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AIDS/HIV One Hour, Current Evidence Based Practice

1 Contact Hour including 1 Advanced Pharmacology Hour
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This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Athletic Trainer (AT/AL), Certified Nurse Midwife, Certified Nurse Practitioner, Certified Nursing Assistant (CNA), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Dietetic Technicians, Registered (DTR), Dietitian/Nutritionist (RDN), Electrologist (EO), Home Health Aid (HHA), Licensed Nursing Assistant (LNA), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Medical Assistant (MA), Medication Aide, Midwife (MW), Nursing Student, Occupational Therapist (OT), Occupational Therapist Assistant (OTA), Pedorthist (PED), Physical Therapist (PT), Physical Therapist Assistant (PTA), Registered Nurse (RN), Registered Nurse Practitioner, Respiratory Care Practitioner, Respiratory Therapist (RT)
This course will be updated or discontinued on or before Saturday, December 6, 2025

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.

CEUFast, Inc. is an AOTA Provider of professional development, Course approval ID#02781. This distant learning-independent format is offered at 0.1 CEUs Intermediate, Categories: Professional Issues & Foundational Knowledge. AOTA does not endorse specific course content, products, or clinical procedures. AOTA provider number 9757.

CEUFast, Inc. (BOC AP#: P10067) is approved by the Board of Certification, Inc. to provide education to Athletic Trainers (ATs).

Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.

≥ 92% of participants will know the current recommended treatment for HIV and AIDS based on the accumulated evidence.


After completing this continuing education course, the participant will be able to:

  1. Identify the civil rights of the HIV/AIDS-infected individual and their family/friends.
  2. Explain the current prevalence of HIV and AIDS.
  3. Describe the modes of transmission of HIV and various strategies to prevent the spread of HIV.
  4. Examine the pathophysiologic changes in the human body following HIV infection.
  5. Compare and contrast current medication modalities prescribed for the HIV-infected individual.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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AIDS/HIV One Hour, Current Evidence Based Practice
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    David Tilton (RN, BSN)


The infectious disease known as Human Immunodeficiency Virus (HIV) has brought devastation and debilitation to individuals and nations since its world debut in the 1980s. HIV remains a fatal communicable infection whose final terminal stage is Acquired Immunodeficiency Syndrome (AIDS). Individuals, countries, and cultures, particularly in central and southern Africa, have suffered tremendously due to the devastation accompanying HIV, which has rightly been referred to as a scourge of our time (Tumwebaze et al., 2023).

In the past few years, new treatments have been developed which may extend by decades the lifespan of those infected, effectively shifting HIV from an acute terminal illness to a chronic debilitating condition requiring a distinct perspective on care and monitoring. As healthcare professionals, we must keep current on the latest information regarding HIV as it is continuously being discovered. We will review the current evidence-based information concerning the spread (i.e., modes of transmission), available treatments, and the care of the HIV-infected individual, both before and after they progress into the final stage of AIDS. Our informed care is crucial as we strive to help those infected to live healthier, more satisfying lives.

The HIV Infected Have Rights

The prospect of having HIV may provoke fear and dread in the sexually active. This anxiety is reasonable given the history surrounding HIV and AIDS in the United States and globally. HIV infection is a profoundly serious medical condition, though not the sentence of an agonizing wasting death that it was during the 1980s and 1990s. There are now medications that can slow the progression of the disease by decades, in many cases, giving an extension of life to those diagnosed with this progressive lethal virus rather than the near specter of a wasting, suffering death.

The question remains as to why so many in the United States avoid HIV testing and prevention when it is so important to avoid or at least become aware of an infection early. It is allowing early treatment with the potential to slow or avoid the fate they see that is being portrayed by the news media visiting impoverished AIDS-stricken countries in Africa's west, central, and southern regions where a diagnosis of HIV has been the equivalent of a death sentence (Senate Foreign Relations Committee [SFRC], 2023). Perhaps it is the fear of receiving a diagnosis with a fatal infectious disease, or the fear of living with the responsibility of keeping a demanding disease such as HIV/AIDS under control. Keeping HIV under control is a time and resource-consuming task. However, the option of letting the disease run its course unchecked would be an extremely poor choice, as well.

Whatever factors bring hesitation to those needing HIV prevention counseling, screening, or treatment, we know that one commonly held fear is the stigma attached to having HIV or AIDS. Having HIV brings a "scarlet letter" fear of repercussions due to possessing an unwanted health status. When questioned, many of those newly diagnosed with HIV seem unaware that federal laws exist to protect them from discrimination and ensure that benefits such as any social or medical services they would otherwise qualify for will not be withheld. As healthcare professionals, it is important to share with those in high-risk groups that key legislative pieces exist that offer protection from discrimination. Interestingly, some of the mandates and pieces of legislation protecting those with current needs predate the HIV/AIDS epidemic, e.g., Section 504 of the Rehabilitation Act of 1973 and pieces of the 1990 Americans with Disabilities Act (ADA) (, 2023c; Centers for Disease Control and Prevention [CDC], 2022b). These well-established laws mean services that apply to an otherwise qualified individual will also be available to HIV-infected individuals.

Title II of the ADA prohibits discrimination by state and local government organizations, even those not dependent on federal funding. For those nervous or fearful concerning how those close to them might be treated should they acquire HIV, Title II of the ADA also protects an HIV positive individual's friends and family against discrimination or denial of services that might come from being related to someone with HIV (, 2023c).

Information privacy regarding an individual's HIV status, or any other issue of a sensitive nature, is addressed in the 1996 Health Insurance Portability and Accountability Act (HIPAA), whose Privacy Rule is enforced by the Office for Civil Rights (OCR). HIPAA protects the privacy of health information while allowing each individual access to their records to see what is written about them and even ask to make corrections to what is documented (Badahman, 2023).

Awareness of their individual rights and the value that each life inherently possesses are crucial foundational steps leading to the inclusion of those suffering from HIV into society and better health. By emphasizing the importance of everyone’s lives, we, as healthcare professionals, can increase participation of the HIV infected individual in their own care and educate them as well.

Important things to educate all individuals about include:

  • Keep informed of any changes in HIV knowledge and care
  • Use measures to stop the transmission of HIV
  • Avoid high-risk behaviors
  • Get routine screening for HIV infection, if necessary
  • Actively participate in treatment should the individual become infected

Therefore, as we progress to viewing the magnitude of the current HIV pandemic with its slowly widening reach into our culture and homes, remember that we are really dealing with the frightened and wounded. Each is faced with the sudden overwhelming burden of managing the chronic terminal condition of HIV/AIDS.

Impact of HIV & AIDS

According to the U.S. government website,, around 1.2 million Americans are currently infected with the HIV virus (, 2022b). Around 13% of them are unaware of their infection and infectious state. The following table includes a breakdown of the most recent HIV/AIDS statistics.

Table 1: HIV/AIDS Statistics
Latest Available StatisticsUnited States (CDC 2021, 2019*)Worldwide (UNAIDS 2022)
HIV Cases1.2 Million39 Million
HIV Cases Receiving Some Degree of Treatment792,00029.8 Million
HIV Annual New Cases36,1361,300,000
HIV New Male-to-Male Sexual Contact Cases24,107 
HIV New Heterosexual Contact Case8,059 
HIV New Injection Drug Use Cases2,513 
HIV/AIDS Annual Deaths15,810*630,000
(CDC, 2023;, 2023a; Myhre & Sifris, 2022a;, 2022b)

The Centers for Disease Control and Prevention (CDC) reports indicate that the estimated incidence of new HIV infections has stabilized at about 36,000 per year while indicates that the United States has been showing a slow yet steady decrease in newly diagnosed cases each year (CDC, 2023;, 2022). At the height of the HIV pandemic, around 1985, around 130,000 new annual cases were reported, as opposed to the 36,136 in the year 2022 (Myhre & Sifris, 2022a).

Gay, bisexual, and other men who have sex with men (MSM) of all races and ethnicities account for 71% of all new cases of HIV (, 2022b). Young to middle-aged Black American MSM remain the population most profoundly affected by HIV, accounting for around 30% of all new infections (, 2022b). Latinx MSM comes in second at around 20% of new infections, and white MSM amounts to about 15% of new infections (Myhre & Sifris, 2022a).

Another behavior warranting following by public health is the use of illegal injectable medications (CDC, 2023;, 2022a). In the United States, injection drug use in all sex and age groups accounted for around 7% of all HIV cases in 2020.

Transmission & Prevention of HIV Infection

How HIV viral particles enter the bloodstream for an individual to become infected relates directly to the prevention of HIV. This virus, once having invaded the body, is tough and resilient, impossible for the infected individuals' body defenses to destroy. However, outside the body, HIV is fragile and does not survive for long. Misleading rumors about the ease of viral spread have led the CDC to provide a list of ways HIV cannot be spread (CDC, 2021):

  • HIV cannot be spread in the air or water
  • HIV cannot be spread by insects, including bed bugs, ticks, or mosquitoes
  • HIV cannot be spread in saliva, sweat, or tears and no documented case exists of HIV being transmitted by spitting
  • HIV cannot be spread by casual contact, as in sharing dishes or shaking hands
  • HIV cannot be spread by closed mouth or social kissing
  • HIV cannot be spread from toilet seats

HIV Sexual Transmission

HIV infection, both worldwide and in the United States, is most often spread through sexual activities. The second most common spread of HIV is by exposure to infectious blood, most commonly from sharing equipment used taking illicit drugs. Male-to-male sexual contact, "men who have sex with men" or MSM, have several times the rate of infection among resolute heterosexuals.

The Six Bodily Fluids That Can Transmit HIV
  • Blood
  • Semen
  • Pre-ejaculatory fluid
  • Breast Milk
  • Rectal Fluid
  • Vaginal Fluid
(Sharkey, 2023)

The transmission of HIV is significantly affected by the type of sexual exposure. Receptive anal intercourse has a much greater risk of viral transmission than receptive vaginal intercourse. The use of condoms does not prevent transmission due to many factors affecting condoms, such as holes, tears, improper fitting, etc. However, condom use does lower the chance of transmission compared to intercourse without protection.

The presence of other sexually transmitted diseases, such as the ulcerations of genital herpes, can increase the risk of transmission by as much as four times. Circumcision has been shown to decrease the chance of HIV acquisition by the circumcised male and decrease the probability of transmitting HIV from the one circumcised to their partner by as much as two-thirds (Prodger et al., 2022). However, it is important to wait for a new circumcision to heal completely before engaging in intercourse.

Oral sex can spread HIV to both receiver and provider. It is not just the risk of ejaculation during oral sex. Cuts, sores, ulcers, bleeding gums, lesions of any type provide both a source of blood and a receptive area into the bloodstream (Sharkey, 2023). It is important to be aware that anilingus, oral-anal sex also known as rimming, also bears a risk of HIV transmission for either provider or receiver.

HIV Blood Transmission

Transmission of HIV particles into the blood can occur through needle exchange, blood sharing rituals, or unsterilized equipment exposed to blood. Injection drug users (IDUs) constitute a growing population of new HIV cases. Cosmetic instrumentation exposed to blood and certain body fluids may be as great or greater a risk than improperly sanitized medical instrumentation due to the lack of awareness held by some practitioners. Body piercing, tattooing, and even manicure/pedicure tools must all be rigorously and methodically cleaned and disinfected between patients to avoid the spread of life-threatening diseases. Body piercings may provoke small lesions or skin tears where viral transmission can occur. HIV from blood transfusion has become a rare phenomenon, as has transmission from legal surgeries and transplants. A higher risk remains for those who engage in procedures involving illegal market materials or unlicensed practitioners. As a healthcare professional, we ask that you discourage any patients expressing interest in traveling outside the country to avoid slow moving transplant waitlists, a practice referred to as transplant tourism (Gonzalez et al., 2020).

Perinatal Transmission

The HIV virus may also be shared during pregnancy, from mother to child, and during breastfeeding, though this means is becoming less common in industrial countries due to an increase in HIV screening during natal checks (Myhre & Sifris, 2022a). Worldwide, however, perinatal transmission accounts for most of the childhood HIV and AIDS cases. In many settings, due to unclean drinking water, breastfeeding is not an optional activity. Studies are being conducted to determine how best to serve the needs in communities with inadequate resources. Currently, when HIV in mother and infant is determined, ART (antiretroviral therapy) is begun in both mother and infant, and what support is available is offered (National Institute of Health [NIH], 2023).

Prevention of HIV During Sex

Transmission methods relate closely to means of prevention. Sexual abstinence, for example, is a 100% secure means of preventing transmission or receiving HIV by sex. Most people have periods of abstinence during their life. Reasons vary and are often personal. Abstaining from sex also prevents other sexually transmitted infections, and pregnancy.

The highest risk sexual practice for HIV for both participants has been shown to be anal sex, with a risk level of 1.38% per exposure for the receiver of the anal sex, and around 0.11% per exposure for the penetrating partner (Eske, 2023). Higher risk by the receptive partner is due to the thin lining of the rectum which is easily injured. The thin tissue of the urethra of the insertive partner may easily pick up HIV or other sexually transmitted diseases. Sores, small cuts, or skin breaks in the skin including small scratches may also serve as portals of entry to the bloodstream.

Vaginal sex carries less of a risk for HIV than any variety of anal sex. It remains a significant risk especially if a participant is in an acute and early (AEH) stage of the HIV infection, a time during which the infectious viral load is high (Wang et al., 2023). Tissue of the vaginal wall and cervix are easily penetrated by the HIV virus even in the absence of skin tears or lesions. Semen and pre-seminal fluid are both carriers of the HIV virus. Both vaginal fluid and any traces of blood present create risk for the insertive partner as the tissue of the urethra may provide viral entry even in the absence of sores, lesions, small cuts, or scratches of the penis and foreskin. The risk of contracting HIV for each episode of vaginal sex has been estimated at 0.08% for the receiving partner, and 0.04% for the insertive partner (Eske, 2023).

Oral sex, as mentioned earlier is considered to have a low, yet present, chance of sharing HIV. Risk increases in the presence of lesions or sores on the mouth, vagina, or penis, oral contact with menstrual blood, or even bleeding gums. Dental dams, or thin sheets of latex which can be used during oral sex, can provide some protection yet are not in common use among those at the highest risk for viral transmission (Huynh & Gulick, 2022).

HIV May Enter the Bloodstream Through
  • Mucous membranes, such as those found in the mouth, rectum, vagina, and tip of the penis
  • Cuts, broken skin, skin cracks, or tears
  • Open sores
  • Direct injection
  • Bleeding gums or oral sores
(Eske, 2023)

The use of condoms, both external male condoms and internal female condoms, provide a significant though not total protection from HIV transmission. Much depends on using condoms correctly and having the foresight to purchase fresh (not dried out, folded, or compressed) condoms which have an increased chance of developing holes, rips, or tears with use. The use of silicone or water-based lubricants with condoms helps to prevent slippage and breaking during use.

Prevention Through Medication: Pre-Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is a way for individuals who do not have HIV, yet are at substantial risk of contracting it, to prevent HIV infection by taking medication every day in the anticipation that they will at some point be exposed. Currently two oral medications and one intramuscular shot have been approved for PrEP use.

The first oral medication is Truvada. This medication is a combination of emtricitabine and tenofovir disoproxil fumarate. It is intended for people at risk of HIV through sex or injection drug use.

The second oral preparation is that of Descovy. This is a combination of emtricitabine and tenofovir alafenamide. This oral medication is for men at risk of HIV transmission through sex. Descovy is not for people assigned female at birth who are at risk for HIV through receptive vaginal sex (, 2022).

The intramuscular injection available as a preventative is Apretude. Apretude (cabotegravir) is a monthly/bi-monthly intramuscular medication approved for use as PrEP. Apretude is for people at risk through sex who weigh at least seventy-seven pounds (35 kg) (Huynh & Gulick, 2022).

These drugs are combined with other medicines to treat existing HIV. When an individual is exposed to HIV through sex and/or injection drug use, these medications can be used to help keep the virus from establishing a permanent infection. PrEP is much less effective if it is not taken consistently, however. PrEP is only for individuals who are at substantial ongoing risk of HIV infection and are willing to have routine HIV testing.

PrEP is a powerful HIV prevention tool especially when combined with condoms and other prevention methods. In all PrEP Clinical Trials, HIV transmission risk was lowest for participants who took the medication consistently. At times it reduced the risk of getting HIV from sexual intercourse by as much as 92% (Huynh & Gulick, 2022). Among those who inject drugs, PrEP showed a reduction of contracting AIDS when taken regularly.

While a PrEP regimen has been deemed safe, it is not for everyone. Possible adverse effects include (CDC, 2022a):

  • Headache
  • Nausea
  • Diarrhea
  • Stomach aches
  • Fatigue

Post-Exposure Prophylaxis (PEP)

Transmission and prevention of HIV are intricately linked. For people who have had a single high-risk event of possible exposure, such as unprotected sex, needle-sharing injection drug use, or sexual assault, there is another treatment option called post-exposure prophylaxis (PEP).

PEP should be used only in an emergency. PEP involves taking antiretroviral medications as soon as possible, no more than 72 hours after exposure to HIV. Taking PEP works by reducing the chance of becoming HIV positive. These antiretrovirals keep HIV from making copies and spreading throughout the body. Two to three antiretrovirals are typically prescribed. These medications are then indicated for 28 days. 

PEP, unfortunately, is not always effective. It does not guarantee that an individual exposed to HIV will not become infected with HIV. Beginning PEP right away after possible HIV exposure is vitally important. The evidence has shown that PEP has little or no effect in preventing HIV infection if it is started longer than 72 hours after exposure. It takes about three days for HIV to make copies of itself once it enters and spreads throughout the body. When HIV is only present in a few cells where it entered the body, progression can sometimes be halted, but when it is in many cells in many places of the body, PEP will not work.

The current preferred antiretroviral therapy (ART) for PEP, in otherwise healthy adolescents and adults, consists of taking the following oral ART agents together for a 28-day course (Huynh & Gulick, 2022):

  • Tenofovir 300 mg/Emtricitabine 200 mg once daily


  • Raltegravir 400 mg twice daily


  • Dolutegravir 50 mg once daily

Case Study

Marissa, 28, comes to you after a public health worker identified her as a newly diagnosed HIV patient contact. Marissa is especially concerned because she recently became pregnant and plans to carry her baby to term.

Confirmation tests indicate Marissa is indeed pregnant and, unfortunately, has also contracted the HIV virus.

The National Institute of Health (NIH) and the CDC recommend HIV testing for all pregnant women. Some regions automatically include HIV testing as part of routine prenatal care. In contrast, others separate it as an additional opt-in test. The CDC recommends and requests that HIV tests be routine for all pregnant women.

Marissa was provided with information about the means of protecting her unborn child, herself, and potential contacts from the dangers of HIV infection. Nonjudgmental information was provided that the unborn baby would be at heightened risk for mother-to-child transmission of HIV during pregnancy, labor, and delivery, and afterward by breastfeeding. Marissa was assured that less than two babies in 100 with HIV-positive mothers get the infection before or during birth with proper medication and treatment.

Antiretroviral HAART medications are strongly recommended:

  • Throughout the pregnancy – combinations of at least three different ART medications are used based on effect profiles.
  • During labor and delivery – additional intravenous ART may be given to the mother during labor and through the delivery process.
  • After birth – liquid ART is often given to the newborn as a six-week preventative. Babies whose mothers were not on a pre-birth ART regimen may also receive additional anti-HIV medications.
  • After delivery – the new mother's ART regimen will be amended to include medications, whose adverse effects prevented their use during the pregnancy.
  • Breastfeeding might be discouraged after delivery to decrease the possibility of transmitting the virus to the newborn.

Marissa was informed that she would also be at risk for the progression of the HIV infection if medications were not started now to slow the infective processes. Potential sexual partners will also be at risk of infection unless deliberate steps to prevent the spread of HIV are implemented in a thoughtful, methodical manner.

A cesarean delivery (C-section) may be preferred to regular vaginal delivery as a means of minimizing exposure of the newborn to infected blood and delivery fluids. The preferred time for the C-section is around 38 weeks gestation or about two weeks before the expected due date.

Marissa was reassured that ongoing monitoring of her newborn would occur at two weeks, two months, and six months to make sure the baby remains HIV-free.

Should the newborn have a positive HIV virologic test result, a combination of HIV medications will be an option.

The HIV Virus

The Human Immunodeficiency Virus belongs to a viral family known as retroviruses. Some viruses are known as retro, or backward, due to an ability to transcribe or copy their genetic code from RNA into the DNA of a host cell instead of the more common DNA to RNA method of transcription. Like other viruses, HIV can neither self-reproduce, nor grow independently. HIV requires a living host, in this case, a human, to make copies of itself, a process known as replication, which, in the end, destroys the host cells enslaved to be production factories.

Favorite prey of HIV viral particles is our CD4 T-cells, macrophages, and dendritic cells. Once the favored cell has been located, the virus locks onto it and quickly regurgitates its core to the inside of the doomed host allowing viral RNA to begin the process of transcribing into the host cell's DNA using an enzyme called reverse transcriptase. The resulting rewritten DNA integrates into the human genome of the body's cells. HIV may remain a quiet passenger in the genome of its human host cell for some time, or it may immediately exert itself, forcing the enslaved human genome to make more copies of viral particles, becoming a mass producer of new viruses ready to continue the spread and conquest throughout more of the infected human body.

Image 1:

micro view of immune cells

(HIV Overwhelming Immune Cells, source CDC)

HIV Virus Spreading Through System

HIV is a prolific breeder, able to create trillions of copies of itself within a brief period. During active viral replication, a single milliliter of blood may contain more than one million copies of the virus. As is the manner of viruses, a small percentage of the trillions of copies will have minuscule differences from the original, thus making them resistant to medications or treatments that would have successfully treated the original virus.

Two significant varieties of the HIV virus have been identified: type 1 (HIV-1) and type 2 (HIV-2). HIV-1 is more virulent and the primary cause of infection worldwide, with around 95% of documented cases consisting of HIV-1 (Burgess, 2023; Seladi-Schulman, 2021). When you hear HIV referred to without clarification as to type, it is HIV-1 being discussed. HIV-2 is less easily transmitted and less common, appearing mostly in West Africa or in individuals who have had contact with a viral carrier from that region, or are themselves from that region. Both types of HIV have AIDS as their end-stage, and both are transmitted through blood, sexual contact, and body fluids.

Three Stages of HIV Infection

Currently, there is no cure for HIV infection. Yet, with diligent, consistent lifelong treatment it is possible to slow, or prevent, the progression of the disease from one stage to the next. It is not a cure. However proper medication may help those infected live longer, and healthier, lives.

HIV infection has three distinct stages defined by the CDC:

  1. HIV Primary or Acute infection
  2. HIV Chronic or Asymptomatic infection
  3. HIV as AIDS (acquired immunodeficiency syndrome)

HIV Primary or Acute Infection

The earliest stage of HIV infection is known as the primary or acute stage. Acute HIV infection develops quickly, showing visible symptoms around two to four weeks after an individual has been infected by enough of the virus. Be aware that there are individuals who will not show visible signs of infection, although they themselves have now become infectious to others. Many newly infected individuals, however, report having flu-like symptoms such as generalized aches, headache, fever, and perhaps even a rash that may persist for several days or even weeks (Leonard, 2023; Myhre & Sifris, 2023). The virus begins taking possession of CD4 Helper-T cells during this stage, destroying them as part of the process by which the virus itself multiplies.

Seroconversion is the term which denotes the period from initial infection to when the body begins to create antibodies in sufficient amounts to be detected by HIV antibody testing. This brief, though variable, period is also referred to as the "window period" of acute HIV infection. An individual may have the infection during this period yet still not register as positive on current screening tests. Unfortunately, viral levels are high enough during this window period that newly infected individuals are able to infect others and can easily transmit HIV by sexual acts, sharing drug paraphernalia, and other modes of transmission specific to HIV. The length of this dangerous window period can be as little as 2 weeks or up to 6 months, making lifestyle screening a crucial tool during HIV pre-test counseling sessions (Spach, 2023).

Due to the window period and the initial high viral quantities in the bloodstream, it is considered that the acute stage of HIV infection holds the greatest risk of disease transmission to others. However, HIV can be transmitted during any of its stages.

Chronic HIV or Asymptomatic Infection

Following the initial flu-like symptoms and the rapid surge of viral levels in the acute stage of HIV infection, comes a chronic or latency period during which infected individuals often feel and look healthy. The length of this asymptomatic stage differs from individual to individual and rarely may linger as long as ten years. During this chronic stage, HIV is still active. However, its replication levels are much slower than the enormous reproduction surge of the acute stage. Individuals who are infected and have started antiretroviral therapy (ART) may be able to extend the symptom-free HIV period for up to several decades.

Individuals in the chronic stage are still able to infect others. While the chronically infected individual may not themselves feel sick, any risky lifestyle habits such as those that brought them initially into contact with HIV must be addressed to limit the continued spread of this deadly infection. HIV carriers know they are infected. Lifestyle changes are important, and the initiation of antiviral medication can reduce the chance of transmitting the infection.

The chronic latency period of HIV infection will at some point end, with or without supporting medications such as ART. The first stage of failure of the latency period is signaled by a progressive rise in viral levels, often referred to as the viral load, and a drop in the CD4 cell count. This combination of events allows symptomatic illness indicators of the HIV infection to once more surface as the beleaguered immune system grows too weak to counteract and control symptoms.

HIV as AIDS: The Final Stage of Infection

Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection. AIDS occurs when the body's immune system has been so severely damaged that the individual is vulnerable to diseases, infections, and even infection-related cancers. The general terms used for these entities are opportunistic illnesses or opportunistic infections. Their presence occurs due to the absence of immune system defenses, allowing these opportunists to take advantage of the opening created by the HIV infection to spread without challenge or check.

Image 2:

graphic showing AIDs case definition

(AIDS-Defining Conditions, Source:

An AIDS diagnosis may only be made by a licensed healthcare provider based on the results of HIV-specific blood tests and/or the ill individual's physical condition. Once diagnosed with AIDS, the current diagnostic protocols do not recognize backward travel through the HIV diagnostic criteria, even when symptoms are in remission and the individual feels better. Therefore, it is diagnostically true that once identified as having AIDS, the diagnosis will always be with that individual.

Certain individuals with AIDS may appear healthy to the casual observer. However, they continue to be infectious and extremely vulnerable to opportunistic diseases, particularly when not receiving adequate supportive treatments. When untreated, the average lifespan from initial conversion from HIV infection to AIDS in the United States is three years (, 2023b). Current medication therapies and lifestyle changes have lengthened the lifespan by decades, so much so that it might be possible with continuous treatment for an infected patient to avoid the transition from HIV to AIDS during their lifespan.

Be aware that a long-standing HIV infection carries its own set of common issues (Myhre & Sifris, 2022b; Scaccia, 2023). In fact, the virus HIV itself can afflict those infected in specific ways. These patients can experience (Cachay, 2023):

  • Cardiovascular disease
  • Lung disease
  • Accelerated aging
  • Liver disease
  • Inflammation related complications
  • Neurocognitive disorders

When a patient’s CD4 cell count drops below 200 cells per cubic millimeter of blood (200 cells/mm), AIDS is officially diagnosed (Montoya, 2023). However, the presence of one or more diagnostically recognized opportunistic illnesses is also considered adequate for finding the diagnosis of AIDS regardless of the CD4 count.

Visible symptoms that the HIV stage of AIDS has been reached include (Leonard, 2023):

  • Persistent low-grade fever
  • Extreme and unexplained fatigue
  • Difficulty recovering from colds or flu
  • Recurring fever or profuse night sweating
  • Diarrhea that continues for more than one week
  • Rapid weight loss
  • Sores on the mouth, anus, or genitals
  • Memory loss, depression, or other neurologic disorders
  • Persistent respiratory difficulties including pneumonia

The following image can help visually summarize the stages of HIV.

Image 3:

graphic showing hiv phases

(Stages of HIV) Click to view full size

HIV Medical Treatment

Currently, there is no cure for HIV infection. An individual's lifespan can be extended and their quality of life enhanced. Yet, every individual diagnosed with HIV infection will die from it if another life-ending event does not take them first. Consequently, prevention is the key, the goal, and the focus of early intervention. Once an HIV diagnosis does occur, early and aggressive therapy can add decades of lifespan and enhance the quality of life.

The current best practice for HIV treatment is early and continuing antiretroviral therapy (ART) for all HIV-infected individuals. It is important to understand that antiretroviral medications do not kill the HIV virus nor cure the disease. ARTs are intended to slow or prevent the growth and spread of the virus.

Several antiretroviral agents are in use since the HIV virus has shown itself proficient in forming single-agent resistance. Highly active antiretroviral therapy (HAART) combines three or more antiretroviral agents that are given to prevent treatment resistance from forming within the infected individual.

Each drug class of antiretroviral medications works by a different mechanism to combat HIV. There are currently six main classes of antiretroviral medication (Eggleton & Nagalli, 2022):

  1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs) or "nukes" block reverse transcriptase. This is an enzyme that HIV needs to create altered DNA from viral RNA to make copies of itself.
    • Examples are abacavir, didanosine, lamivudine, stavudine, tenofovir, and zidovudine.
  2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) or "non-nukes" bind to and later alter reverse transcriptase to block the altered DNA creation from viral RNA, though in a different fashion from the NRTIs.
    • Examples are delavirdine, efavirenz, nevirapine, and rilpivirine.
  3. Protease Inhibitors (PIs) interfere with the process of the newly formed HIV virus using the enzyme protease to gather components it needs to mature into full function.
    • Examples are atazanavir, darunavir, and indinavir.
  4. Entry Inhibitors, sometimes called Fusion Inhibitors (FIs), block proteins on the CD4 cells that HIV needs to enter cells. This category includes the CCR5 antagonists, which block viral entry into CD4.
    • An example is enfuvirtide.
  5. Chemokine Receptor Antagonists (CCR5 Antagonists), selectively and reversibly block entry into the CD4 T-cells by preventing interaction between CD4 cells and the gp120 subunit of the viral envelope glycoprotein.
    • An example is maraviroc.
  6. Integrase Strand Transfer Inhibitors (INSTI) act to prevent the DNA from the virus from being inserted into the chromosome of the host cell by interfering with the HIV integrase enzyme, the tool the virus uses to unzip and then patch in its own genetics.
    • Examples are dolutegravir, elvitegravir, and raltegravir.

HIV Medication Combination Therapies

CDC guidelines recommend initiating prompt treatment following diagnosis with combination antiretroviral medications (cART's). Everyone should have personalized medications based on drug resistance testing, epidemiologic determination of susceptibilities of the local prevalent viral strains, comorbid conditions, possible drug-to-drug interactions, and anticipated adverse effect profiles. The CDC provides recommendations for a general starting combination therapy focused on the HIV-1 strain most common in North America.

In an antiretroviral-naive patient, general guideline suggestions include a starting regimen considering the following factors (Welhe, 2023):

  • All new HIV-positive patients should be offered ART.
  • While there are more than twenty-five medications from six major antiretroviral medication classes used for HIV treatment, the most used are NRTIs, NNRTIs, and PIs.
  • The general starting regimen should include two nucleoside/nucleotide reverse transcriptase agents (NRTIs), plus a drug from the NNRTI class, boosted with a PI inhibitor.


HIV infection is a chronic medical condition that those infected will have until they succumb to it in its final stage of AIDS, or death ensues from another cause. There is no cure for HIV infection, which means prevention is key to controlling its spread. Distributing knowledge of HIV and information concerning an infected individual's rights and the value that their lives hold form essential parts for positively affecting individuals/groups whose behaviors place them at a heightened risk for exposure and infection. It is important to share information concerning the transmission of HIV along with the risks of unprotected sex, sharing of needles, and exposure to unsterilized blood-contaminated devices as methods by which the HIV retrovirus can be transmitted to still another victim.

It is estimated that one in five HIV-infected individuals is unaware of their infection and therefore unable to begin life-extending treatment. HIV testing is available both from healthcare professionals and home tests. Once a positive test is confirmed, early aggressive treatment with antiretroviral medications is highly encouraged. 

The state of HIV medications allows those infected to live decades longer than they otherwise would without medication, and with a greater quality of life. However, the medication regimen can be taxing. Support for adherence to the medication regimen and behavioral changes that minimize the chance of spread of the virus by those infected are important objectives for healthcare professionals as they work toward helping the HIV infected live healthier, more satisfying lives.

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Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


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