Being HIV positive means you have evidence of the human immunodeficiency virus (HIV) in your body. Depending on the type of HIV testing done, this could be a detectable amount of the virus itself, or, more commonly, something that the immune system only finds or produces when the virus is present.
HIV-positive status can only be confirmed after two HIV tests have been completed.
This article explains what it means to be HIV positive, how people can become active, what to expect from testing, and how treatment can affect the lives of people living with HIV.
What makes someone HIV positive
HIV is a virus that attacks the cells of the immune system, killing them and rendering the body unable to fight infection. It is spread through contact with infected blood, semen or vaginal fluids.
Once HIV enters the body, it introduces an antigen called p24. This is a viral protein that prompts the immune system to activate white blood cells. Once the virus is detected, the immune system starts producing antibodies, proteins that help fight infection.
The presence of HIV antigens or antibodies in blood, saliva, or urine can confirm that someone is HIV positive. This is detected with an HIV test.
Two tests are required
Two HIV tests are needed to confirm someone’s HIV status. This helps ensure correct diagnosis.
False positives — when a test falsely says you’re infected — are rare. However, they can occur due to laboratory problems (such as sample confusion or mishandling) or misinterpretation of results. They can also occur in people with certain health conditions, such as autoimmune diseases.
This is why confirmation testing is essential. A positive result is considered valid only if it is replicated by a second positive result.
While it’s certainly a relief to get a negative result from your initial test, it’s still possible for you to be positive. Therefore, you will also need to take a second test to confirm your results.
False negatives — when the test results show you are not infected — are more common than false positives. They are usually the result of testing for markers of infection during a “window period,” which is the time between when someone has HIV and when the test can correctly detect it.
The window period depends on the type of HIV testing done. For example, an antigen/antibody test for HIV on a blood sample drawn from a vein may take 18 to 45 days.
You are HIV positive when you are positive on both the first test and the confirmation test. A positive HIV test means HIV antibodies or antigens have been found in your blood. False positives are rare, but can happen. False negatives are more common and occur in premature tests.
HIV testing options and when to take them
How someone becomes HIV positive
Anyone can get HIV. The virus is spread through sexual contact, sharing medical equipment, or general contact with infected bodily fluids. It can also be passed from parent to child during pregnancy and through breast milk.
The following conditions may put someone at a higher risk of contracting HIV:
- unprotected sex
- anal sex
- Sharing medication needles and syringes
- have other sexually transmitted diseases such as syphilis, chlamydia, and gonorrhea
- Accidental needlestick injury (more common among healthcare workers)
Although it is possible to acquire HIV during a blood transfusion, this is extremely rare. This is because in the United States, all blood donors are tested for HIV. However, HIV transmission could theoretically occur if blood is collected when a person is infected but has not yet acquired enough antibodies for testing.
How common is HIV today?
HIV Stages: Severity of Infection
Being HIV positive simply means the virus is present in your body. This status does not indicate the severity of the infection.
HIV is classified by severity. These three stages distinguish between early infection and progression to acquired immunodeficiency syndrome (AIDS).
Stage 1: Acute HIV infection
Stage 1 of HIV infection is called acute HIV infection. During this phase, the immune system tries to attack the virus by producing HIV antibodies. This process, called seroconversion, usually occurs within a few weeks of infection.
At this stage, people living with HIV may experience:
- night sweats
- joint pain
- sore throat
- Muscle pain
- swollen lymph nodes
- mouth ulcers
However, some people may have no symptoms.
Remarkably, antibodies persist and remain detectable for many years. As a result, people living with HIV often continue to test positive for HIV. This is the case even if their viral load (the amount of HIV in the blood) is undetectable – thanks to modern treatments.
Stage 2: Clinical incubation period
When the body enters stage 2, it is called clinical latency. At this stage, the virus is still multiplying, but at very low levels.
Infected people begin to feel better and have few symptoms. At this stage, however, HIV can still spread to other people.
Stage Three: AIDS
If HIV infection goes untreated, it progresses to stage 3, Acquired Immune Deficiency Syndrome (AIDS). That’s the point where the virus is now causing something.
In the advanced stages of HIV infection, the body’s immune system is severely compromised and it is also vulnerable to other infections.
People with AIDS may experience recurrent fever, extreme fatigue, chronic diarrhea, depression, and memory loss. Other symptoms of AIDS include:
- Thrush (yeast infection in the mouth/throat)
- swollen lymph nodes
- skin problems
- Tongue lesions
- night sweats
- Unexplained weight loss
Fortunately, today, most people living with HIV do not develop AIDS. Taking HIV medicines as prescribed can stop the disease from progressing to this stage. However, without early detection and access to health care, some people will still progress to stage 3.
Without HIV medicines, people with AIDS can usually survive for about three years.
However, once untreated individuals develop opportunistic infections, their life expectancy drops to about a year. These infections are more likely to occur and are often more severe in people with HIV/AIDS due to a compromised immune system.
HIV is staged by severity, including acute, latent, and AIDS. Symptoms vary by stage. Some people have no symptoms at all.
Test after diagnosis
After a positive HIV test is confirmed, your healthcare provider will perform further testing to determine your stage of infection and monitor your case over time.
In addition to testing for HIV antibodies and antigens, healthcare providers study how a person’s immune system works and check the level of HIV in the body. One measure they looked at was the CD4 test count. This is the number of CD4 immune cells in the blood.
These cells are essential for the proper functioning of the immune system. A healthy CD4 count is between 500 and 1,600 cells per cubic millimeter. The more CD4 cells a person has, the healthier they are.
A low CD4 count (defined as 200 cells per cubic millimeter or less) indicates AIDS. Additionally, it indicates a high risk of life-threatening opportunistic infections.
How often should you test for CD4 and viral load?
Start antiretroviral therapy
Unlike when HIV was first discovered, the virus can now be effectively controlled with antiretroviral therapy (ART).
ART is a combination of drugs that stops the HIV virus from replicating in an infected person. There are eight classes of antiretroviral drugs and dozens of different antiretroviral drugs.
Doctors recommend that people start ART as soon as they become HIV positive. Although ART is not a cure, it can stop the development of HIV and keep infected people healthy for many years.
ART has two main benefits that redefine the HIV-positive experience:
- Protects the immune system: When a person has less than 200 copies of HIV per milliliter of blood, the virus is considered suppressed. This helps protect the immune system from virus attack and reduces the likelihood that infected individuals will get sick.
- Reduce the risk of transmission: ART can also reduce the risk of HIV transmission by keeping the amount of HIV in a person’s blood (called viral load) low. A study of serodiscordant couples — consisting of one person with HIV and another person without HIV — found that HIV-positive people on antiretroviral therapy were 96% less likely to infect their partner .
ART can actually help someone achieve an undetectable viral load, meaning they have HIV levels so low in their blood that they have can not Spread the virus to others.
People with undetectable viral load within a year of treatment were more likely to have a normal life expectancy than those who failed to achieve viral suppression.
HIV medications can still help people with AIDS, but are more effective if taken before the virus reaches this stage.
ART is a standard HIV treatment that combines drugs to prevent the virus from replicating. While not a cure, it can keep you healthy and reduce your risk of spreading the virus to others.
Full List of Approved HIV Drugs
take care of yourself
Other ways to stay healthy after a positive HIV test include:
- Stay up-to-date on vaccines
- quit smoking
- reduce alcohol intake
- maintain regular medical appointments
- see a therapist
An HIV diagnosis often leaves people distressed and anxious. It is important to have a support system that can help you cope with a new HIV positive diagnosis.
If you feel alienated or confused, join an HIV support group.
Coping with HIV and Living Well
A positive HIV test means that blood tests and confirmation tests have found HIV antibodies or antigens in your blood. False negatives occur when you test too early after exposure. False positives are rare, but can occur due to technical mishaps or certain health conditions.
While testing can tell you if you have HIV, it cannot tell you how advanced the disease is. If you test positive, you will undergo further blood tests, which will help the healthcare provider determine the stage of the disease.
ART treatment can suppress the virus, keep you healthier, and reduce the risk of transmission.
Getting an HIV-positive diagnosis can be overwhelming. But finding it early can allow you to get treatment and prevent the infection from getting worse.
If you have been diagnosed with HIV, find your HIV care service, your state HIV hotline, HIV health providers, and HIV specialists. In addition, the Centers for Disease Control and Prevention (CDC) provides numerous resources for housing, mental health care, travel, and fighting the stigma surrounding HIV.
Fortunately, advances in HIV treatment mean that most people living with HIV are still able to live long, healthy lives.
When you test positive for HIV