV infection

People who use PrEP still need to use other methods to prevent HIV infection, including consistent use of condoms and not sharing needles to inject drugs.

People who have been exposed to HIV from a blood splash, needlestick, or sexual contact may reduce the chance of infection by taking antiretroviral drugs for 4 weeks. These drugs are more effective when they are started as soon as possible after the exposure. Taking two or more drugs is currently recommended.

Doctors and the person who was exposed typically decide together whether to use these preventive drugs. They base the decision on the estimated risk of infection and the possible side effects of the drugs. If they do not know whether the source is infected with HIV, they consider how likely the source is to be infected. However, even when the source of the exposure is known to be infected with HIV, the risk of infection after exposure varies, depending on the type of exposure. For example, risk from a blood splash is less than that from a needlestick.

Immediately after exposure to HIV infection, what is done depends on the type of exposure:

• If skin is exposed, it is cleaned with soap and water.

• Puncture wounds are cleaned with antiseptic.

• If mucous membranes are exposed, they are flushed with large amounts of water.

• Antiretroviral drugs

• Drugs to prevent opportunistic infections

• Drugs to relieve symptoms

Treatment with antiretroviral drugs is recommended for almost all people with HIV infection because without treatment, HIV infection can lead to serious complications and because newer, less toxic drugs have been developed. For most people, early treatment has the best results. Research has shown that people who are promptly treated with antiretroviral drugs are less likely to develop AIDS-related complications and to die of them.

Treatment cannot eliminate the virus from the body, although the HIV level often decreases so much that it cannot be detected in blood or other fluids or tissues. The goals of treatment are

• Reducing HIV level to undetectable

• Restoring CD4 count to normal

If treatment is stopped, the HIV level increases, and the CD4 count begins to fall. Thus, people need to take antiretroviral drugs for their lifetime.

Before starting a treatment regimen, people are taught about the necessity of the following:

• Taking drugs as directed

• Not skipping any doses

• Taking the drugs for the rest of their life

Taking the drugs as directed for a life time is demanding. Some people skip doses or stop taking the drugs for a time (called a drug holiday). These practices are dangerous because they enable HIV to develop resistance to the drugs.

Because taking HIV drugs irregularly often leads to drug resistance, health care practitioners try to make sure that people are both willing and able to adhere to the treatment regimen. To simplify the drug schedule and to help people take the drugs as directed, doctors often prescribe treatment that combines two or more drugs in one tablet that can be taken only once a day.

Exposure to HIV does not always lead to infection, and some people who have had repeated exposures over many years remain uninfected. Moreover, many HIV-infected people remain well for more than a decade. A very few HIV-infected, untreated people have remained well for over 20 years. Why some people become ill so much sooner than others is not fully understood, but a number of genetic factors appear to influence both susceptibility to infection and progression to AIDS after infection.

If infected people are not treated, AIDS develops in most of them. How quickly the number of CD4 cells decreases and HIV infection progresses toward AIDS varies greatly from person to person. Generally, experts estimate that if untreated, people develop AIDS at the following rates:

• For the first several years after infection: 1 to 2% each year

• Each year thereafter: 5 to 6%

• Within 10 to 11 years: 50%

• Eventually: More than 95%, possibly all if they live long enough

However, with effective treatment, the HIV RNA level decreases to undetectable levels, CD4 counts increase dramatically, and people can continue to lead productive, active lives. The risk of illness and death decreases but remains higher than that of people who are of similar age and who are not infected with HIV. However, if people cannot tolerate or take drugs consistently, HIV infection and immune deficiency progresses, causing serious symptoms and complications.

Usually, HIV infection does not directly cause death. Instead, HIV infection leads to a substantial loss of weight (wasting), opportunistic infections, cancers, and other disorders, which then lead to death.

Cure has been thought to be impossible, although intensive research on how to eliminate all of the latent HIV from infected people continues.

Because death rarely occurs suddenly in people with AIDS, people usually have time to make plans for the kind of their health care they want if their condition worsens. Nonetheless, people should record such plans in a legal document early and should include clear instructions about the kind of care they want (called advance directives Advance Directives Health care advance directives are legal documents that communicate a person’s wishes about health care decisions in the event the person becomes incapable of making health care decisions. There... read more ). Other legal documents, including powers of attorney and wills, should be prepared. These documents are particularly important for those patients whose partners, loved ones, or caregivers are not legally recognized, which may result in those partners or other loved ones being unable to visit or be involved in decision-making or carry out funeral and burial wishes, being excluded from inheriting assets, possibly including the family home, or other dire consequences.

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

• HIVinfo: Information from the National Institutes of Health (NIH), including a glossary of HIV-related terms and a drug database

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