Pregnancy and HIV Testing

HIV, or human immunodeficiency virus, is the virus that causes AIDS (acquired immune deficiency syndrome). HIV weakens a person's immune system reducing their ability to fight infections and cancers. A person can get HIV by coming into contact with an infected person's body fluids (blood, semen, vaginal fluids, breast milk), and HIV can be spread through:

• Vaginal, oral, or anal sex
• Sharing unclean needles to take drugs
• Pregnancy (from an infected mother to baby)
• Blood transfusions (since 1985, blood donations have been routinely tested for HIV, so infection from blood transfusions is rare)

You cannot get HIV from:

• Touching or hugging someone who has HIV or AIDS
• Public bathrooms or swimming pools
• Sharing cups, utensils, telephones, or other personal items
• Bug bites

Doctors recommend all pregnant women get tested for HIV. Medications are available to prevent the spread of the virus to your unborn baby. In addition, steps can be taken during delivery to prevent spreading the infection. Some studies show a woman can further reduce the risk of spreading the virus to her baby by having a cesarean section before her water breaks. Moreover, your health care provider can take steps to help you stay healthy longer.

HIV testing is voluntary. Anyone is free to decline testing. Your decision to not get tested, or the test result itself, will not prevent you from getting health care during pregnancy.

What Do the HIV Test Results Mean?

A confirmed, positive test result means you have been infected with HIV. Being infected with HIV does not necessarily mean that you have AIDS. It can take many years for people with HIV to develop AIDS.

A negative test result means that no signs of HIV infection were found in your blood. A negative test does not always mean that you do not have HIV. Signs of HIV may not show up in the blood for several months after infection. For this reason, you should be tested again if you could have been exposed to HIV or are at risk for HIV infection.

Though HIV tests performed at most doctors offices become part of the patient's medical record, there are places you can go that provide confidential HIV testing. These places will perform HIV tests without even taking your name (anonymous testing). An anonymous HIV test does not become part of your medical record.

Should you discover that you have HIV, inform you medical providers so that you can receive proper care.

When AIDS Viruses Are Transmitted Despite Treatment

While antiretroviral drugs offer an efficient means of preventing the replication of HIV in the blood, shedding of HIV may occur in semen, so that other persons can become infected during unprotected sexual intercourse. This occurs in particular if the male genital tract also has other viral infections.

That is the conclusion reached by a scientist who is supported by the Swiss National Science Foundation (SNSF).
In principle, modern combination therapies are very effective at keeping AIDS causative agents in check. The treatment usually leads to a situation in which there is no longer any evidence of Human-Immunodeficiency Viruses (HIV) in the body. In this way, the drugs can also reduce the disease transmission rate to just one tenth. So why do new infections occur despite treatment?

Sperm containing a cocktail of viruses

The answer, according to findings recently published by the Swiss researcher Sara Gianella Weibel and her American colleagues, is that other viruses also play a role. Working at the University of California in San Diego, the SNSF-funded scientist studied the semen of 114 HIV-infected men undergoing treatment who have sex with men. She found that the seminal fluid of 11 of the men contained a considerable quantity of HI viruses, even though the viral load of the blood of all of the men was very low. In eight of these 11 cases, Gianella Weibel also found evidence of various forms of herpes.

Locally activated immune system

Some of these herpes viruses, such as cytomegalovirus, often remain unnoticed. However, if the viruses infect the male genital tract, they locally activate the immune system. As a result, there is a build-up of immune cells, including those in which HIV replicate, in the genital area. "Our data suggests that we must also direct our focus towards other viruses, if we really want to interrupt the transmission of AIDS," explains Gianella Weibel.

Myths and Facts about HIV/AIDS

Having HIV Means You Have AIDS?

Myth. Human immunodeficiency virus (HIV) is a virus that destroys the body's CD4 immune cells, which help fight disease. With the right medications, you can have HIV for years or decades without HIV progressing to AIDS. AIDS (acquired immunodeficiency syndrome) is diagnosed when you have HIV as well as certain opportunistic infections or your CD4 cell count drops below 200.

It's Difficult to Get HIV From Casual Contact?

Fact. You can't catch or spread HIV from hugging someone, using the same towel, or sharing the same glass. It's very rare to get HIV from a blood transfusion -- the U.S. blood supply is carefully tested. However, you can spread the disease from having unprotected sex, sharing needles, or getting a tattoo from unsterilized equipment.

You Have Just a Few Years to Live?

Myth. Everyone with HIV experiences it differently. Some people may develop AIDS within a few months as the virus quickly weakens their immune system. Many others can live for decades with HIV and have a normal life expectancy. You can help prevent HIV from progressing to AIDS by seeing your doctor regularly and following your doctor's recommendations.

You'll Know You Have HIV Because of Your Symptoms?

Myth. Some people don't show any signs of HIV for years after being infected. Many can have some symptoms within 10 days to a few weeks after infection. These first symptoms are similar to the flu or mononucleosis and may include fever, fatigue, rash, and sore throat. They usually disappear after a few weeks and you may not have symptoms again for several years. The only way to tell you have HIV is to get tested.

HIV Can Be Cured?

Myth. There is no cure for HIV, but treatment can keep virus levels low and help maintain your immune system. Some drugs interfere with proteins HIV needs to copy itself; others block the virus from entering or inserting its genetic material into your immune cells. Your doctor will consider your general health, the health of your immune system, and the amount of virus in your body to decide when to start treatment.

Anyone Can Get HIV?

Fact. About 56,000 people in the U.S. get HIV each year, and 18,000 people with AIDS die each year. Anyone can get HIV -- men, women, and children, people who are gay or straight. Men who have sex with men make up more than half (53%) of new HIV infections each year. Women account for 27% of new infections, and children 13%. African-Americans make up almost half of all new HIV infections each year.

Sex Is Safe When Both Partners Have HIV?

Myth. Just because you and your partner both have HIV, doesn't mean you should forget about protection when you have sex. Using a condom or other latex barrier can help protect you from other sexually transmitted diseases as well as other strains of HIV, which may be resistant to anti-HIV medication. Even if you are being treated and feel well you can still infect others.

You Can Have a Baby if You Are HIV-Positive?

Fact. Infected mothers can indeed pass HIV to their babies during pregnancy or delivery. However, you can lower the risk by working with your doctor and getting the appropriate care and medication. Pregnant women with HIV can take medications to treat their infection and to protect their babies against the virus.

You Can’t Avoid Other HIV-Related Infections?

Myth. Due to weakened immune systems, people with HIV can be vulnerable to infections like pneumocystis pneumonia, tuberculosis, candidiasis, cytomegalovirus, and toxoplasmosis. The best way to reduce your risk is to take your HIV medications. Some infections can be prevented with drugs. You can lessen your exposure to some germs by avoiding undercooked meat, litter boxes, and water that may be contaminated.

Without Insurance You Can't Get Lifesaving Drugs?

Myth. There are government programs, nonprofit groups, and some pharmaceutical companies that may help cover of the cost of HIV/AIDS drugs. But be aware: These drug "cocktails" can cost $15,000 a year. Talk to your local HIV/AIDS service organization to learn about financial help.

HIV No Barrier to Getting Liver Transplant

Liver transplants to treat a common type of liver cancer are a viable option for people infected with HIV.
 The Italian study found that the AIDS-causing virus doesn't affect survival rates and cancer recurrence after transplants among HIV patients with this particular type of liver cancer, called hepatocellular carcinoma (HCC). The study's authors noted, however, that HCC is more aggressive in people with HIV and it is becoming a major cause of death among these patients as antiretroviral treatment prolongs their lives.

The key message of this study is that liver transplantation is a valid option for HCC treatment in HIV-infected patients.
The study involved 30 HIV-positive patients and 125 patients not infected with HIV who received a liver transplant to treat HCC at three different hospitals in northern Italy between 2004 and 2009.

During a follow-up period of roughly 32 months, the researchers found a recurrence of HCC in 6.7 percent of the patients with HIV and 14.4 percent of the patients who were not HIV positive.

The study also revealed that survival was similar for all of the patients one year after surgery and three years post-surgery.

The researchers, led by Dr. Fabrizio Di Benedetto, associate professor of surgery at the University of Modena, said the HIV-positive patients were treated with antiretroviral therapy until they underwent the transplant. The therapy was not resumed until their liver function stabilized after surgery.

None of the HIV-positive patients developed AIDS during the post-surgery follow-up period. The study's authors suggested that this may be due to timely resumption of HIV therapy following the liver transplant.

New options in antiviral therapy for people with HIV could improve control of the HIV virus as well as outcomes following liver transplant for HCC, the researchers said.

Patients with HIV undergoing liver transplant for HCC would benefit most from a multidisciplinary approach to care, the study authors said, which would involve collaboration among oncologists, radiologists, gastroenterologists, liver surgeons and infectious disease specialists.

How HIV Kills Immune Cells

Untreated HIV infection destroys a person's immune system by killing infection-fighting cells, but precisely when and how HIV wreaks this destruction has been a mystery until now.

New research by scientists at the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, reveals how HIV triggers a signal telling an infected immune cell to die. This finding has implications for preserving the immune systems of HIV-infected individuals.

 HIV replicates inside infection-fighting human immune cells called CD4+ T cells through complex processes that include inserting its genes into cellular DNA. The scientists discovered that during this integration step, a cellular enzyme called DNA-dependent protein kinase (DNA-PK) becomes activated. DNA-PK normally coordinates the repair of simultaneous breaks in both strands of molecules that comprise DNA. As HIV integrates its genes into cellular DNA, single-stranded breaks occur where viral and cellular DNA meet. Nevertheless, the scientists discovered, the DNA breaks during HIV integration surprisingly activate DNA-PK, which then performs an unusually destructive role: eliciting a signal that causes the CD4+ T cell to die. 

The cells that succumb to this death signal are the very ones mobilized to fight the infection.

According to the scientists, these new findings suggest that treating HIV-infected individuals with drugs that block early steps of viral replication -- up to and including activation of DNA-PK and integration -- not only can prevent viral replication, but also may improve CD4+ T cell survival and immune function. The findings also may shed light on how reservoirs of resting HIV-infected cells develop and may aid efforts to eliminate these sites of persistent infection.

Strategy to Help Vaccines Outsmart HIV

A new discovery at Oregon Health & Science University highlights an ingenious method to ensure the body effectively reacts when infected with the highly evasive HIV virus that causes AIDS. 

The same team of researchers has been utilizing this unique approach to develop its own HIV vaccine candidate, which has so far shown promising results in animal studies.

A major challenge in developing an effective HIV vaccine is figuring out how to target this evasive virus," said Dr. Louis Picker, M.D., associate director of the OHSU Vaccine and Gene Therapy Institute, where the work was conducted.

CD8+ "cytotoxic" T cells are an important component of the immune system and are particularly important for pathogens, like HIV, that easily evade antibodies. They serve as sentries within the body that detect and destroy virus-infected cells, accomplishing this function by recognizing short viral peptides on the surface of infected cells. T-cells are designed to be quite frugal in the number of different viral peptides they recognize, typically responding to just a handful of such peptides. This is a problem for control of HIV, which is able to able change its peptides and thus escape T cells responses that do not target the relatively few functionally critical peptides that can't change without debilitating the virus. In the vast majority of HIV infections, the few viral peptides recognized by T cells are not the vulnerable ones, and the virus escapes.

Therefore, the strategy that Dr. Picker and his colleagues adopted was to try to develop a vaccine to increase the number of viral peptides that T cells would recognize, reasoning that increasing this "recognition breadth" would allow T cells to more effectively respond to HIV.

The researchers found that cytomegalovirus or CMV, a common virus already carried by a large percentage of the population, may hold the key. Their studies in the non-human primate model of HIV, called SIV, found that a modified version of CMV engineered to express SIV proteins generates SIV-specific T cells that recognize three-fold as many SIV peptides as T cell generated by conventional vaccines and SIV itself. 

Moreover, these responses were entirely different from conventional responses, such that even viruses that had previously escaped natural responses would still be vulnerable. In effect, the hunters of the body were provided with a much better targeting system to help them find and destroy an elusive enemy.

Picker and his colleagues believe an HIV vaccine equipped with a modified CMV vector might be able to both prevent infection (prophylactic vaccine) and effectively battle the virus even if applied post-infection in individuals with infections suppressed by anti-retroviral therapy. Moving forward, the research team hopes to utilize this new information to create customized CMV vectors with a broad ability to identify several components of HIV and then incorporate this component into an effective vaccine.

"We hope we can begin clinical trials in human patients within a few years," explained Dr. Picker. "This new information gives us a much clearer roadmap for effectively targeting the disease which to this point has found ways to evade the human immune system."

HIV Drugs May Help Protect Young Patients' Hearts

Long-term use of powerful drug cocktails known as highly active antiretroviral therapy (HAART) may help protect the hearts of children and teens infected with HIV.

HAART is a form of antiretroviral therapy that is widely used to treat people with HIV, the virus that causes AIDS. Prior to the introduction of antiretroviral therapies, youngsters infected with HIV were at increased risk for heart failure. 

Since the advent of powerful HIV-suppressing medications, "the effects of HIV and on the cardiovascular system of HIV-infected children are not completely understood. 

The new study sought to clear that up. It included nearly 600 HIV-infected and uninfected patients from 14 pediatric HIV clinics across the United States.
According to the team, heart function was better among HIV-infected children receiving HAART than those who were infected with HIV and did not receive HAART, and children who were exposed to HIV but not infected.
"Our results indicate that the current use of combination [antiretroviral therapy], usually HAART, appears to be cardioprotective in HIV-infected children and adolescents," the study authors reported. "This finding is even more relevant in the developing world where the prevalence of HIV disease in children is much higher."
The researchers added that further study comparing different drug regimens might be beneficial "in optimizing HIV outcomes and protecting long-term cardiac health" of children with HIV.

New Tool for Identifying Powerful HIV Antibodies

A team of NIH scientists has developed a new tool to identify broadly neutralizing antibodies (bNAbs) capable of preventing infection by the majority of HIV strains found around the globe, an advance that could help speed HIV vaccine research. Scientists have long studied HIV-infected individuals whose blood shows powerful neutralization activity because understanding how HIV bNAbs develop and attack the virus can yield clues for HIV vaccine design.

But until now, available methods for analyzing blood samples did not easily yield specific information about the HIV bNAbs present or the parts of the virus they targeted. In addition, determining where and how HIV bNAbs bind to the virus has been a laborious process involving several complicated techniques and relatively large quantities of blood from individual donors.

The new tool lets scientists determine precisely the HIV bNAbs present in a particular blood sample by analyzing the neutralized HIV strains there.
Calledneutralization fingerprinting, the tool is a mathematical algorithm (a problem-solving procedure) that exploits the large body of data on HIV bNAbs generated in recent years. The neutralization fingerprint of an HIV antibody is a measurement of which virus strains it can block and with what intensity.
Antibodies that target the same portion of the virus tend to have similar fingerprints.

Blood samples contain mixtures of antibodies, so the new algorithm calculates the specific types of HIV bNAbs present and the proportion of each by comparing the blood's neutralization data with the fingerprints of known HIV bNAbs. This approach is particularly useful when other methods of determining bNAbs targets in a blood sample are not feasible, such as when just a small amount of blood is available. Neutralization fingerprinting also is significantly faster than older analytic methods.

According to the researchers who developed the assay, the underlying approach could be applied to the study of human responses to other pathogens, such as influenza and hepatitis C viruses, for which scientists have much information about neutralizing antibodies.

Human Breast Milk Can Help Reverse Antibiotic Resistance.

A protein complex found in human breast milk can help reverse the antibiotic resistance of bacterial species that cause dangerous pneumonia and staph infections, according to new University at Buffalo research.

In petri dish and animal experiments, the protein complex -- called Human Alpha-lactalbumin Made Lethal to Tumor Cells (HAMLET) -- increased bacteria's sensitivity to multiple classes of antibiotics, such as penicillin and erythromycin.

The effect was so pronounced that bacteria including penicillin-resistantStreptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) regained sensitivity to the antibiotics they were previously able to beat.

Long-term use of highly active antiretroviral therapies (HAART) does not appear to be associated with impaired heart function in children and adolescents in a study that sought to determine the cardiac effects of prolonged exposure to HAART on children infected with the human immunodeficiency virus (HIV), according to a report published Online First by JAMA Pediatrics, a JAMA Network publication.

Prior to contemporary antiretroviral therapies (ARTs), children infected with HIV were more likely to have heart failure.

Steven E. Lipshultz, M.D., of the University of Miami Leonard M. Miller School of Medicine, Florida, and colleagues used statistical models to compare echocardiographic measures in the National Institutes of Health-funded Pediatric HIV/AIDS Cohort Study's Adolescent Master Protocol (AMP).

The study included 14 pediatric HIV clinics in the United States. The participants were 325 perinatally HIV-infected children receiving HAART; 189 HIV-exposed but uninfected children; and 70 HIV-infected (mostly HAART-unexposed) historical pediatric controls patients from the National Institutes of Health-funded Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection (P2C2-HIV) Study.

"Our results indicate that the current use of combination ART, usually HAART, appears to be cardioprotective in HIV-infected children and adolescents. This finding is even more relevant in the developing world where the prevalence of HIV disease in children is much higher," the study notes.

Scores for left ventricular (LV) fractional shortening (a measure of cardiac function) were significantly lower among HIV-infected children from the P2C2-HIV Study than among the AMP HIV-infected group or the 189 AMP HIV-exposed but uninfected controls, the study results indicate. The results also show that for HIV-infected children, a lower nadir CD4 percentage and a higher current viral load were associated with significantly lower cardiac function.