Living with HIV

Once the individual is diagnosed with HIV, there is no cure for the infection. However, early initiation of the treatment or antiretroviral therapy (ART) as prescribed by the healthcare provider, as well as receiving proper care, will help in controlling HIV within around 6 months, depending on each person, by suppressing the virus, leading to a low viral load and preserving high CD4 count.

HIV treatment is for everyone who is living with the virus, regardless of their health status and how long they have had it.

Moreover, effective treatment goes beyond managing the infection and contributes to a fulfilled physical, sexual, and psychological journey, allowing the person living with HIV to have a long and healthy life. In addition, engaging in a healthy lifestyle helps in reducing the treatment’s side effects that some individuals might experience.

Therefore, regular checkups and viral load tests are essential to check the status of an HIV infection. A viral load test is recommended every 4 to 6 months before changing the HIV medicine, and around 2 to 8 weeks after starting or changing medicine.

U=U

Undetectable = Untransmittable.

An undetectable viral load is characterized by having less than 200 copies of HIV per milliliter of blood. It can be reached after around 6 months of consistent treatment and routine checkups, which signifies the effectiveness of the treatment in controlling and suppressing the virus and leads to untransmittable HIV even through condomless sex.

Usually, after 4 weeks of initiating the treatment, HIV RNA testing is performed and repeated every 4 to 8 weeks until it becomes undetectable. Follow-up testing is generally performed every 3 to 4 months to ensure viral suppression.

While U=U leads to a negligible risk of transmitting HIV to HIV-negative partner(s), the risk of contracting and transmitting other STIs, such as Hepatitis B and C, HPV, Herpes, Syphilis, Chlamydia, and Gonorrhea, is still present. Therefore, using condoms in any anal, vaginal, and oral sex and regular testing are still recommended.

The ultimate objective of HIV treatment is navigating towards a life of well-being, breaking down the barriers and the stigma, and achieving a U=U status.

U=U

Pregnancy and breastfeeding

Being diagnosed and living with HIV might raise a lot of concerns related to the safety of getting pregnant, giving birth, breastfeeding, and how to reduce the possibility of transmitting the virus to the baby. Therefore, many steps should be discussed with the healthcare provider before deciding to go through this journey.

First of all, the person should discuss the desire to have a child and the planned time frame with their healthcare providers.
Second, discuss ways to prevent HIV transmission to the partner(s) (such as PrEP) and encourage the partner(s) to know their status regarding HIV and any other STIs.

Additionally, it is important to set a treatment plan and discuss safe conception ways to prevent transmission to the fetus/newborn. Studies show that with a suppressed viral load, the risk of transmission during pregnancy, delivery, and breastfeeding is very low.

Third, engaging in a healthy lifestyle and consistently taking the treatment before and during the pregnancy is essential to keep the virus suppressed and reduce the risk of transmitting it to the child and the partner.

In conclusion, maintaining a healthy lifestyle and a balanced diet is essential to preventing opportunistic infections . In addition, achieving a low viral load, thus making HIV untransmittable, along with a high CD4 count that helps the immune system resist any possible infection, can help in having a safe pregnancy.

Immune system

Undetected and untreated HIV primarily targets the CD4 T-cells, a type of white blood cell that plays a crucial role in triggering the immune system to fight any type of infection. HIV targets CD4 T-cells by entering the cell and using it as a host for its replication, leading to a decreased number in CD4 T-cells. This process leads to weakening the immune system as the virus compromises it, which makes the body more vulnerable.

HIV treatment or ART works on suppressing viral replication to restore the immune system function, reduce the risk of opportunistic infections, and achieve a U=U status.

To preserve a strong immunity, prevent potential opportunistic infections, and live a fulfilling and healthy life, it is important to consistently take the ART, do routine checkups, receive vaccinations against preventable diseases, adopt a healthy lifestyle and a balanced diet, and take care of mental wellbeing.

Opportunistic infections (OIs)

OIs are types of illnesses that are more frequent in people living with HIV due to the inability of the immune system to fight them, particularly in people who are unaware of their status or not consistently adhering to treatment. Adhering to the prescribed HIV treatment and regularly following up with the healthcare provider contribute to fortifying the immune system and help in preventing opportunistic infections. It also helps to prevent exposure to other sexually transmitted infections, limit the risk of attracting any disease that might affect the immune system, and adopt a healthy lifestyle and a balanced diet.

In case the person living with HIV plans to travel, change residence, go for a local trip, or embark on new adventures, thoughtful precautions should be taken into consideration to ensure overall well-being and to avoid contracting any OI. Therefore, the person should discuss travel plans with their healthcare provider in order to assess the risks, review the medical record to check the need to take any vaccination, maintain continuity of care and treatment, and check for healthcare resources in their destination.

Here are some opportunistic infections:

Candidiasis: a fungal infection that affects the skin, nails, and mucous membranes throughout the body.
Coccidioidomycosis: a fungal infection caused by inhaling spores of the fungus.
Cryptococcosis: a fungal infection that enters the body through the lungs.
Histoplasmosis: a fungal infection caused by inhaling spores of the fungus.
Pneumocystis pneumonia (PCP): a fungal infection of the lungs.
Cryptosporidiosis (Crypto): a tiny parasite that causes severe diarrhea.
Cystoisosporiasis: a parasite contracted through consumption of contaminated food or water.
Toxoplasmosis: a parasitic infection caused by Toxoplasma gondii.
Cytomegalovirus: a member of the herpesvirus family.
Herpes simplex virus (HSV): a virus that causes oral and/or genital herpes.
Tuberculosis (TB): an infectious disease that affects the lungs.
Pneumonia: inflammation of the lungs.
Salmonella septicemia: a bacterial infection caused by Salmonella bacteria.
Invasive cervical cancer: cancer that starts by affecting the cervix and spreads to other body parts, can be prevented through regular pap smears.
Kaposi’s sarcoma (KS): a type of cancer characterized by skin lesions.
Lymphoma: a type of cancer that affects the lymphatic system.
Encephalopathy, HIV-related: a brain dysfunction associated with HIV.
Mycobacterium avium complex (MAC): an infection caused by diverse types of bacteria.
Progressive multifocal leukoencephalopathy: a rare brain infection.
Wasting syndrome due to HIV: unexplained weight loss and muscle atrophy.

Tracking HIV status

Testing for CD4 and HIV viral load are key components to tracking the HIV status.

The CD4 test: gives an idea about how the virus is affecting the immune system by checking it every 3 to 6 months.
The viral load test: shows the effectiveness of the ART medication and should be tested every 4 to 6 months.

Moreover, keeping track of the symptoms and side effects can help in understanding how the body is reacting. It is also important to discuss symptoms and side effects with the healthcare provider and to stay informed about HIV treatment, possible reactions, and new recommendations.

Healthy lifestyle & balanced diet

Living with HIV is a unique journey that extends beyond medical treatment. The individual’s lifestyle has a huge impact on managing HIV symptoms and achieving an overall state of health and wellbeing.

The inflammatory nature of HIV puts those who have it at greater risk for infections, kidney failure, and certain types of cancer.

While altering established habits may not be easy, adapting positive changes in nutrition, physical activity, substance use, and more can make a meaningful impact on keeping the risks at bay. Therefore, embracing a healthier lifestyle empowers the individual, enhances their immune system, and improves their quality of life.

Tips for healthy changes & benefits:

Balanced Nutrition:

Supports the immune system by providing essential nutrients and energy.
Helps in weight management and preserving muscle mass (loss of muscle mass is one of the common side effects for people taking HIV treatment).
Improves cholesterol levels, and balances blood sugar.
Enhances metabolic processes.
Body fuel that improves overall health.

Food rich in:

Protein: Poultry, fish, meat, eggs, beans, lentils.

Fats: peanut butter, avocados, nuts, olives.

Starches: bread, muffins, biscuits, oatmeal, pasta, rice.

Simple sugars: jelly, dried fruits, honey, maple syrup.

Carbohydrates: for better energy.

Fruits and vegetables, brown rice, quinoa, potato.

Fibers: raw vegetables, fruit, beans, nuts, whole grains.

Vitamins and minerals: Vegetables, fruits, whole grains, low-fat dairy, meat, fish, chicken, grains, citrus fruits, peanuts, spinach, vegetable oils, and beans.

Dietary and herbal supplements: To be discussed with the healthcare provider.

It is better to avoid raw eggs, raw fish, raw meat, processed food, and foods with high amounts of sugar.

Adequate hydration:

Helps in reducing the side effects.
Prevents dehydration.
Maintains high energy levels.

Follow the Clean, Separate, Cook, and Chill steps:

Clean: Wash your hands, utensils, and tabletop before starting.
Separate: Separate food to avoid spreading germs (for example: Separate vegetables from raw chicken).
Cook: Make sure food is cooked to safe temperatures.
Chill: Refrigerate or freeze food at the correct time after purchase (2 hours maximum).

Food safety:

Support the all-over body function by preventing dehydration and boosting the effectiveness of the medicines.
Avoid foodborne illnesses or food poisoning.

Practice good oral hygiene:

Decrease the risk of oral warts, thrush, and cavities.
Brush and floss the teeth regularly, and visit the dentist once to twice a year.

Weight management:

Better health and decreased risk of diseases.
Combine physical activity and a balanced diet for better weight management.

Physical activity:

A huge support for mental and physical health, boosting the immune system.
Increases energy levels, maintains muscle mass, and strengthens the bones.
Improves appetite and blood circulation.

Staying updated with the vaccines:

Protection against many types of severe preventable diseases.
Discuss recommended vaccines with healthcare providers based on risk factors and location, such as Hepatitis B, HPV, flu, and tetanus vaccines.

Avoid smoking and misuse of alcohol and drugs:

Reduces the risk of liver damage, various types of cancer, and other diseases like pneumonia and lung cancer.
Helps the person to refrain from making impaired judgments that might lead to risky behavior.
Some tips include trying to identify the situation that triggers your consumption.
Finding alternative strategies to cope with stress or boredom.
Setting limits to the amount and frequency of smoking or drinking.
Engaging in alternative activities and educating yourself about the interactions between HIV medications and alcohol or drugs.

Protected sexual activity:

Decreases the risk of sexually transmitted infections.
Regular testing for STIs.
Communicate with your partners about testing and STIs.
Always use condoms for anal, vaginal, and oral sex.
Avoid brushing your teeth 2 hours before and after having sex.

Stress management:

Less stress leads to a healthier immune system, better appetite, regulated sleeping patterns, and a healthier lifestyle.
Try to get enough sleep consistently.
Seek psychological support when needed.
Find healthy coping mechanisms to deal with stressful situations.
Some examples include: walking, reading, going out, engaging in physical activities...
The guidance of a nutritionist is essential to better understand the needs of your body.
Drink around 8 glasses of water per day. Be cautious of outdoor water sources that may contain bacteria, parasites, and viruses. Wash fruits and vegetables thoroughly.
Consult your healthcare provider for personalized recommendations.
Choose activities that suit you like daily walks, cardio exercises, aerobics, resistance training, etc.

Written by:

Cristel Lahoud | Sexual health educator, midwife

Cristel Lahoud is a sexual health educator at Marsa, holding a Bachelor's degree in Midwifery and currently pursuing a Master's degree in Clinical Psychology. Her profound dedication lies in raising awareness and promoting advocacy for both sexual and reproductive health.