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1. Will my HIV medicines give me skin problems?
Most of the times, there are no skin problems whatsoever. However, in rare instances HIV medications can cause skin changes. Emtricitabine, which is in Truvada and many single-tablet regimens, can cause darkening of the skin, mainly on the palms and soles. This may happen in 2% of people and is not harmful. Others may cause a fleeting rash.
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2. Will my HIV medicines make me gain weight?
Usually not, but HIV medications can cause lipodystrophy. Lipodystrophy is when there is an abnormal accumulation of body fat on your body in places where you do not want it, like your upper back or abdomen. This was more commonly seen with the older HIV medications prescribed in the 1990s and early 2000s than with the newer medicines prescribed today. Protease inhibitors can cause diabetes and high cholesterol which, in turn, can cause weight gain.
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3. Can a woman spread HIV to a man?
Yes. HIV is carried in vaginal fluid. A man can get HIV through the opening (urethra), the foreskin, or any cuts or sores on the penis, when it comes into contact with HIV-positive vaginal fluid. Menstrual or “period” blood, also, carries HIV. Having sex while on your period may cause infected blood to enter through the opening of the penis or any cuts or sores on the penis. Receiving oral sex from a man who has any sores or cuts in his mouth can, also, cause him to get infected.
1 in 2500 men will acquire HIV from female-to-male transmission.
www.cdc.gov/hivrisk/transmit/activities/vaginal_sex.html
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4. Can a woman spread HIV to another woman during sexual intercourse?
Yes, although it is very rare. The chances of spreading HIV from woman-to-woman are very low (negligible). However, unprotected exposure to HIV-infected vaginal fluids or “period” blood during oral sex or during the sharing of sex toys can spread HIV. The rough use of sex toys, to the point of causing bleeding, is a known contributor to the spread of HIV from one woman to another one.
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5. Can I spread HIV to my friends or family members?
No, you cannot and will not spread HIV to your family members or anyone else through everyday interaction and contact with them. HIV is spread only through the exchange of semen, vaginal fluid, rectal fluid, breast milk or blood. Only activities that involve the exchange of these bodily fluids will potentially transmit HIV between people. HIV is not spread in spit or saliva, nor in urine or tears. Therefore, you cannot spread HIV by using the same bathroom or dishes, hugging, closed-mouth kissing, or having a good, ugly cry with tears with your family members or friends.
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6. Can I have a pet if I am HIV-positive?
Absolutely. You cannot spread HIV to a pet and a pet cannot give HIV to you or to anyone else. It is recommended that you avoid animal feces, animals less than 6 months old, and exotic pets, because these may transmit other infections that can cause severe illness.
Things to be aware of are:
• If your CD4 count is very low (less than 100), you may be at risk of getting an infection called Toxoplasmosis from cat feces or changing cat litter. Always wear gloves and take careful precautions when changing the cat litter.
• If your pet looks sick or has bad diarrhea, take it to a vet. Animals can carry other infections, such as: cryptosporidiosis or Mycobacterium avium complex, which can be harmful to you, especially when your CD4 count is low.
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7. Can I have sexual intercourse with my partner if I am HIV-positive?
Absolutely. You can have an enjoyable and fulfilling sexual relationship with your partner. First, you must tell your partner that you are HIV-positive before you have sex with him or her. In many states, you can be charged with a crime if you do not disclose your HIV status to your partner prior to sex. If your partner is okay with continuing with sexual activity, then it is advised that you use condoms properly and every time that you have sex. It is, also, advised that you take HIV medicines so that you are undetectable and nearly incapable of giving HIV to your partner.
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8. Can I get pregnant if I am HIV-positive?
Yes and women do every day. You can safely plan a pregnancy so that you, your partner and your unborn baby have healthy outcomes. Many women who are HIV-positive have gotten pregnant naturally and delivered healthy babies where neither their partner nor their baby was infected with HIV. Be sure to speak to your health care provider before trying to get pregnant so this process can be planned for the benefit of your family.
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9. Can I only get pregnant through artificial insemination if I am HIV-positive?
No. Although artificial insemination will virtually eliminate the risk of HIV transmission from you to your partner, it is not your only option to get pregnant. There are other low-transmission-risk conception options that you may explore with your health care provider.
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10. Should I take HIV medicines if I am pregnant?
Yes. It is highly recommended that you take HIV medicines while pregnant to protect yourself and your unborn baby. Starting combination drugs early in pregnancy and during the birth process are ideal. Taking HIV medication to decrease your viral load to as low as possible will decrease the risk of giving HIV to your baby.
It is generally recommended that you continue taking the same medications as you were taking before becoming pregnant. However, there are some medications that should be avoided during pregnancy and your doctor may change you to a different combination of medicines during your pregnancy.
Globally, only about 2.8% of babies are born with birth defects believed to be from HIV medications. There are risks of preterm birth, small babies, and still birth, but these outcomes are often due to other circumstances, like limited nutrition.
a. Chen. Et al. (2012). Highly Active Antiretroviral Therapy and Adverse Birth Outcomes Among HIV-Infected Women in Botswana. J Infect Dis.; 206(11): 1695–1705.
b. Ndirangu. Et al. (2012). Maternal HIV infection associated with small-for-gestational age infants but not preterm births: evidence from rural South Africa. Hum Reprod; 27(6): 1846–1856.
c. Williams. Et al. (2016). Congenital Anomalies and in utero Antiretroviral Exposure in HIV-exposed Uninfected Infants. JAMA Pediatr; 169(1): 48–55.
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11. Can I get married if I am HIV-positive?
Yes. Being infected with HIV should not change your life’s plans and, with proper medication and treatment, you can live a healthy and normal life. You are legally obligated to tell your partner your HIV status if you plan on having a sexual aspect to your marriage or starting a family, but HIV does not change your opportunity to get married.
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12. Should I tell my children that I am HIV-positive?
It is up to you. Some women are too ashamed to ever disclose their HIV status to anyone, especially their children. Other women want their children to be the first, if not only, people to know. You should know that you have no legal obligation to tell your children your HIV-positive status. However, telling your children may establish a valuable support system for you. Disclosing your status may, also, educate them on ways to protect themselves from HIV or help to erase the stigma associated with the infection.
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13. Can I go to jail if I have sexual intercourse with my partner?
Yes, you could potentially face felony criminal charges if you are living with HIV, fail to disclose your HIV status, intentionally seek to transmit HIV, and then engage in sexual behavior that poses a significant risk of HIV transmission. The specific laws regarding HIV disclosure to sexual partners vary per state, however. In the state of Georgia, laws regarding HIV disclosure were amended in 2022 such that criminal charges may be imposed with a sentence up to 5 years imprisonment if a person living with HIV shows intent to transmit HIV and the act in question has a significant risk of transmission based on current scientifically supported levels of risk transmission.
It is recommended out of concern for the safety and emotional wellbeing of your sexual partner that you and your partner discuss your HIV status PRIOR to SEXUAL RELATIONS so there is mutual understanding and acceptance of the potential transmission risks involved.
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14. Is there a medicine that my partner can take to prevent him or her from getting HIV?
Yes, there are 2 FDA-approved options for prevention of HIV transmission from HIV-positive to HIV-negative persons who maintain a sexual relationship. These prevention options are called "PrEP," which stands for pre-exposure prophylaxis. One options is Truvada or "the other little blue pill" which should be taken by mouth every day. This is the only pill option available to persons who may acquire HIV through vaginal-receptive intercourse. If your HIV-negative partner is a man, he may take Truvada or another medicine called Descovy.
The newest PrEP options is called Apretude, an injectable, long-acting medication. This injection is done in your physician's office every 2 months and is safe and effective for women and men.
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15. Is it safe for people who are living with HIV to get the COVID-19 vaccine?
As we continue to learn more about COVID-19, we now know that people who are living with HIV do not respond as well to COVID-19 vaccines as HIV-negative people do. A study from the University of California, San Francisco matched 100 people with HIV infection to 100 people without HIV infection and compared the COVID-19 antibody levels between the 2 groups after they received both doses of either the Moderna or Pfizer vaccines. The odds of having no response to the vaccines was more than 2-fold greater in those living with HIV. The factors that seemed connected to a poorer response to vaccine was (1) having a low T cell count; (2) not being undetectable and (3) getting the Pfizer instead of the Moderna vaccine.
Each group had about 13 women each.
Spinelli M, et al. Abstract LB8. Presented at ID Week; Sept 29-Oct 3, 2021 (virtual meeting)
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16. Can I breastfeed my baby if I am HIV-positive?
According to the latest CDC recommendations, HIV-positive mothers who have questions about breastfeeding or who desire to breastfeed should receive patient-centered, evidence-based counseling on infant feeding options, allowing for shared decision-making. Here's what you should know in order to make your decision. HIV can be spread through certain body fluids, including breast milk. While HIV transmission to infants can occur during pregnancy, birth, or breastfeeding, treatment for HIV substantially reduces the risk of transmission. Although maternal treatment of HIV substantially reduces the risk of transmission through breast milk, it does not eliminate the risk. You should therefore weigh the benefits of breastfeeding against the potential risks of HIV transmission to your infant.
The best way to prevent transmission of HIV to your infant through breast milk is to not breastfeed. In the United States, where mothers have access to clean water and affordable replacement feeding (infant formula), it is recommended that mothers living with HIV completely avoid breastfeeding their infants, regardless of consistent HIV treatment and maternal viral load. Infant formula and pasteurized donor human milk are safe feeding alternatives to breastfeeding for mothers living with HIV. These recommendations differ from those in certain parts of the world, where mothers do not have access to the same infant feeding options. In countries where resources are limited, it is recommended that mothers living with HIV breastfeed exclusively for the first 6 months of life and continue breastfeeding for at least 12 months, with the addition of complementary foods. These mothers should be fully supported with HIV treatment access that reduces the risk of transmission through breastfeeding.
If you choose to breastfeed, you should remain fully committed to taking your HIV treatment to achieve and maintain an undetectable viral load. You should, also, receive close follow-up with your HIV provider to maintain risk-reduction measures that minimize the risk of HIV transmission to your infant.
