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Alto Pharmacy Technician

Alto Pharmacist

It’s official: Alto Pharmacy is a great place to work! We’re honored to join the community of Great Place to Work-Certified™ companies based on team member feedback and a rigorous assessment of our company’s culture and benefits.

Join us in delivering our industry-leading pharmacy care to millions of people across the country. As a member of the team, you’ll play an integral role in improving our customers’ quality of life and redefining what’s possible in pharmacy. 

Be Part of a Great Place to Work — Join Our Team

Hear first-hand from members of the Alto technology teams.

Read the latest Alto blog posts covering healthcare, family health, managing diseases, and other Alto highlights.

Blog | Alto Pharmacy

At Alto, we strive to reduce the stress that comes with managing your diabetes however we can. As a pharmacy for all of your diabetes needs, we’re able to sync all of your medications and supplies into a single delivery every month. In fact, you might even be a little surprised by just how much is included in a diabetes delivery, so we put together a short overview of what’s inside the box.

What’s in Your Alto Pharmacy Diabetes Delivery

We recommend unpacking your full package upon delivery and making sure you have everything you need. Carefully check insulated wrappers or ice packs to make sure you don’t miss any medications or supplies, and promptly place any items marked “Refrigeration Needed” in your refrigerator.

A quick note on refrigeration: we understand how important it is that your medications and supplies arrive in good condition, and we use temperature controlled packaging to ensure that insulin is held at the right temperature while it’s on the way to you.

Depending on what your care team has prescribed, you’ll probably have many or all of the following in your Alto delivery:

Diabetes medications in the form of vials, pens, pills, tablets, or inhalation devices

Insulin pumps (small electronic devices that deliver doses of insulin at specific times - common brands include Omnipod®)

Blood glucose meters, test strips, and lancets (common brands include Accu-Chek® and OneTouch®)

Smart insulin pens (a method of insulin delivery that combines insulin and syringe into a single device - common brands include InPenTM)

Continuous glucose meters (CGMs) (a small electronic device that automatically collects glucose readings at regular intervals throughout the day - common brands include Dexcom® and Freestyle Libre®)

Supplies like needles or syringes will be packaged in their own bag with a label that explains their purpose.

Note: the specific medications and supplies you have for your injections and diabetes care may look different than what is displayed in these photos. If your physician has instructed you to use a specific device, supply or medication, always follow their instructions.

It’s important to practice safe disposal methods for your needles and other injection or testing supplies. 

Use your red sharps container to safely store your needles after use. Sharps should never be thrown loosely into the trash, in the toilet, or in the recycling bin. Sharps that retract after use or are very small should follow the same disposal method as all other sharps.

Alto does not accept returns of sharps containers - you can find a safe local disposal site here.

If you need a new sharps container, send us a message in the app, and we’ll add it to your next delivery.

We’re a one stop shop for all your diabetes management needs. In addition to auto refills and med syncing, we offer free, same-day delivery and automatic savings investigations. And our team of pharmacists is always here to answer your questions by phone or the Alto app. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can be a partner in your diabetes care.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

All third party trademarks (including logos and icons) referenced by Alto Pharmacy remain the property of their respective owners. Unless specifically identified as such, Alto’s use of third party trademarks does not indicate any relationship, sponsorship or endorsement between Alto and the owners of these trademarks.

Emphysema — which falls under the umbrella of chronic obstructive pulmonary disease (COPD), along with chronic bronchitis — is a lung disease that most often develops as the result of many years of heavy smoking. It affects more than 3 million people in the United States.

Emphysema: Causes, Symptoms and Treatments

As a progressive lung disease, symptoms of emphysema become more pronounced over time. While there is no cure, emphysema is both manageable and preventable. You can slow the progression of the disease by following the treatment plan your doctor recommends and maintaining a healthy lifestyle.

Read on to learn more about the causes and symptoms of emphysema and common treatment options.

Emphysema involves slow and gradual damage to the tiny air sacs in your lungs (alveoli). As these air sacs weaken over time, the surface area of the lungs is reduced, limiting how much oxygen can travel to your bloodstream.

Since emphysema progresses gradually, signs and symptoms may not appear until the lung tissue has already been significantly weakened. For many people, the first noticeable symptoms include shortness of breath and more frequent coughing, especially during physical activities. Other symptoms of emphysema include wheezing, exhaustion, and chest tightness, and producing greater amounts of mucus.

In some cases, the lack of oxygen can cause blue or gray lips or fingernails. If you experience this symptom, seek immediate medical attention.

The majority of emphysema cases occur as the result of cigarette smoking, with heavier smoking linked to a higher risk of developing emphysema. Additional risk factors for emphysema include the following:

Age — in many cases of smoking-related emphysema, symptoms first become noticeable between the ages of 40 and 60

Exposure to high pollution chemical fumes or lung irritants

Having a history of childhood respiratory infections

To determine if you have emphysema, your doctor will ask about your health history and the potential symptoms of emphysema that you are experiencing. They may ask you questions about your smoking history, your exposure to secondhand smoke or chemical fumes, and if you have a family history of lung health issues.

After taking your health history, they may order one or more of the following tests to confirm a diagnosis of emphysema:

Imaging tests, including chest X-rays and computerized tomography (CT) scans, which combines X-ray images taken from different angles.

An arterial blood gas test, which measures how well your lungs transfer oxygen to your bloodstream and remove carbon dioxide.

An electrocardiogram (ECG) to check your heart’s function and rule out a diagnosis of heart disease.

A pulse oximetry, which measures the oxygen level of your blood. This can show how well oxygen travels to the parts of your body furthest from your heart.

Lung function tests, which measure how much air your lungs can hold, how easy it is for them to empty air, and how well they deliver oxygen into your bloodstream.

Quitting smoking is the most important thing you can do to slow the progression of emphysema. If you are having trouble quitting, ask your doctor for smoking cessation resources like nicotine replacement therapy to help manage withdrawal symptoms and cravings. In addition, the treatment options below can slow the progression of emphysema and help you live an active lifestyle.

Several types of medications are used to manage and treat emphysema.

Bronchodilators like albuterol (Ventolin®, Proventil®, AccuNeb®), albuterol sulfate (ProAir® HFA®, ProAir RespiClick), and levalbuterol (Xopenex®) help relax your airway muscles and open your lungs to reduce discomfort. Although not common, potential side effects of bronchodilators include nervousness or shakiness, headache, throat or nasal irritation, and muscle aches. Your doctor can explain more about the risks and benefits of using a bronchodilator when building your treatment plan.

Inhaled corticosteroids reduce swelling in your lungs and open your airways so that more air can move in and out of your lungs. They may be taken via inhaler or nebulizer. Corticosteroids commonly prescribed to treat emphysema include beclomethasone dipropionate (branded options include Qvar Redihaler®), budesonide (Pulmicort®), ciclesonide (Alvesco®), flunisolide (Aerospan®), fluticasone propionate (Flovent®), and mometasone (Asmanex Twisthaler®). 

Inhaled corticosteroids typically do not cause long-term side effects, but mouth and throat irritation and oral yeast infections may occur. As a precaution, rinse your mouth with water after each dose to prevent infections.

Antibiotics may also be used to fight infections that can lead to emphysema-related complications like acute bronchitis or pneumonia.

Pulmonary rehabilitation is an outpatient educational program that provides the skills and knowledge needed to manage your emphysema and increase your level of physical strength and fitness. The classes are led by a team of healthcare professionals, physical therapists, and dietitians and taught in a group setting, giving you the opportunity to connect with other individuals living with emphysema and other lung diseases. Pulmonary rehabilitation is often a good fit for individuals who frequently experience shortness of breath when performing daily activities despite taking medication as prescribed.

Supplemental oxygen, or oxygen therapy, can relieve shortness of breath and increase your tolerance for physical activities. There are several devices used in oxygen therapy. Your doctor can guide you in choosing the right oxygen delivery system based on your health needs, lifestyle, and insurance benefits. You may be prescribed one oxygen device to use at home and one to use when you are on the go.

Be sure to follow all of your doctor’s instructions when using your oxygen device, including the flow rate setting (how much oxygen you’ll need per minute). In addition, you may find it helpful to explore the American Lung Association's resources on oxygen therapy.

We’re here to support your emphysema treatment

Sticking to the treatment your doctor has recommended is critical to managing emphysema. At Alto, we make that as easy as possible by offering free hand-delivery, automatic savings investigations, and easy medication management tools through our website and app. And our team of pharmacists is always here to answer your questions by phone or through the Alto app. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881 to learn how Alto can support your emphysema treatment plan.

In our previous post, we discussed how we designed our biometric authentication system with both privacy and a better user experience in mind. In this post, we'll show you exactly how we did it.

Considerations and Approaches for Implementing Biometric Login: Part 2

In Part 1, we discussed how we designed our biometric authentication system with both privacy and a better user experience in mind. In this post, we'll show you exactly how we did it.

To build a new authentication mechanism, we opted to use the react-native-biometrics library. This library interfaces with the device's biometrics, generates a keypair, and stores the private key within the device's keystore. When logging in with biometrics, the library creates a signature using the stored private key, and the signature is then sent to the server for validation. (Note: this library is now unmaintained. At the time of writing, this implementation can instead be accomplished with the following maintained libraries: expo-local-authentication to access device biometrics, keypair to generate a keypair, react-native-keychain to access the device keystore.)

Check if biometrics are supported and configured by the user for this device.

const { available } = await ReactNativeBiometrics.isSensorAvailable();

If yes, prompt the user for a biometric scan.

const { success } = await ReactNativeBiometrics.simplePrompt({ promptMessage: 'Confirm ID' });

If the scan succeeds, generate a keypair. The react-native-biometrics library's createKeys method will automatically save the private key to the device's keystore, and return the public key counterpart. Send the public key to your server.

const { publicKey } = ReactNativeBiometrics.createKeys('Confirm biometrics');

// Save the public key to your database
post('/save_biometric_key', { key: publicKey, device_id: 'xyz' })

When the user tries to login with biometrics, scan their biometrics. This time, if the scan succeeds, create a signature using the stored private key. The react-native-biometrics library's createSignature method handles all of this.

// Prompts for scan
// On scan success, accesses private key and uses it to generate a signature, which is then returned
const signatureResponse = ReactNativeBiometrics.createSignature({
  promptMessage: 'Face or fingerprint ID for Alto Pharmacy',
  payload: BIOMETRIC_SIGNATURE_PAYLOAD,
});

Send the signature to the server to validate against the public key. If validation succeeds, the user has successfully authenticated with biometrics and can proceed into the app.

// Call your server API to validate the signature against the public key that you've stored in the database
const validationSuccess = await post(
  `/validate_biometric_signature`,
  {
    signature: signatureResponse.signature,
    payload: BIOMETRIC_SIGNATURE_PAYLOAD,
		device_id: 'xyz',
  },
);

if (validationSuccess) {
  // Login Success
} else {
  // Login failure
}

import ReactNativeBiometrics from 'react-native-biometrics';

const setUpBiometricLogin = async () => {
  // Check if biometrics are supported and configured on this device
  const { available } = await ReactNativeBiometrics.isSensorAvailable();

  if (available) {
    // Prompt user to scan biometrics
    const { success } = await ReactNativeBiometrics.simplePrompt({ promptMessage: 'Confirm ID' });
      
    if (success) {
      // If scan is successful, generate a keypair, then save the public key to the server
      const { publicKey } = await ReactNativeBiometrics.createKeys('Confirm biometrics');

      post('/save_biometric_key', { key: publicKey, device_id: 'xyz' })
    }
  }
}

const loginWithBiometrics = async () => {
  // Scan user's biometrics. On scan success, generate a signature
  const signatureResponse = await ReactNativeBiometrics.createSignature({
    promptMessage: 'Face or fingerprint ID for Alto Pharmacy',
    payload: BIOMETRIC_SIGNATURE_PAYLOAD,
  });

  // Validate the signature against the public key saved on the server
  const validationSuccess = await post(
    `/validate_biometric_signature`, 
    {
      signature: signatureResponse.signature,
      payload: BIOMETRIC_SIGNATURE_PAYLOAD,
      device_id: 'xyz',
    },
  );

  if (validationSuccess) {
    // Login Success
  } else {
    // Login failure
  }
}

1. build a way to store a public key associated with a device

2. write a method to validate a signature against a public key

3. expose endpoints to save a public key, and validate a signature

Once biometric authentication is built, there are additional decisions to make. The right decisions for your app will depend on your goals; the approach we took here at Alto may not align with what is best for your app.

How should biometric sessions interact with our existing email and password sessions?

We opted to treat email and password sessions as longer-lived primary sessions, with biometrics as a shorter-lived secondary session on top of that primary session. This means that a user must first login with email and password in order to use biometrics on subsequent app opens. If the user logs out for any reason, they will need to log in again with email and password before they can use biometrics again.

How often should we prompt the user for biometrics vs. email and password?

We opted to prompt the user for biometrics far more frequently than email and password, but made this configurable in case we want to adjust.

We use tokens and cookies for session management.

There are plenty of edge cases to consider as you're developing biometric capabilities for your app, including: what should happen when the biometric scan fails, or when the signature validation fails? What should happen if a user disables biometric permissions from their device? What should happen when two users share a device? What should happen if 'risky' activity is flagged for this account? How can we disable biometric login if needed?

Face and fingerprint ID login has clear benefits for both the end-user and the application itself, but it comes with a host of implementation decisions. If you're considering building biometric login for your app, I hope this article gives you clarity on what biometrics is, the different ways you can integrate it into your app, and the tradeoffs and edge cases to consider.

At Alto, the Patients Engineering team worked closely with our Security Engineering and Product teams to align on our goals and build the best solution for our needs. Our Security team offered deep expertise on the authentication strategies to adopt and avoid, and our Product team kept us tethered to building the best experience for our users.

Working as a team is one of the best parts about developing at Alto. If you want to meet the awesome team I'm talking about, come join us - we're hiring!

Face and fingerprint ID login is a convenient, seamless way to gain app access on a mobile device. Instead of typing in a lengthy, hard-to-remember username and password, many apps allow you login with just a quick scan of your face or fingerprint (also known as biometrics).

Considerations and Approaches for Implementing Biometric Login: Part 1

It's a desirable feature for both our end user and the Patients Team here at Alto — we want to make it as easy as possible for users to log in while also performing more frequent authentication checks. Improve the user experience and the security of our app? Sounds like a win-win.

As an engineer, implementing biometric login might seem easy, as mobile devices already capture, manage, and encrypt biometric data and expose APIs for app developers like myself to initiate a biometric scan. All I need to do is call that API and wait to hear if the scan is successful or not. What isn't as simple, though, is figuring out what to actually do with a successful biometric scan response. What does a successful scan mean, and how does that relate to the username and password credentials that users currently use to access our app?

This post walks through the decision points we encountered while implementing biometric login and how our healthcare privacy concerns influenced the final implementation approach.

Prior to implementing biometric login, the only way for users to access the Alto app was with email (username) and password. A valid email and password generates a session, which expires at some frequency. Once the session expires, the user must re-enter their email and password to regain access to the app.

From the beginning, we knew that biometrics would need to be built with our existing email and password session management in mind. This is made clear in the Apple developer docs: "Use biometrics as a supplement to something you’re already doing. Don’t depend on biometrics as your only authentication option."

Make it easier for users to login. Nobody likes typing in an email and password — especially on a mobile app. Our goal was to reduce the number of times a user must enter their email and password.

Enhance the security of our app using more frequent authentication checks. As a healthcare app that displays Personal Health Information (PHI), conducting more frequent authorization checks decreases the likelihood of PHI becoming exposed to an unauthorized third party.

Have the ability to revoke biometric access from a particular user. Similarly, we want to be extra careful to ensure that if a device is lost or stolen, we have a fallback plan to invalidate a user's session and protect the user’s PHI. For email and password initiated sessions, this happens when a user changes their password, as any change in login credentials will invalidate all active sessions for that user. We needed a similar contingency plan for biometric login.

There are several ways to use a mobile device's biometrics to authenticate a user, with varying degrees of security.

No server-side authentication. Simply integrate with the device's biometrics as an extra layer of authentication. If the biometric scan is successful, let the user proceed into the app.

Provides an extra check and gives your app a sense of modern polish

No server-side validation means that nothing is being validated against your system, so this is not a good substitute for account authentication. Therefore, even if you add this check, the user should still be prompted to re-enter their email and password at the same frequency as before.

Given this, this approach wouldn't help us reach our goal of reducing the number of times a user must enter their email and password.

This approach is a good fit if your application already has an existing login and session management system, and you want extra authentication checks throughout the user's session without modifying any other part of the system.

Tie biometrics to our existing email and password authentication. Use the user's biometrics to unlock an encrypted version of their email and password credentials. When a user sets up biometric login, store the user's login credentials within the device's keystore — the keystore will automatically encrypt the credentials. After a successful biometric scan, retrieve those credentials from the keystore and send them to your existing login API.

Still easy to implement, no backend changes needed

Biometric scan can be used in place of entering an email and password

Changing email and password credentials will revoke biometric access: if a user changes their credentials, their biometrics will access stale credentials and fail to login. (This is somewhat of a con as well — it provides a poor user experience, but it's an edge case that should happen infrequently.)

There is still only one way for a user to authenticate server-side, but now two ways to pass server-side authentication — essentially weakening your app's existing account security.

This approach effectively hands out internal login credentials to third party storage. While not a huge risk considering a device's secure storage is encrypted and trusted by most users, it’s not necessarily a best practice either.

This approach is a good fit if your application doesn't contain sensitive data, and your goal is to make it more convenient for a user to login by replacing email and password with a biometric scan.

Create a separate authentication mechanism for biometrics. Introduce a new authentication mechanism specifically for biometrics, resulting in two independent forms of server-side session authentication: email with password and biometrics. The implementation could look like generating a keypair or a shared secret to save and validate against the server whenever a user attempts to login with biometrics.

Biometrics is now tied to its own secure server-side authentication mechanism, which means it can be used independently of email/password (or even replace it, if you choose to).

Two layers of authentication adds security to the app. Not only does a user need a valid email/password session, they also need a valid biometric session.

It provides fine-grain control over a user's biometric session. You can invalidate a user's biometric session by invalidating the public key and can even invalidate a biometric session without impacting an email-and-password session if needed.

Requires building and maintaining a separate authentication mechanism

This approach is a good fit if your application contains sensitive data (e.g. PHI or financial information), and your goals are to make it both more convenient for a user to login by replacing email and password with a biometric scan while also strengthening the security of your account management system.

Because we are a healthcare company dealing with sensitive data, we chose this last path. It required greater engineering investment, but we agreed it was imperative that we maintain a secure system while introducing biometric login for users.

In part 2, we talk implementation details, including the library we used, code snippets, and questions to consider before you get started. Interested in learning more about engineering at Alto? Follow us on LinkedIn.

Residents of the Austin metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

Hello Austin

Alto's new Austin-based pharmacy marks our third location in Texas.

Starting today, December 7th, residents of the Austin metro area can now choose Alto’s same-day doorstep delivery for their pharmacy needs. 

At Alto, we believe it’s our job to ensure you have your medications at the best price, on time and with the support you need. We bring pharmacy to you - no more waiting in line, making an extra trip, or finding out your prescription isn’t ready to be picked up after you’ve already arrived. Our free doorstep delivery means your medications come directly to you on the day and time you select, and most medications are available the same-day. Stay up to date on your courier’s progress with text alerts or in our mobile app. 

Starting a new medication or doing an injection for the first time? Message a pharmacist with your questions, even in the evenings and on weekends. And we’re a full service pharmacy - we stock all major brand, generic, over-the-counter and specialty medications, meaning your entire family’s pharmacy needs can be managed in the Alto app and coordinated into one delivery.

Courier delivery windows
Monday - Friday: 6 - 9 pm CT (7 - 10 pm CT for outlying areas)
Saturday - Sunday: 2 - 5 pm CT (3 - 6 pm CT for outlying areas)

Walk-in hours
Monday - Friday: 9 am – 7 pm CT
Saturday - Sunday: 8 am - 4:30 pm CT

Austin residents interested in using Alto’s services for their medication needs can ask their doctor’s office to send all prescriptions to Alto Pharmacy (via ePrescribe, phone or fax).

Have existing prescriptions at another pharmacy? Start a transfer online or give us a call at 1 (800) 874-5881, and we’ll handle the switch.

Need to pick up? Our pharmacy is located at 4175 Freidrich Lane, Suite 202.

General customer support hours are Monday - Friday 8 am - 11 pm CT and Saturday - Sunday 9 am - 8 pm CT. Patients can reach out to Alto via phone at 1 (800) 874-5881 or in the Alto app.

Founded in 2015, Alto is a patient-centric digital pharmacy based committed to the health and wellbeing of you and your family. We provide free same-day delivery to your door seven days a week for prescriptions, but, more importantly, offer cost transparency, personalized in-app and phone support, and real-time coordination with doctors and insurance companies to get you the care that you need. Alto is headquartered in San Francisco with offices in Denver and Dallas, and currently delivers across the greater Bay Area, Los Angeles, Orange County, San Diego, Seattle, Denver, Las Vegas, New York City, Houston, Dallas and Austin.

Editor’s Note: This post was originally published in December 2021 and has been updated for accuracy and completeness.

While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

All About HIV: Stages, Symptoms and Treatment

More than 40 years have passed since AIDS, the disease caused by HIV, was first identified in the United States. While HIV and AIDS remain urgent public health issues, the prevention and treatment landscape has transformed drastically throughout the past four decades. Breakthroughs in treatment have made it possible to stop the progression of HIV and prevent transmission of the virus to others. Read on to learn more about HIV stages, symptoms, treatment, and prevention.

HIV (human immunodeficiency virus) is a virus that attacks your immune system, making you more vulnerable to other illnesses. It is transmitted through contact with the blood, semen, or vaginal fluids of someone who has HIV.

If untreated, HIV can lead to AIDS (acquired immunodeficiency syndrome), which is also considered the last stage of HIV. When HIV progresses into AIDS, your immune system has been significantly weakened by the virus.

Currently, there is no cure for HIV, but taking HIV medicine called antiretroviral therapy (ART) as prescribed stops the progression of the disease. As a result, most people living with HIV in the U.S. do not develop AIDS. There are also HIV prevention medications, PrEP and PEP, which are effective at preventing the transmission of HIV through sex or intravenous drug use.

As the HIV epidemic emerged in the U.S. in the 1980s and 90s, gay and bisexual men were disproportionately affected — in part because the virus transmits more easily through anal sex than vaginal sex — and subsequently stigmatized as carriers of the virus. However, the medical community soon discovered that anyone can contract HIV regardless of gender identity or sexual orientation, as the virus can be transmitted through anal sex, vaginal sex, or the sharing intravenous drug equipment such as needles or syringes.

In recent years, there has been significant progress toward reducing the annual HIV infection rate, and new cases of HIV among gay and bisexual men ages 13-24 dropped by 33% between 2015-2019. Still, gay and bisexual men accounted for 69% of all new HIV diagnoses in the U.S. in 2019. And in recent years, Black and Latinx individuals have been disproportionately affected by HIV. Racial and ethnic discrimination and disparities in healthcare access — which can discourage people from seeking HIV prevention services and testing — factor into HIV’s outsized impact on these communities.

There are three primary stages of HIV: acute HIV infection, chronic HIV infection, and stage 3 HIV, or AIDS.

Acute HIV infection, the first stage of HIV, may develop within two to four weeks of contracting the virus. During this stage of HIV, the virus multiplies rapidly and there is a high amount of HIV in your bloodstream (also known as your viral load). While the virus replicates and spreads, it destroys your CD4 cells, a type of white blood cell that plays a role in your immune system.

Some people with acute HIV infection quickly experience flu-like symptoms including fever, chills, rash, night sweats, muscle aches, sore throat, fatigue, swollen lymph nodes, and mouth ulcers. The only way to know your HIV status is by getting tested. If you have any of these symptoms and believe you may have been exposed to HIV, seek prompt medical care and take an HIV test. Find a free and confidential HIV testing site near you..

Experiencing these symptoms does not necessarily mean that you have HIV, as they overlap with symptoms of the flu and other illnesses. And some individuals with HIV develop these symptoms later, while others never develop them at all, which is why it’s critical to get tested for HIV on a regular basis — ideally every three months. You can still transmit the virus to others even if you do not have noticeable symptoms of HIV.

During the chronic HIV infection stage, the virus replicates less rapidly than it did in the acute stage, but it continues to damage your CD4 cells and weaken your immune system.

Many people experience no symptoms or mild symptoms during this latent period, which is also sometimes referred to as asymptomatic HIV infection or clinical latency. However, just like during the acute HIV infection stage, you can still transmit the virus to others even if you are not experiencing symptoms.

Without effective treatment, your viral load will increase and your CD4 cell count will decrease as this stage of HIV progresses. You are more likely to experience symptoms of HIV when your viral load is high and your CD4 cell count is low. Taking HIV medication as prescribed can help you maintain a low or even undetectable viral load and prevent your HIV from progressing into AIDS.

AIDS is the third and most advanced stage of HIV. In this stage, your immune system is severely weakened, your viral load continues to increase, and your CD4 cell count continues to decrease. 

HIV progresses into AIDS when you have a CD4 cell count of less than 200 cells per cubic milliliter or when you develop an opportunistic infection (OI), an illness that occurs more frequently in individuals with HIV because of their weakened immune systems.

Opportunistic infections experienced by individuals with HIV include kaposi’s sarcoma, a type of cancer that develops in your blood and lymph vessels; pneumocystis pneumonia (PCP), and mycobacterium avium complex (MAC), tuberculosis-related bacteria. However, OIs continue to occur less frequently as HIV treatment becomes more effective.

There are many effective HIV treatment options that can keep you healthy and help you maintain a low viral load. The primary treatment for HIV is called antiretroviral therapy (ART), a combination of medications that lower the amount of HIV in your bloodstream.

If you take your HIV medication every day as prescribed, you can maintain an undetectable viral load. This will preserve the strength of your own immune system and prevent you from transmitting the virus to others.

Starting ART as soon as possible after you receive an HIV diagnosis is critical to lowering your risk of developing AIDS and preventing you from transmitting the virus to others. If you have tested positive for HIV, reach out to your healthcare provider right away to begin treatment.

If you have tested negative for HIV, there are important HIV prevention medications that can help you continue to protect your health: PrEP and PEP.

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%. PrEP may be right for you if you have a partner who is HIV-positive or unsure of their HIV status, or if you have multiple partners. Pharmacists in a growing number of states can now prescribe PrEP.

PEP, or post-exposure prophylaxis, is a medication taken within 72 hours of potential exposure to HIV to lower your chances of contracting the virus. It can be prescribed by a healthcare provider at emergency rooms, sexual health clinics, community-based health centers, and, in some states, pharmacies. PEP is only for emergencies and accidental exposures. If you anticipate ongoing risk of exposure to HIV, speak with your doctor about potentially taking PrEP for long-term protection.

We’re here to help you navigate HIV treatment and prevention therapies

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with antiretroviral therapy, PrEP, or PEP. We will coordinate with your doctor and your insurance provider to ensure that you’re receiving the best option for your needs at the best price. 

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

World AIDS Day, observed on December 1st every year, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

Take Action for World AIDS Day 2021

World AIDS Day, observed on December 1st every year since 1988, is an important reminder that progress in the global fight against AIDS requires action and awareness from each individual around the world.

AIDS (acquired immunodeficiency syndrome) was heavily stigmatized from the beginning of the epidemic in the 1980s. Four years passed between the first cases of AIDS in the U.S. in 1981 and the Reagan administration’s first public mention of the disease. There were many misconceptions about how HIV (human immunodeficiency virus) — the virus that causes AIDS — can be transmitted and who is at risk of contracting it.

The stigma and lack of information about transmission and prevention led to many preventable cases of HIV/AIDS in the U.S. At the peak of the epidemic in 1995, complications from the disease were the leading cause of death for adults ages 25-44, and to date, more than 700,000 people in the U.S. have died from an HIV-related illness.

The HIV and AIDS landscape looks dramatically different today than it did back when World AIDS Day was first established. With greater awareness of HIV and AIDS, and more government funding of research, new HIV infections in the U.S. decreased by 73% between 1984 and 2019. Still, the fight to end AIDS isn’t over, with more than 1.2 million people living with HIV in the U.S.

In honor of World AIDS Day 2021, take a look at what has already been accomplished in the fight against AIDS and learn about what is needed next.

There were 34,800 new HIV infections in 2019

13% of those living with HIV don’t know it

57% of those living with HIV are virally suppressed (meaning they are not at risk of transmitting the virus to others)

Milestones in the history of HIV and AIDS

AIDS first emerged in the U.S. in 1981, but researchers did not learn that HIV caused AIDS until three years later in 1984. The history of HIV medication dates back to 1986, when clinical trials for azidothymidineor (AZT), the first antiretroviral HIV/AIDS medication, began. AZT was approved to treat HIV a year later.

Highly active antiretroviral therapy, often referred to as antiretroviral therapy (ART), became the frontline treatment for HIV in 1997. ART is a combination of medications that lower your viral load, which is the amount of HIV in your bloodstream. When taken every day as prescribed, these medications can help individuals with HIV maintain an undetectable viral load, virtually eliminating their risk of transmitting the virus to others.

The U.S. Food and Drug Administration (FDA) first approved a PrEP medication in 2012. PrEP, or pre-exposure prophylaxis, can lower the risk of sexual transmission of HIV by 99% when taken daily and reduces the risk of getting HIV from intravenous drug use by about 74%.

With these breakthroughs in HIV treatment and prevention therapies, the U.S. government recently announced a goal to reduce the number of new HIV infections by 75% by 2025 and at least 90% by 2030, preventing an estimated 250,000 additional cases of HIV.

Next steps in the fight against HIV and AIDS

Despite the progress that has been made in the fight against HIV and AIDS, prevention, care, and treatment remain inaccessible for many individuals at risk of contracting HIV — both in the U.S. and around the world. The theme for World AIDS Day 2021 is Ending the HIV Epidemic: Equitable Access, Everyone’s Voice, in recognition of how health inequities contribute to the epidemic.

In the U.S., racial discrimination and deeper inequities in healthcare have contributed to HIV’s disproportionate impact upon people of color. Black and Latinx individuals — particularly gay and bisexual men — are among the groups disproportionately affected by HIV. A variety of factors contribute to these disparities, including income inequality, unequal access to healthcare, and lower use of HIV prevention and treatment services. According to 2016 CDC data, white individuals accounted for 69% of PrEP use, while Latinx and Black individuals accounted for 13% and 11%, respectively.

Fortunately, HIV prevention medication continues to become more accessible, with generic medication options and expanded health insurance coverage of PrEP. And legislation in a handful of states, including California and Colorado, allows pharmacists to prescribe PrEP. There are also a number of organizations working hard to make HIV services more accessible to communities of color, like NMAC and Black AIDS Institute.

Getting an HIV test is one of the most important things you can do for World AIDS Day. Not only will learning your HIV status give you the information you need to take control of your health, it will also help combat the stigma surrounding HIV and AIDS. Each person who makes use of testing and prevention services — and each person who speaks openly about HIV and AIDS, without perpetuating fear or stigma — brings us closer to a future without AIDS.

Search for a free and confidential HIV testing site near you.

View the CDC’s HIV stigma language guide to learn the power of the words you use when discussing HIV and AIDS.

Get support navigating HIV treatment and prevention medication

At Alto, we’re committed to doing our part to make HIV treatment and prevention services as accessible as possible. Our extensive library of HIV-focused content covers the information you need to make informed decisions about your health. And if you take PrEP or ART, our team will coordinate with your doctor’s office and your insurance provider to ensure that you’re receiving the best medication option for your health needs at the lowest price.

To learn more, reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

Editor’s Note: This post was originally published in November 2021 and has been updated for accuracy and completeness.

How to Take Action for World AIDS Day 2021

Prioritizing your heart health becomes even more important during the holiday season. The good news? A little self-care goes a long way, and even small actions can have a big impact on your physical and mental well-being. Here are simple ways to keep your heart healthy this holiday season

How to Keep Your Heart Healthy During the Holidays

Prioritizing your heart health becomes even more important during the holiday season. Not only is it more difficult to maintain your typical exercise routine and healthy habits amid the shopping, traveling, and hosting, but the seasonal stress can also put more strain on your heart. The good news? A little self-care goes a long way, and even small actions can have a big impact on your physical and mental well-being. Here are simple ways to keep your heart healthy this holiday season.

Stress can increase your risk of heart disease both directly and indirectly. It increases inflammation, which is linked to high blood pressure, and can also lead to sleep deprivation or disruption, another risk factor for heart disease.

As you plan for heart-healthy holidays, identify potential sources of stress in advance and look for opportunities to limit it. Some degree of holiday stress is bound to occur, but try to avoid overextending yourself by setting priorities and limiting how much you take on.

Throughout the season, watch for the emotional, physical, and behavioral symptoms of stress. Each individual experiences stress differently, but common signs include headaches, chronic pain, decreased energy, changes in appetite, digestive issues, and depression.

If you find yourself feeling overwhelmed, seek out positive outlets for stress relief, like mindfulness, meditation, and exercise. Simply pausing to take a breath on a busy day can help counteract the physical effects of stress: in signaling the brain to calm, deep breathing can lower your heart rate and blood pressure.

In addition, here are some apps that can help you proactively manage stress and anxiety this holiday season:

Insight Timer, which offers a variety of free guided meditations

What’s Up?, which uses a cognitive behavioral therapy (CBT) approach to managing stress and negative thoughts

It may seem difficult to maintain a heart-healthy diet during the holidays: sodium — which can lead to high blood pressure — and trans fats — which increase your blood levels of “bad cholesterol” — are found in many popular seasonal dishes.

Prioritizing your heart health during the holidays doesn’t mean avoiding your favorite foods altogether, but rather trying to strike a balance. If you’re preparing food for holiday celebrations, look for small ingredient swaps that can transform a dish into a heart-healthy recipe. The American Heart Association has a list of holiday recipe hacks like swapping Greek yogurt for sour cream and applesauce for butter, and cooking with low-sodium or frozen vegetables.

The importance of moderation also applies to drinking, as increased alcohol consumption over the holidays can also impact your heart health. In the long term, heavy alcohol use — defined by the CDC as 8 or more drinks per week for a woman and 15 drinks or more for a man — may increase your risk for high blood pressure, heart failure, and stroke. In the shorter term, experiencing an increased heart rate as the result of drinking heavily during holiday celebrations is sometimes referred to as “holiday heart syndrome.”

Get creative with making time for exercise

It’s great to set New Year’s fitness goals, but that doesn’t mean November and December are a time to step back from your exercise routine. Regular physical activity lowers your risk for heart disease, and it’s especially important to stay active during the holidays in light of the added stress and opportunities to overindulge.

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