Human Immunodeficiency Virus (HIV) Infection - What Increases Your Risk

Most people get HIV by having unprotected sex with someone who has HIV. Another common way of getting the virus is by sharing needles with someone who is infected with HIV when injecting drugs.

You have an increased risk of becoming infected with HIV through sexual contact if you:

    Have unprotected sex (do not use condoms).
    Have multiple sex partners.
    Are a man who has sex with other men.
    Have high-risk partner(s) (partner has multiple sex partners, is a man who has sex with other men, or injects drugs).
    Have or have recently had a sexually transmitted infection, such as syphilis or active herpes.

People who inject drugs or steroids, especially if they share needles, syringes, cookers, or other equipment used to inject drugs, are at risk of being infected with HIV.

Babies who are born to mothers who are infected with HIV are also at risk of infection.
What to think about

HIV may be spread more easily in the early stage of infection, and again later, when symptoms of HIV-related illness develop.

The risk of getting HIV from a blood transfusion or organ transplant is extremely low because all donated blood and organs in the United States are screened for HIV.

Ways HIV cannot be spread

HIV does not survive well outside the body. So HIV cannot be spread through casual contact with an infected person, such as by sharing drinking glasses or by casual kissing. HIV is not transmitted through contact with an infected person's saliva, sweat, tears, urine, or feces, or through insect bites.
Contagious and incubation period

The incubation period—the time between when a person is first infected with HIV and when early symptoms develop—may be a few days to several weeks.

It can take as little as 2 weeks or as long as 6 months from the time you become infected with HIV for the antibodies to be detected in your blood. This is commonly called the "window period," or seroconversion period. During the window period, you are contagious and can spread the virus to others. If you think you have been infected with HIV but you test negative for it, you should be tested again. Tests at 6, 12, and 24 weeks can be done to be sure you are not infected.

After you become infected with HIV, your blood, semen, or vaginal fluids should always be considered infectious, even if you receive treatment for the HIV infection.

The Shingles Care Plan: Treating the Virus and Its Symptoms

A shingles care plan involves treating the causes as well as the rash, itching, pain, and other symptoms.


Shingles causes a blistering rash that runs along one half of the body in a belt-like fashion. The rash is caused by the reactivation of the chickenpox virus, varicella zoster, which can lie dormant for years in the nerve tissue of a person who has had chickenpox. Once the virus reawakens, it spreads up the nerve fibers to the skin and produces the telltale rash of shingles.

An appropriate shingles care plan will employ multiple strategies to help you overcome the varicella zoster virus and cope with the symptoms. You can take medications to help boost your immune system, and relieve the pain and itching associated with the rash, and topical treatments for shingles will soothe the rash directly. Your shingles doctor will most likely be your primary care physician. It is important that you see your doctor as soon as possible after possible shingles symptoms appear so you can get treatment that will effectively reduce the duration of your shingles rash. More severe cases may require shingles treatment from a dermatologist, who can help treat the rash and skin infections, or a neurologist, who can deal with severe or chronic nerve pain.

What to Expect at the Doctor’s Office

There is no immediate cure for shingles. The disease will have to run its course. However, there are a number of medical treatments proven to relieve symptoms and fight the varicella zoster virus:

    Antiviral medications. If you get to your doctor within 72 hours of first developing a shingles rash, he or she can reduce the length of your shingles infection by days through the use of antiviral medications. Antivirals are the first line of shingles treatment.
    Tricyclic antidepressants. These prescription drugs have been proven effective in dulling the pain associated with shingles. They also reduce your chances of developing postherpetic neuralgia, a shingles complication that causes continued pain even after the rash has cleared.
    Opioids. Drugs like oxycodone, morphine, and codeine can relieve shingles pain.
    Steroids. Anti-inflammatory medications like corticosteroids can reduce the swelling of the shingles rash and lower the intensity and duration of your pain symptoms.

Your doctor will create a shingles care plan for you and prescribe medications based on a number of factors, including:

    Your age and overall health
    How advanced your shingles infection is
    Your medical history and proven tolerance for different medications and therapies
    How your shingles is likely to evolve over time
    What you are willing to do to treat your shingles

At-Home Shingles Care

In addition to the medication that your doctor probably prescribed, much of shingles treatment involves home health care you can do for yourself to relieve your symptoms and prevent complications:

    Get plenty of rest. The shingles virus is opportunistic and flourishes when your immune system is compromised. Rest is critical to strengthen your immune response to the disease.
    Drink plenty of fluids. Dry skin can cause your shingles rash to become more irritated. Staying hydrated helps keep your skin from drying out.
    Use soothing skin care. Calamine lotion or other soothing lotions can help treat some of the itching and burning from your rash.
    Take over-the-counter pain relievers. Medications like aspirin, acetaminophen, or ibuprofen are recommended for relieving itching, burning, and pain.
    Apply cold compresses. A clean cloth soaked in cold water or an astringent cooling agent can soothe your rash.
    Practice good hygiene. Bathe yourself daily to reduce your chance of bacterial infection.
    Clip your fingernails. Keeping your nails clean and trimmed will reduce scratching, which can cause scarring and infection.

Call your doctor if there is any change in your condition — for example, if your rash continues to spread or if your pain increases. The physician will be able to adjust your shingles care plan accordingly and keep you on the road to recovery.

Treating Meningitis With Corticosteroids

Early treatment of meningitis with steroids may prevent some common meningitis complications.

Prompt treatment of meningitis with steroids, such as dexamethasone may prevent two common complications associated with the condition, hearing loss and seizures. But the use of steroids in meningitis treatment is not without controversy. Some experts advocate their use, while others disagree.

Using Steroids to Treat Meningitis

Bacterial meningitis inflames the tissues and fluid around the brain, often creating pressure within the brain. Seizures may occur because of this increased pressure and inflammation. Also, this inflammation and pressure can damage the nerves coming from the brain stem that control hearing, causing hearing loss. Steroids reduce inflammation and pressure within the brain, thus lessening a person's risk of having seizures and hearing problems.

“A number of studies have shown that when steroids are given along with antibiotics, there’s a lower risk of hearing loss,” says Nathan Litman, MD, director of pediatric infectious diseases at Children’s Hospital at Montefiore Medical Center in Bronx, New York. Studies have also found that meningitis treatment with steroids significantly reduce the risk of death in adults.

When Are Steroids Used for Meningitis?

To be helpful, a steroid must be given right away. “They need to be administered at the same time that antibiotics are started,” says Dr. Litman. “If you wait eight to 12 hours, that’s too late.”

That’s because steroids work by halting the body’s inflammatory response. This will help prevent swelling and pressure in the brain and subsequent neurological complications. “Once hearing is lost due to meningitis, it’s usually irreversible,” says Litman.

Most children and adults of all ages can take steroids — the only exception is very young babies. Infants six weeks and younger are not likely to be treated with steroids because this meningitis treatment hasn’t been studied in this age group.

Pros of Steroid Treatment

A number of studies have shown that meningitis treatment with steroids clearly reduces the chance of deafness, and may lessen mortality as well.

In one review of 18 of those studies involving 2,750 patients, steroids appeared to reduce the risk of severe hearing loss in children. Additionally, an earlier study published in the British Medical Journal found that death among adult meningitis patients taking steroids was less than half that of patients not receiving steroids. Study results have been mixed regarding fatality reductions in children, however. 
Cons of Steroid Treatment

Corticosteroids can have adverse effects, including:

    Bleeding in the stomach
    Elevation of blood sugar
    Fluid retention
    Sleeping issues
    Mood swings
    Ringing in the ears (tinnitus)

There’s also concern that meningitis treatment with steroids could interfere with the body’s ability to recover from non-bacterial types of meningitis, such as meningitis caused by viruses or fungi.

“If it turns out that if it’s not bacterial meningitis, treatment with steroids could potentially do some harm,” says Litman. When test results rule out bacterial meningitis, steroids are typically stopped. Some doctors are also concerned that steroids could decrease the penetration of antibiotics into the fluid around the brain and spinal cord where bacteria reside, but not all experts agree about this.

But, depending on the patient, meningitis treatment with steroids may be warranted.

“From my perspective, the benefits of using steroids outweigh the potential risks, especially if given for a short period of time,” says Litman. Research on the use steroids to treat meningitis is continuing at a number of medical centers around the country.

Pros and Cons of Topical Steroids for Viral Conjunctivitis

Many physicians have found topical steroids to be helpful for patients with debilitating conjunctivitis. By reducing inflammation, steroids can bring dramatic improvement in patient comfort. However, others caution that steroids may delay resolution of the disease, prolonging the contagious course of the virus. In fact, studies in rabbit models have shown that topical steroids may prolong ocular shedding of adenovirus by several weeks.

Until recently, no well-designed human study has assessed the risks and benefits of topical steroids in the treatment of viral conjunctivitis. In a study by Wilkins and colleagues,3 111 patients with presumed viral conjunctivitis were randomly assigned to receive either preservative-free dexamethasone 0.1% or hydroxypropyl methylcellulose (the vehicle used by the Moorfields pharmacy for compounding topical dexam- ethasone) four times daily for 1 week. Statistically significantly more patients in the dexamethasone group (39 of 45) felt the drops to be helpful than in the vehicle group (30 of 43). No adverse events were seen in either group.

The decision to use steroids for the treatment of viral conjunctivitis is a personal one. Research has shown that, when used appropriately (ie, in cases where bacterial or herpetic infection has been ruled out and when used in short pulses), topical steroids can be beneficial to patients by ameliorating the symptoms for which they initially presented. Steroid use may somewhat prolong the length of the contagious period; however, many patients will gladly accept this so that they may begin to feel ocular relief.

Topical steroid drops should be used with great caution, as herpetic viral infection of the ocular surface is a common mimicker of adenoviral conjunctivitis, and unopposed steroid drops can promote viral replication and corneal scarring. Additionally, as noted above, multiple studies have demonstrated that topical steroids prolong the viral shedding period.2 The key to managing adenoviral conjunctivitis is to limit its spread. Patients with viral conjunctivitis who are treated with topical steroid drops may return to work or school while they are still in the contagious phase of the infection, and therefore have the potential to further increase the disease burden on the health care system.

Because the symptoms of adenoviral conjunctivitis may be severe, investigators have explored other treatment options for patients with symptomatic disease including a topical combination of dexamethasone 0.1% and povidoneiodine 0.4%.4 This novel formulation was compared with cidofovir 0.5%, a combination tobramycin-dexamethasone ophthalmic suspension (Tobradex; Alcon Laboratories, Inc., Fort Worth, Texas), and balanced salt solution in rabbit eyes. The combination topical dexamethasone 0.1% and povidoneiodine 0.4% was equally effective as cidofovir 0.5% in reducing viral titers and was the most efficacious in reducing clinical symptoms of adenovirus infection in rabbit eyes.

A dexamethasone/povidone-iodine combination drop is not yet commercially available, but other options are. Gordon et al demonstrated that topical ketorolac or diclofenac did not increase the viral shedding period and may be a safer alternative t topical steroids.5 More recently, during an epidemic of viral conjunctivitis in a military garrison in Karachi, Pakistan, 200 patients were randomly assigned to topical decongestant/antihistamine combination drops or to eye washing and cool compresses.6 Acute illness symptoms of eye watering, itching, burning, pain, and photophobia lasted a mean 4.91 days in the decongestant/ antihistamine drop and 7.86 days in the cool compresses group.