HIV and Opportunistic Infections, Coinfections, and Conditions

Opportunistic infections (OIs) are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. People with weakened immune systems include people living with HIV.

OIs are caused by a variety of germs (viruses, bacteria, fungi, and parasites). OI-causing germs spread in a variety of ways, for example, in the air, in body fluids, or in contaminated food or water. Some OIs that people with HIV may get include candidiasis, Salmonella infection, toxoplasmosis, and tuberculosis (TB). The Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV provide detailed information on HIV-related OIs.

Once a person has HIV, the virus begins to multiply and damages the immune system. A weakened immune system makes it harder for the body to fight off OIs.

HIV medicines prevent HIV from damaging the immune system. But without treatment with HIV medicines, HIV can gradually destroy the immune system and advance to acquired immunodeficiency syndrome (AIDS). Many OIs, for example, certain forms of pneumonia and TB, are considered AIDS-defining conditions, which are infections and cancers that are life-threatening in people with HIV.

In the United States, OIs have become less common among people with HIV than in previous years. Fewer people with HIV get OIs, because HIV medicines are now widely used in the United States. By preventing HIV from damaging the immune system, HIV medicines reduce the risk of OIs.

However, OIs are still a problem for many people with HIV. Some people with HIV get OIs for the following reasons:

• They may not know that they have HIV. Therefore, they are not getting HIV treatment. An OI may be the first sign that they have HIV.
• They may know that they have HIV, but they are not getting HIV treatment.
• They may be getting HIV treatment, but the HIV medicines are not controlling their HIV.

For people with HIV, the best protection against OIs is to take HIV medicines every day.

People living with HIV can also take the following steps to reduce their risk of getting an OI.

Avoid contact with the germs that can cause OIs.

The germs that can cause OIs can spread in a variety of ways, including in body fluids or in feces. To avoid sexually transmitted diseases (STDs) or infections, use condoms every time you have sex. If you inject drugs, do not share drug injection equipment. After any contact with human or animal feces, wash your hands thoroughly with warm, soapy water.

Ask your health care provider about other ways to avoid the germs that can cause OIs.

Be careful about what you eat and drink.

Food and water can be contaminated with OI-causing germs. To be safe, do not eat certain foods, including undercooked eggs, unpasteurized dairy products or fruit juices, or raw seed sprouts.

In addition, do not drink water directly from a lake or river. For more information, read the HIV and Nutrition and Food Safety fact sheet from HIVinfo.

Travel safely.

If you are visiting a country outside the United States, avoid eating food and drinking water that could make you sick. Before you travel, read the Centers for Disease Control and Prevention (CDC) fact sheet on Traveling with HIV.

Get vaccinated.

Talk to your health care provider about which vaccines you need. To learn more, read the HIVinfo fact sheet on HIV and Immunizations.

There are many medicines to treat HIV-related OIs, including antiviral, antibiotic, and antifungal drugs. The type of medicine used depends on the OI.

Once an OI is successfully treated, a person may continue to use the same medicine or an additional medicine to prevent the OI from coming back. The Clinicalinfo Drug Database includes information on many of the medicines used to prevent and treat OIs.

From CDC:

• AIDS and Opportunistic Infections

From the Department of Health and Human Services:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV:
  • Introduction

From the U.S. Department of Veterans Affairs:

• Preventing Opportunistic Infections (OIs)

Also see the HIV Source collection of HIV links and resources.

COVID-19 is caused by a virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and can be spread from person to person. Transmission of SARS-CoV-2 primarily occurs when a person inhales respiratory droplets or particles that contain the virus or when a person touches their mucous membranes with hands that have been contaminated with the virus.

Anyone can get infected with SARS-CoV-2 and become severely sick or die from COVID-19. However, people with underlying medical conditions or those who are immunocompromised or have a weakened immune system are more likely to get very sick, be hospitalized, need intensive care, require a ventilator to breathe, or die from COVID-19. People with HIV have higher rates of certain underlying medical conditions. The human immunodeficiency virus (HIV) weakens the immune system and can cause a person to be immunocompromised.  

People with HIV, especially those with advanced HIV or untreated HIV, may have an underlying condition or a comorbidity that can make them severely sick if they become infected with SARS-CoV-2.

You should follow CDC recommendations regarding symptoms of COVID-19 and get tested immediately if you think you may be infected with SARS-CoV-2. A person can be infected with SARS-CoV-2 but show only a few symptoms or no symptoms at all (also known as asymptomatic infection). Testing is the only way to know that someone has been infected with SARS-CoV-2. Testing also ensures that people are not spreading the virus to others.

Most health care providers offer COVID-19 testing. Contact your health care provider if you are experiencing COVID-19–related symptoms or have come in contact with an infected person. People can also get tested for COVID-19 at their local pharmacies by making scheduled appointments or drive-throughs or by purchasing at-home rapid tests over the counter at local pharmacies. Residential households in the United States can now order free at-home testing kits from the U.S. Postal Service. Visit the CDC website for more information about self-testing and free at-home COVID-19 tests, and visit your state or local health department’s website for information on additional testing sites.

Important: If you have HIV you should immediately contact their health care provider if you test positive for COVID-19, and you should also continue taking your HIV medicines (also known as antiretroviral drugs) as prescribed.

There are several COVID-19 vaccines that are Food and Drug Administration (FDA)-approved or authorized for emergency use in the United States. CDC recommends that people with HIV who are eligible should get COVID-19 vaccines regardless of viral load or CD4 T lymphocyte cell count. Vaccination schedules depend on age and vaccine manufacturer. See the CDC’s Interim COVID-19 Immunization Schedule (PDF), or the (easier to understand) infographics COVID-19 Vaccination Recommendations Infographic (PDF) for most people, or COVID-19 Vaccination Recommendations Infographic (Immunocompromised) (PDF).

CDC also recommends that people with advanced or untreated HIV get an additional primary dose to boost their immune response. An additional primary dose is the dose given after a person receives the initial dose of a COVID-19 vaccine. If you have HIV, you should talk to your health care provider about getting additional doses of updated COVID-19 vaccines.

People who are vaccinated against COVID-19 can still get infected with SARS-CoV-2 but getting vaccinated decreases the risk of severe illness, hospitalization, and death from COVID-19.

COVID-19 vaccines are safe for people with HIV. People with HIV were included in COVID-19 vaccine clinical trials. COVID-19 vaccines meet the FDA’s standards of safety, effectiveness, and quality. According to CDC, there is no evidence that COVID-19 vaccines interfere with medicines to treat or prevent HIV. HIV medicines that prevent HIV are called pre-exposure prophylaxis.

There are drugs that are FDA-approved or authorized for the treatment of COVID-19. Some of these approved drugs have drug-drug interactions with certain HIV medicines. If you take HIV medicines, you should talk to your health care provider about potential drug-drug interactions taking COVID-19 treatment. To learn more about drug-drug interactions, read the What is a Drug Interaction HIVinfo fact sheet.

If you have HIV, you should follow the general CDC protocols on how to protect yourself and others from COVID-19. Getting fully vaccinated against COVID-19 can protect you and others from COVID-19. People with HIV can also protect themselves from COVID-19 by—

• Maintaining a healthy lifestyle.
• Continuing to take antiretroviral drugs to strengthen the immune system.
• Ensuring that all vaccinations, including vaccination against the flu, are up to date.
• Maintaining adequate supply of antiretroviral drugs (at least 30 days’ supply) and other drugs needed to manage HIV; you can talk to your health care provider about getting your HIV medicine by mail.
• Keeping all medical appointments and observing safety protocols during in-person medical visits; people with HIV should use telemedicine when possible.

From CDC:

• How to Protect Yourself and Others
• COVID-19 Vaccines for People Who Are Moderately or Severely Immunocompromised

From National Institutes of Health: 

• Guidance for COVID-19 and People with HIV
• Coronavirus Disease 2019 (COVID-19) Treatment Guidelines
  • Special Considerations in People with HIV
• COVID-19 Testing

Also see the HIV Source collection of HIV links and resources.

Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). The abbreviation HBV can stand for either the virus or the infection it causes.

HBV can be a short-term (acute) or a long-term (chronic) illness:

• Acute HBV occurs within 6 months after a person is exposed to HBV. In some people, acute HBV can lead to chronic HBV.
• Chronic HBV is a lifelong disease. Without treatment, chronic HBV can cause liver cancer or liver damage that leads to liver failure.

HBV is a contagious infection that can spread from person to person.

HBV is spread through contact with the blood, semen, or other body fluid of a person who has HBV. Among adults in the United States, HBV is spread mainly through sexual contact.

HBV can also spread from person to person in the following ways:

• By sharing needles or other injection drug equipment (works) with someone who has HBV
• By sharing razors, toothbrushes, or similar personal items with someone who has HBV
• From contact with the blood or open sores of a person who has HBV
• From an accidental prick or cut from an HBV-contaminated needle or other sharp object
• From a mother who has HBV to her child during childbirth

Both HIV and HBV spread from person to person in semen, blood, or other body fluids. For this reason, the main risk factors for HIV and HBV are the same: having sex without a condom and injection drug use.

According to the Centers for Disease Control and Prevention (CDC), approximately 10% of people with HIV in the United States also have HBV. Infection with both HIV and HBV is called HIV/HBV coinfection.

Chronic HBV advances faster to cirrhosis, end-stage liver disease, and liver cancer in people with HIV/HBV coinfection than in people with only HBV infection. But chronic HBV does not appear to cause HIV to advance faster in people with HIV/HBV coinfection.

Yes. The best way to prevent HBV is to get the hepatitis B vaccine.

CDC recommends that people with HIV and people who are at risk for HIV get the HBV vaccine (or the combined hepatitis A virus/HBV vaccine). The housemates and sexual partners of people with HBV should get the HBV vaccine, too.

People, including people with HIV, can also take the following steps to reduce their risk of HBV infection:

• Use condoms during sex to reduce the risk of HBV infection and infection with other sexually transmitted diseases, such as gonorrhea and syphilis.
• Do not inject drugs. But if you do, do not share needles, syringes, or other drug injection equipment.
• Do not share toothbrushes, razors, or other personal items that may come in contact with another person's blood.
• If you get a tattoo or body piercing, make sure the instruments used are sterile.

CDC recommends that all people with HIV get tested for HBV. Testing can detect HBV even when a person has no symptoms of the infection.

There are several HBV blood tests. Results of different tests show different things. For example, a positive hepatitis B surface antigen (HBsAg) test result shows that a person has acute or chronic HBV and can spread the virus to others.

To learn more about HBV tests, visit the CDC webpage Hepatitis B Questions and Answers for the Public.

Some people with acute HBV do not have symptoms. But some people can have signs of HBV soon after becoming infected. Symptoms of acute HBV can include the following:

• Loss of appetite
• Tiredness
• Nausea
• Vomiting
• Fever
• Abdominal pain
• Dark urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellowing of the skin or the whites of the eyes)

Most people with chronic HBV do not have any symptoms and may not have symptoms for many years. Abnormal results on liver function tests may be the first sign of chronic HBV infection.

In general, HBV is treated with antiviral medicines. The medicines work to help limit damage to the liver.

People with HIV/HBV coinfection should be treated for both infections. Some HIV medicines are effective at treating both HIV and HBV.

The choice of medicines to treat HIV/HBV coinfection depends on the person. For example, some people may take HIV medicines that are also effective at treating HBV. Other people may take HIV medicines and an HBV antiviral medicine. If you have HIV/HBV coinfection, talk to your health care provider about the best medicines for you.

From CDC:

• Hepatitis B Questions and Answers for the Public
• People Coinfected With HIV and Viral Hepatitis
• Travelers' Health: Hepatitis B

From the Department of Health and Human Services:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV:
  • Hepatitis B Virus Infection
• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • Hepatitis B Virus/HIV Coinfection

From the National Institute of Diabetes and Digestive and Kidney Diseases:

• Hepatitis B

Also see the HIV Source collection of HIV links and resources.

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). The abbreviation HCV can stand for either the virus or the infection it causes.

HCV can be either a short-term (acute) or a long-term (chronic) illness:

• Acute HCV occurs within 6 months after exposure. In most people, acute HCV becomes chronic HCV.
• Chronic HCV can last a lifetime. Without treatment, chronic HCV can cause liver cancer or severe liver damage that can lead to liver failure.
• HCV is a contagious infection that can spread from person to person.

HCV is spread mainly through contact with the blood of a person who has HCV. In the United States, HCV is spread mainly by sharing needles or other injection drug equipment (works) with someone who has HCV. HCV can also be spread through sexual contact. While the risk of transmission through sexual contact is low, the risk is increased in people with HIV.

Because both HIV and HCV can spread in blood, a major risk factor for both HIV and HCV infection is injection drug use. Sharing needles or other drug injection equipment increases the risk of contact with HIV- or HCV-infected blood.

According to the Centers for Disease Control and Prevention (CDC), approximately 21% of people with HIV in the United States also have HCV. Infection with both HIV and HCV is called HIV/HCV coinfection.

In people with HIV/HCV coinfection, HIV may cause chronic HCV to advance faster. Whether HCV causes HIV to advance faster is unclear.

The best protection against HCV is to never inject drugs. If you do inject drugs, always use new, sterile needles, and do not reuse or share needles, syringes, or other injection drug equipment.

People, including people with HIV, can also take the following steps to reduce their risk of HCV infection:

• Do not share toothbrushes, razors, or other personal items that may come in contact with another person’s blood.
• If you get a tattoo or body piercing, make sure the instruments used are sterile.
• Use condoms during sex. The risk of HCV infection through sexual contact is low, but the risk increases in people with HIV. Condoms also reduce the risk of HIV transmission and infection with other sexually transmitted diseases, such as gonorrhea and syphilis.

Every person who has HIV should get tested for HCV. Usually, a person will first get an HCV antibody test. This test checks for HCV antibodies in the blood. HCV antibodies are disease-fighting proteins that the body produces in response to HCV infection.

A positive result on an HCV antibody test means that the person has been exposed to HCV at some point in their life. However, a positive antibody test does not necessarily mean the person has HCV. For this reason, a positive result on an HCV antibody test must be confirmed by a second test. This follow-up test checks to see if HCV is present in the person’s blood. A positive result on this test confirms that a person has HCV.

Most people with acute HCV do not have symptoms. But some people can show signs of HCV soon after becoming infected. Symptoms of acute HCV can include the following:

• Fever
• Tiredness
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark-colored urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellowing of the skin or the whites of the eyes)

Most people with chronic HCV do not have any symptoms. Chronic HCV is often discovered based on results from routine liver function tests.

HCV is treated with antiviral medicines. Many newer HCV medicines are more effective and have fewer side effects than older medicines. The newer medicines can cure HCV in most people.

People with HIV/HCV coinfection may be treated for both infections. However, when to start each treatment and what medicines to take depends on the person. For example, some HIV and HCV medicines cannot be safely used together because of drug-drug interactions.

Health care providers prescribe HIV and HCV medicines carefully to avoid drug-drug interactions and closely monitor those taking the medicines for any side effects.

If you have HIV/HCV coinfection, talk to your health care provider about the best medicines for you.

From CDC:

• Clinical Overview of Hepatitis C
• Hepatitis C Basics
• Viral Hepatitis Among People With HIV

From the Department of Health and Human Services:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV:
  • Hepatitis C Virus Infection
• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • Hepatitis C Virus/HIV Coinfection

From the National Institute of Diabetes and Digestive and Kidney Diseases:

• Hepatitis C

Also see the HIV Source collection of HIV links and resources.

Human papillomavirus (HPV) is a common virus spread through intimate skin-to-skin contact. There are many types of HPV that can be split into two main categories:

• Low-risk HPV, which can cause oral, anal, and/or genital warts
• High-risk HPV, which can cause different kinds of precancers (abnormal cells that could lead to cancer) and cancer, such as cervical, vaginal, vulvar, penile, anal, and oropharyngeal (back of the throat)

People with HIV are more likely to acquire both kinds of HPV.

HPV is considered a sexually transmitted infection. You can get HPV by having vaginal, anal, or oral sex with someone who has the virus, even if they do not show any signs or symptoms. A person can have HPV for years without experiencing symptoms. For more information on sexually transmitted infections, see the HIVinfo fact sheet HIV and Sexually Transmitted Diseases.

Both HIV and HPV can be spread through sexual activity. Behaviors that put people at increased risk for HIV also increase their risk for HPV and other sexually transmitted infections. These behaviors include the following:

• Having sex without a condom
• Having sex with many partners, especially anonymous partners
• Having sex while using drugs or alcohol.

Since HIV targets the immune system’s infection-fighting CD4 cells (CD4 T lymphocyte), it is more difficult for the body to fight off infections and illnesses. HPV is an opportunistic infection, meaning that people with HIV are more likely to acquire HPV. Compared to people without HIV, people with HIV may have larger or more numerous warts and are more likely to develop HPV-associated warts, precancers, and cancers.

For more information on opportunistic infections, see the HIVinfo fact sheet What is an Opportunistic Infection?

Get vaccinated.

The HPV vaccine can protect against many disease-causing types of HPV. Getting the HPV vaccine can reduce your risk of getting genital warts and developing precancers and cancers.

CDC recommends that people with HIV, starting at age 9, can receive the HPV vaccine. People with HIV usually receive 3 doses of the vaccine over a 6-month period. The HPV vaccine is most effective administered before a person is sexually active or exposed to the virus.

For information on other immunizations, see the HIVinfo fact sheet HIV and Immunizations.

Protect yourself during sex.

If you are sexually active, reducing the number of people you have sex with and avoiding sexual activity with people who have had many sexual partners can reduce your risk of getting HPV. Using condoms correctly every time you have sex can also reduce the risk of getting HPV and other STIs. Visit Centers for Disease Control and Prevention (CDC) to learn how to use condoms correctly.

Detecting cancer at an earlier, more curable stage can mean more effective treatment. Therefore, the NIH recommends that people with HIV (even those who have been vaccinated) undergo regular anal screening and cervical cancer screening.

Anal Cancer Screening

All adults with HIV should be assessed for anal abnormalities (such as pain, burning, or masses) and undergo a digital anorectal exam (DARE) annually. During a DARE, your health care provider will examine the outside of the anus and use a gloved, lubricated finger into the rectum to check for any abnormal findings. If there are abnormal findings, anal cells are collected and checked for signs of precancer or cancer.

The age at which anal screening should start depends on their individual risk. Most people with HIV should start anal cancer screening at age 45. Others, such as men who have sex with men and transgender women, are at increased risk of anal cancer and should begin anal cancer screening starting at age 35.

Cervical Cancer Screening

Once a person who is age 21 years or older is diagnosed with HIV, they should undergo annual cervical cancer screening, which can include an HPV test to determine the type of HPV involved and a Pap smear to collect and check cervical cells for signs of precancer or cancer. If signs of precancer or cancer or high-risk HPV are found, your health care provider may need to do additional testing, such as a colposcopy to examine the cervix, vagina, and vulva more closely.

Factors such as age and test availability impact what tests are used.

There is no treatment for HPV infection specifically, but there are treatments for HPV-associated warts, precancers, and cancers.

Genital or oral warts can be treated with ointments or gels at home or by surgery or cryotherapy (freezing) in a clinic, depending on their location, size, and number.

Precancers can be removed, lasered, or frozen before they become cancer.

Cancer treatment can involve surgery, chemotherapy, and/or radiation.

People with HIV receive treatment for warts, precancers, and cancers similar to those without HIV.

From NIH Office of AIDS Research:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV:
  • Human Papillomavirus Disease

From National Cancer Institute:

• Human Papillomavirus (HPV) Vaccines

From CDC:

• HPV Infection
• HPV Vaccine
• Cancers Caused by HPV
• Screening for Cervical Cancer

From Medline:

• HPV (Human Papillomavirus)
• Human Papillomavirus (HPV) Test

From Office on Women's Health:

• Human Papillomavirus

Also see the HIV Source collection of HIV links and resources.

Tuberculosis (TB) is a disease caused by a bacterium called Mycobacterium tuberculosis. The TB bacterium can spread from person to person through the air.

TB usually affects the lungs, but it can affect any part of the body, including the kidneys, spine, or brain. If not treated, TB can cause death.

When a person with TB disease of the lungs coughs or speaks, droplets of TB bacteria spread through the air. People nearby who breathe in the TB bacteria can get TB.

Once in the body, TB can be inactive or active. When the TB bacterium is inactive, this is called latent TB infection. When the TB bacterium is active, this is called TB disease. The image below shows the difference between latent TB infection and TB disease.

TB is an opportunistic infection (OI). OIs are infections that occur more often or are more severe in people with weakened immune systems than in people with healthy immune systems. HIV weakens the immune system, increasing the risk of TB in people with HIV.

Infection with both HIV and TB is called HIV/TB coinfection. Untreated latent TB infection is more likely to advance to TB disease in people with HIV than in people without HIV. In people with HIV, TB disease is considered an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening in people with HIV.

Treatment with HIV medicines is called antiretroviral therapy (ART). HIV medicines protect the immune system and prevent HIV from advancing to acquired immunodeficiency syndrome (AIDS). In people with HIV and latent TB infection, treatment with HIV and TB medicines reduces the chances that latent TB infection will advance to TB disease.

Worldwide, TB disease is one of the leading causes of death among people with HIV. In the United States, where HIV medicines are widely used, fewer people with HIV have TB disease than in the past. But TB disease still affects many people with HIV in the United States, especially those born outside the United States.

Yes, all people with HIV should get tested for TB infection. If test results show that a person has latent TB infection, additional testing is needed. More testing will determine whether the person has TB disease.

People with latent TB infection have no symptoms. But people with TB disease that affects the lungs may have the following symptoms:

• A persistent cough that may bring up blood or sputum
• Chest pain
• Weakness or fatigue
• Loss of appetite
• Weight loss
• Chills
• Fever
• Night sweats

When TB disease affects other parts of the body, a person may have other symptoms.

TB medicines are used to prevent latent TB infection from advancing to TB disease and to treat TB disease. The choice of TB medicines and the length of treatment depend on whether a person has latent TB infection or TB disease.

People with HIV/TB coinfection should be treated for both HIV and TB; however, when to start treatment and what medicines to take depends on a person’s individual circumstances. Taking certain HIV and TB medicines at the same time can increase the risk of drug-drug interactions and side effects. People being treated for HIV/TB coinfection are carefully monitored by their health care providers.

If you have HIV/TB coinfection, talk to your health care provider about a treatment plan that works for you.

From the Centers for Disease Control and Prevention (CDC):

• About TB
• TB Risk and People with HIV

From the Department of Health and Human Services:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV:
  • Mycobacterium Tuberculosis Infection and Disease
• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • Tuberculosis/HIV Coinfection

Also see the HIV Source collection of HIV links and resources.

STD stands for sexually transmitted disease, also called sexually transmitted infections (STIs). STDs are infections that spread from person to person through sexual activity, including anal, vaginal, or oral sex. STDs are caused by bacteria, parasites, and viruses.

Many health care providers use the term “infection” instead of “disease”, because a person with an infection may have no symptoms but still require treatment. When untreated, an STI can become a disease.

HIV is a sexually transmitted infection, but it can progress to a disease called acquired immunodeficiency syndrome (AIDS) when HIV infection is untreated with HIV medicines. Other examples of STDs are chlamydia, gonorrhea, human papillomavirus (HPV) infection, and syphilis.

Behaviors that put people at risk for HIV also increase their risk for other STDs. These behaviors include the following:

• Having sex without a condom.
• Having sex with many partners, especially anonymous partners.
• Having sex while using drugs or alcohol. Using drugs and alcohol can affect a person's judgement, which can lead to risky behaviors.

Having an STD can make it easier to get HIV. For example, an STD can cause a sore or a break in the skin, which can make it easier for HIV to enter the body. Having HIV and another STD may increase the risk of HIV transmission.

Sexual abstinence (never having vaginal, anal, or oral sex) is the only way to eliminate any chance of getting an STD. But if you are sexually active, you can take the following steps to lower your risk for STDs, including HIV.

Choose less risky sexual behaviors.

• Reduce the number of people you have sex with.
• Do not drink alcohol or use drugs before and during sex.

Use condoms correctly every time you have sex.

• Visit this website from the Centers for Disease Control and Prevention (CDC) to learn how to use condoms correctly.

Take HIV medicines daily. Treatment with HIV medicines (called antiretroviral therapy or ART) helps people with HIV live longer, healthier lives. One of the goals of ART is to reduce a person's viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partner through sex.

If your viral load is not undetectable—or does not stay undetectable—you can still protect your partner from HIV by using condoms and choosing less risky sexual behaviors. Your partner can take medicine to prevent getting HIV, which is called pre-exposure prophylaxis (PrEP). PrEP is an HIV prevention option for people who do not have HIV but who are at risk of getting HIV. PrEP involves taking a specific HIV medicine every day to reduce the risk of getting HIV through sex or injection drug use.

To learn more, read the HIVinfo Pre-Exposure Prophylaxis (PrEP) fact sheet.

Symptoms of STDs may be different depending on the STD, and not everyone will experience the same STD symptoms. Examples of possible STD symptoms include painful urination (peeing), unusual discharge from the vagina or penis, and fever.

STDs may not always cause symptoms. Even if a person has no symptoms from an STD, it is still possible to pass the STD on to other people.

Talk to your health care provider about getting tested for STDs and ask your sex partner to do the same.

To find STD information and testing sites near you, call CDC-INFO at 1-800-232-4636 or visit CDC's GetTested webpage.

STDs caused by bacteria or parasites can be cured with medicine. There is no cure for STDs caused by viruses, but treatment can relieve or eliminate symptoms and help keep the STD under control. Treatment also reduces the risk of passing on the STD to a partner. For example, although there is no cure for HIV, HIV medicines can prevent HIV from advancing to AIDS and reduce the risk of HIV transmission.

Untreated STDs may lead to serious complications. For example, untreated gonorrhea in women can cause pelvic inflammatory disease, which may lead to infertility. Without treatment, HIV can gradually destroy the immune system and advance to AIDS.

From CDC:

• About Sexually Transmitted Infections (STIs)
• Sexually Transmitted Infections (STIs)
• HIV and Substance Use
• Preventing HIV
• Living With HIV

From the Eunice Kennedy Shriver National Institute of Child Health and Human Development:

• Sexually Transmitted Diseases (STDs)
• About Sexually Transmitted Diseases (STDs)

Also see the HIV Source collection of HIV links and resources.

There are many different types of heart diseases. Coronary heart disease (also called coronary artery disease) is the most common type of heart disease. It is the leading cause of death in the United States. In this fact sheet, the term “heart disease” refers specifically to coronary heart disease.

Heart disease is caused by the buildup of plaque inside the blood vessels (called the coronary arteries) that carry blood to the heart. Plaque is a waxy substance made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque buildup in the coronary arteries (called atherosclerosis) reduces the blood flow to the heart, which can cause chest pain (called angina) or a heart attack.

Some risk factors for heart disease can be changed or controlled by lifestyle changes or medicines, while other risk factors cannot. Risk factors that can be controlled to prevent or delay heart disease include the following:

• High blood pressure (also known as hypertension)
• High blood cholesterol levels
• Diabetes
• Eating an unhealthy diet
• A lack of physical activity
• Smoking
• Being overweight or obese
• Stress

Risk factors for heart disease that cannot be changed include having a family history of early heart disease and older age.

Yes. The risk factors for heart disease are the same for people with HIV and people without HIV. However, HIV and some HIV medicines may increase the risk of heart disease in people with HIV.

Research is underway to understand the connection between HIV and heart disease. Go to ClinicalTrials.gov to find HIV research studies related to heart disease. For help with your search, call a Clinicalinfo health information specialist at 1-800-448-0440 or email HIVinfo@NIH.gov.

Some people who have heart disease have no symptoms. However, some people may have chest pain, shortness of breath, fatigue, or weakness. If you have any of these symptoms, contact your health care provider.

Chest pain that does not go away or occurs while a person is resting may be a sign of a heart attack. If you think you may be having a heart attack, call 9-1-1 immediately.

Treatment for heart disease often includes lifestyle changes. For example, people with heart disease may change their eating habits, exercise more to lose weight, or quit smoking.

Medicines and surgery are also used to treat heart disease.

Medicines

Medicines used to treat heart disease include drugs to lower blood pressure, reduce cholesterol levels, or prevent or relieve chest pain. Some of these medicines may interact with HIV medicines. Health care providers carefully consider potential drug-drug interactions between HIV medicines and any other medicines a person may be taking.

Surgery

Coronary artery bypass grafting (CABG) is the most common type of surgery to treat heart disease in adults. During CABG, a healthy artery or vein from the body is used to bypass (go around) the blocked part of a coronary artery.

Visit the National Heart, Lung, and Blood Institute’s Heart Surgery webpage to learn more about the different types of heart surgery.

People with HIV can take the following steps to reduce their risk of heart disease:

• Take HIV medicines every day to keep HIV under control.
• Eat a healthy diet that includes lots of vegetables, fruits, and whole grains, and is low in saturated fats, added sugars, and salt.
• Be physically active on a regular basis.
• Quit smoking.
• Keep all medical appointments. During medical visits, talk to a health care provider about the risk of heart disease.

For more information on how to lower your risk of heart disease, visit the How to Prevent Heart Disease webpage from MedlinePlus.

From the Department of Health and Human Services:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • Drug-Drug Interactions
  • Poor CD4 Cell Recovery and Persistent Inflammation Despite Viral Suppression

From MedlinePlus:

• Coronary Artery Disease
• Coronary Heart Disease

From the National Heart, Lung, and Blood Institute:

• Atherosclerosis
• Heart Surgery
• Coronary Heart Disease

Also see the HIV Source collection of HIV links and resources.

The kidneys are two fist-sized organs in the body. They are located near the middle of the back on either side of the spine.

The main job of the kidneys is to filter harmful waste and extra water from the blood. The waste and water become urine, which is flushed from the body. The kidneys also release hormones that help control blood pressure, make red blood cells, and keep bones strong.

Kidney function declines as people age. Injury or disease, including HIV infection, can damage the kidneys. Damage to the kidneys can lead to kidney disease (also called renal disease). Kidney disease can advance to kidney failure known as end-stage renal disease.

Diabetes and high blood pressure are the leading causes of kidney disease. Other factors that increase the risk of kidney disease include heart disease and a family history of kidney failure.

A person's risk of kidney disease increases as they get older. The longer a person has diabetes, high blood pressure, or heart disease, the greater their risk of kidney disease.

The risk of kidney failure is especially high among African Americans, Hispanics, and American Indians, partially because these communities have high rates of diabetes and high blood pressure.

The risk factors for kidney disease in people with HIV include all those listed above. In addition, poorly controlled HIV infection and coinfection with the hepatitis C virus (HCV) increase the risk of kidney disease in people with HIV.

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV. People on ART take a combination of HIV medicines (called an HIV treatment regimen) every day. HIV medicines are recommended for everyone who has HIV. Some HIV medicines can affect the kidneys. Health care providers carefully consider the risk of kidney damage when recommending specific HIV medicines to include in an HIV treatment regimen. If a person with HIV shows signs of kidney disease, their health care provider may adjust the dose of their HIV medicines or change which HIV medicines are included in their treatment regimen.

Kidney disease can advance very slowly. Slowly worsening kidney disease is called chronic kidney disease.

As kidney disease gets worse, a person may have swelling of the legs, feet, or ankles (called edema). Symptoms of advanced chronic kidney disease can include:

• Increased or decreased urination
• Feeling tired or having trouble sleeping
• Nausea and vomiting
• Itching or numbness

Blood and urine tests are used to detect kidney disease. Care for people with HIV includes testing for kidney disease.

People with kidney disease can take steps to protect their kidneys from further damage. For example, many people with kidney disease take medicines to control high blood pressure. They may also reduce the amount of salt and protein in their diet to manage their kidney disease.

Some people live with kidney disease for many years; in others, kidney disease progresses to kidney failure. The treatments for kidney failure are dialysis and a kidney transplant. Both treatments take over the job of the failed kidneys.

• There are two main types of dialysis. Like the kidneys, both types filter harmful waste and extra water out of the blood. In hemodialysis, a machine outside of the body is used to filter the blood. In peritoneal dialysis, the lining of the abdomen filters the blood inside the body.
• A kidney transplant is surgery to place a healthy kidney from a donor into the body of a person with kidney failure. The donated kidney can be from a person who just died or from a living person.

Both dialysis and a kidney transplant are used to treat kidney failure in people with HIV.

People with HIV can take the following steps to reduce their risk of kidney disease:

• Take HIV medicines every day to keep HIV under control.
• Eat a healthy diet that includes fresh fruits, fresh or frozen vegetables, whole grains, and low-fat or fat-free dairy products. Cut back on foods high in salt and sugar.
• Be physically active for 30 minutes or more on most days.
• Keep all medical appointments. During medical visits, talk to a health care provider about the risk of kidney disease.

From the Department of Health and Human Services:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV:
  • Initiation of Antiretroviral Therapy
  • HIV and the Older Person
  • Appendix B, Table 11. Antiretroviral Dosing Recommendations in Persons with Renal or Hepatic Insufficiency

From the U.S. Department of Veterans Affairs:

• Primary Care of Veterans with HIV: Renal Disease

From the National Institute of Diabetes and Digestive and Kidney Diseases:

• Your Kidneys & How They Work
• Race, Ethnicity, & Kidney Disease 
• Chronic Kidney Disease (CKD)
• Kidney Failure

Also see the HIV Source for a collection of HIV links and resources.