The following information is provided by
The New York State Department of Health

1. What are the symptoms of HIV infection?

   Many people infected with HIV have no symptoms at all and may be unaware that they carry the virus. Some people may develop mild, temporary fly-like symptoms that disappear after a few days or weeks following infection. Others may have persistent swollen glands. The earlier HIV infection is detected, the sooner medical treatment can begin, which may help people stay healthier longer.

   Many of the symptoms of advancing HIV disease are similar to other health problems not related to HIV. The following symptoms should prompt a medical visit to determine the cause and appropriate treatment.

   Symptoms include:

   • Swollen glands in the neck, armpit or groin
   • Continued fever or night sweats
   • Weight loss of more than 10 pounds which id not due to dieting or increased physical activity
   • Heavy, continual dry cough that is not from smoking or that has lasted too long to be a cold or flu
   • Increasing shortness of breath
   • Continuing bouts of diarrhea
   • Thrush, a thick whitish coating on the tongue or in the throat, which may be accompanied by a sore throat
   • Recurring vaginal yeast infections
   • Unexplained skin rashes, like psoriasis or seborrhea
   • Herpes infections that last longer than usual.

2. When Does HIV Become AIDS?

   People with HIV are diagnosed as having AIDS if their CD4 cell count falls below 200, or if they develop any of the serious conditions associated with HIV infection. (CDC4 cells are immune cells that are damaged by HIB). These conditions include a number of unusual infections (known as "opportunistic infections") and cancers, as well as severe weight loss or wasting; and brain and nervous system disorders. One of the most common opportunistic infections is a type of pneumonia called PCP (Pneumocystis carinii pneumonia).

3. Why is it important for people with HIV to get medical care?

   New treatments that fight HIV have been shown to improve health and to help people with AIDS live longer, so receiving care from a doctor who is knowledgeable about HIV is important. Treatments are also available to prevent some illnesses, such as Pneumocystis carinii pneumonia (PCP). And, there is a new blood test called a "viral load test" that measures the amount of virus in the blood. This test gives people with HIV and their doctors better information on when to start treatment, which may be before any symptoms appear. The viral load test can also tell how well treatment is working.

   People with HIV should seek early medical care from a doctor knowledgeable about HIV, to find out about drugs that fight HIV and to receive care for other HIV-related conditions.

   Another reason to seek medical care is to have tests done for other infections, such as tuberculosis (TB) and sexually transmitted diseases (STDs) and to receive treatment as needed. These infections can hasten the progression from HIV infection to AIDS.

   It is especially important for pregnant women with HIV to get medical care, since they can take medication that will significantly reduce the risk of their babies being born with HIV. The progression of HIV infections in young children is frequently different from that in adults; some children become sick more quickly. It is important that children with HIV infection receive medical care as early as possible.

   Sex and needle-sharing spouse/partners also need to know they have been exposed to HIV so they can get tested and benefit from early treatment, if needed.

4. Are there special reasons why women with HIV should get medical care?

   There are some medical conditions that are more common in women with HIV. Cervical abnormalities, including cervical cancer, seem to be more common in women who have HIV. Women with HIV need to have pelvic exams and a yearly PAP smear to look for these conditions. Also, women with HIV who have vaginal infections such as yeast infections may require more treatment than other women. Women with HIV should discuss family planning with their doctor, and be aware that oral contraceptives can react with some antiretroviral medications. A woman and her doctor need to review all her medications to make sure they can be combined without any problems.

5. Should people with HIV tell their health care providers, e.g., doctor, dentist, physician assistant and nurse practitioner?

   Yes. In order to receive appropriate medical care and monitoring, it is important for health care providers to know the HIV status of their clients. It is against the law for health care providers to deny care to people with HIV because of their HIV status.

6. What are the new treatments for HIV?

   A number of new drugs to treat HIV have been approved, including a group of drugs called protease inhibitors. When these newer drugs are combined with earlier drug treatments, the level of virus in the blood can fall so low that it cannot be detected by a viral load test. This does not mean that the virus is gone from the body, just that there is so little of it in the blood that the test cannot detect it. When the level of the virus is this low, treatments may work longer and the immune system can begin to repair some of the damage done by HIV. It is important to remember that even if a person with HIV has an "undetectable" virus load, he/she can still transmit HIV to others.

   While the new treatments are not a cure, they can extend life and improve health, especially for people with AIDS. It is very important that the new treatments be taken exactly as prescribed. Missing or delaying just a few doses can lead to resistance, meaning that the drugs will no longer work. People who become resistant to one drug may be resistant to other drugs they have never taken, so it is important that people with HIV learn how to take their medications correctly.

7. How is HIV infection treated?

   1. Antivirals (drugs that stop or slow HIV): Currently, there are 11 drugs approved that fight HIV. These include the "nucleosides": AZT (or ZDV), ddC, ddl, d4T, 3TC; the "non-nucleosides": falavirdine and nevirapine; and the protease inhibitors: saquinaavir, ritonavir, indinavir and nelfinavir. These drugs are used in combinations or 2, 3 or 4 to best fight the virus.
   2. Preventive medications: If a person's CD4 count falls below 200, drugs are used to prevent serious illness, such as PCP (Pneumocystis carinii pneumonia). PCP is the most common life-threatening illness for people with AIDS, and can be effectively prevented with a common medication. Since the CD4 count can fall below 200 before any symptoms appear, it is important that people with HIV get regular CD4 counts so preventive treatment can begin as soon as needed. Preventive treatment for other illnesses, such as MAC (Mycobacterium avium complex), is recommended if the CD4 count falls below 50.
   3. Treatments for HIV-related illnesses: Much progress has been made in treating the various infections and conditions that occur in people with HIV. New treatments for AIDS-related cancers and other conditions have been approved. Combining these treatments with the new antivirals can mean better health for people with AIDS.
   4. Healthy Living: Good health practices can play an important role in the treatment of HIV. Proper diet with food safety precautions, appropriate use of vitamins, exercise (both aerobic and muscle-building), regular sleep habits, stress management and avoidance of substance use are all important parts of living health with HIV.

8. What is the connection between HIV and TB?

   TB is one of the many diseases that can often be kept under control by the immune system Only about 10% of people with a normal immune system who have the TB germ will get sick with active TB. But a person with HIV who has the TB germ and a weakened immune system is much more likely to develop active TB disease. That's why it is very important for people with HIV to get tested for TB. Active TB can be prevented by taking mediation before symptoms start. TB symptoms are similar to those to their HIV-related diseases They include: coughing, shortness of breath, weakness, feeling sick, coughing up blood, weight loss, fever and night sweats. TB is curable in most cases, but untreated active TB can be spread to others by coughing.

9. How can someone using injectable drugs eliminate or reduce his/her risk of HIV infection?

   • Drug treatment programs: Risk of infection from used syringes can be completely avoided by entering a drug treatment program and ending use of injected drugs. Drug treatment programs are available throughout New York State to assist an individual in reaching recovery.
   • Syringes exchange programs: Risk of infection can also be avoided by using a new syringe for each injection and by not sharing syringes or works. Injection drug users may obtain unused syringes by participating in a syringe exchange program. Syringe exchange programs have been authorized to give syringes and needles to injection drug users without a prescription in order to prevent the spread of HIV and other blood-borne diseases.
   • Cleaning needles and works: Risk of infection can be reduced by always cleaning injection equipment (needles and works) immediately after use and just before reuse, even if it seems to be packaged as new.
   
   
   
   1. FIRST, wash out the syringe with clean water by drawing the water up through the needle to the top of the syringe, shake the set, then squirt out. DO NOT REUSE THIS WATER. Repeat at least 3 times.
   2. NEXT, draw undiluted bleach up through the needle to the top of the syringe and shake the set. Leave the bleach in the syringe for at least 30 seconds and squirt out. DO NOT REUSE THIS BLEACH. Repeat this entire step at least 3 times.
   3. LAST, rinse the syringe and needle with clean water. Draw the clean water up through the needle to the top of the syringe, shake the set and squirt it out. DO NOT REUSE THIS WATER. Repeat this step 3 times.

   In addition to steps 1, 2 and 3, one can improve cleaning effectiveness by taking the set apart, removing the plunger from the barrel and soaking them in bleach for at least 30 seconds.

   NEVER shoot or drink the bleach.

   DO NOT reuse the cotton, water or cooker. However, if the cooker must be reused, soak it in bleach for at least 30 seconds and then rinse it with clean water. Since bleach loses its effectiveness with exposure to light, store all bleach for cleaning needles and works in a container that does not let light pass through.

   NEVER assume a syringe is new, even if it seems to be packaged as new.

10. How can the use of alcohol or other non-injectable drugs increase the risk of HIV infection?

    Using non-injectable, mood-altering drugs, such as alcohol, marijuana or crack cocaine lowers one's ability to make good decisions about safer sex and cleaning needles and works before use. Crack may increase sexual drive, resulting in increased sexual activity when used.

11. What do people with HIV need to know about hepatitis?

    People with HIV should ask their doctor to do tests for hepatitis A, B, and C. Those who do not have hepatitis A, B or C should talk to their doctor about avoiding exposure to these hepatitis viruses through sexual practices or needles sharing. Hepatitis infection may increase the viral load of a person with HIV, so people with HIV should talk to their doctor about their risk for hepatitis, and whether they should receive vaccines to prevent Hepatitis A and Hepatitis B. There is no vaccine for Hepatitis C.

12. Where can people with HIV get medical care?

    1. Community health centers and private doctors: Many people with HIV receive their medical care from clinics or private doctors in their community. There are also special programs for children, adolescents and substance users. Most HIV clinics also provide special programs for children, adolescents and substance users. Most HIV clinics also provide case management to help people with HIV obtain and other services they need. People who need referral to doctors and health facilities may contact the nearest AIDS Service Organization or HIV Counseling and Testing Program.
    2. Hospitals and their clinics: The State Health Department has identified a number of hospitals as "Designated AIDS Centers" because they have developed specialized care programs for people with HIV infection and AIDS. AIDS Centers are required to coordinate the full range of medical services needed by patients with HIV and AIDS, including inpatient and outpatient care, home health care, dentistry and psychological counseling. Some AIDS Centers now have special units for women, children and adolescents with HIV and AIDS These hospitals are also generally involved in HIV-related research programs There are also hospitals that are not Designated AIDS Centers, but have considerable experience in treating HIV disease.
    3. Skilled Nursing Facilities: The State Health Department has encouraged the development of HIV/AIDS nursing homes that provide medical care and other specialized services. For more information about skilled nursing facilities, call the New York State AIDS Institute Chronic Care Section at (518) 474-8162. In New York City, call the Community Health Service at (212) 645-0875.
    4. Home care programs: Throughout the state, a number of AIDS home care programs provide nursing and other services at the homes of individuals who have AIDS-related illnesses.
    5. Day treatment programs: There are approximately 12 AIDS Day Treatment Programs in New York State that offer medical and nursing care, and substance use and related health services, to people with HIV who meet certain eligibility criteria.

13. How can people with HIV pay for their medical care?

    Care for patients with HIV infection and AIDS is paid for by the same means as all medical care: the government (Medicaid or Medicare), private insurance companies, and individuals Most group health insurance plans cover HIV and AIDS medical treatment, although some have maximum allowances.

    The State Medicaid Program pays for the drugs for persons on Medicaid. In addition, the State Health Department operates the HIV Uninsured Care Programs which offer free drugs, primary care and home care for people who do not qualify for Medicaid and who meet the program's income requirements. The HIV Uninsured Care Program can help people with no insurance or with partial insurance.

    1. AIDS Drug Assistance Program (ADAP) pays for medications for the treatment of HIV and AIDS-related conditions.
    2. ADAP Plus (Primary Care) pays for medications for the treatment of HIV and AIDS related conditions.
    3. HIV Home Care Program pays for home care services at enrolled clinics and hospital out-patient programs, drug treatment programs and private doctors' offices.

14. Will people with HIV on Medicaid be required to join a managed care program?

    No, not until Special Needs Plans (SNPs) for persons with HIV infection are established. Currently, most managed care enrollment for persons on Medicaid in NYS is voluntary. However, with the approval of NYS's Partnership Plan by the Federal government, mandatory Medicaid managed care will be phased in over the next three years in NYS. In counties where mandatory Medicaid managed care is in place, people with HIV may choose to enroll in a managed care plan, but will not be required to do so until the SNPs are established. Then, people with HIV on Medicaid will be required to make a choice between a regular managed care plan or a SNP.

15. Do prisoners have access to the new treatments?

    All people with HIV, including those in prison, should have access to health care and appropriate HIV treatment. For more information, speak with medical staff at the facility or contact AIDS In Prison Project Hotline at (212) 674-0800.

16. How can people learn about experimental treatments?

    For information n clinical trials or new treatment for HIV in New York State and nearby areas, people can call the AIDS Treatment Data Network, which publishes the Experimental Treatment Guide, a directory of current clinical trials. The Network can help locate a specific clinical trial, and provides treatment education and information on community services for men, women and children. Call 1-800-734-7104 for more information.

    Additional information on clinical trials in New York State, New Jersey, Connecticut and Philadelphia can be obtained from th4e AIDS Institute Experimental Treatments Info Line at 1-800-MEDS 4 HIV.

    For information on national clinical trials, the AIDS Clinical Trials Information Service provides detailed information on many federally and privately sponsored clinical trials. Call 1-800-TRIALS-A.

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