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The HIV prevention medication PrEP — short for pre-exposure prophylaxis — has played a critical role in reducing the number of new HIV infections in recent years. It is highly effective when taken as prescribed every day, lowering the risk of sexual transmission and intravenous drug transmission by 99% and 74%, respectively.

What to Know About PrEP Follow-Up Appointments and Testing

Staying on track with PrEP treatment includes not only taking the medication as prescribed, but also regularly attending all follow-up appointments and completing recommended lab tests. Here’s an overview of ongoing medical care related to PrEP.

Note that PrEP is distinct from PEP — post-exposure prophylaxis — a prevention medication for emergencies and accidental exposures. Learn more about PEP.

If you think PrEP may be right for you, make an appointment with your doctor or other healthcare provider as a first step. (Check with your provider about the possibility of telehealth appointments, if interested.) They can write you a prescription for PrEP and conduct an HIV test, which is required to begin taking the medication.

If you do not have a provider or are unable to get a prescription from your doctor, the following resources can connect you with a provider who will prescribe PrEP for you:

There are several FDA-approved oral medication options — Truvada®, Descovy®,  and a generic for Truvada — and as of December 2021, PrEP is now available as an injectable treatment option called cabotegravir (Apretude®).

For those who find it difficult to remember to take a pill every day, the injectable form may make it easier to stay on track with PrEP treatment. However, oral PrEP continues to offer highly effective prevention for anyone at risk of HIV infection.

Always consult with a doctor if you are interested in switching from one form of PrEP to another.

What is the typical schedule of medical appointments when taking PrEP?

Work with your provider to determine the frequency of your follow-up appointments. A typical schedule often consists of the following:

First follow-up appointment between 2-4 weeks

Ongoing follow-up appointments every three months

What happens at the initial intake appointment?

If you are interested in getting started with PrEP, the first appointment will include an overview of PrEP as well as HIV testing and other lab work. If you qualify for PrEP and can commit to start taking the medication as prescribed, your doctor can write a prescription right away.

The baseline lab work includes the following:

An HIV test, to confirm that you do not have HIV at the beginning of your PrEP treatment

Testing to screen for other sexually transmitted infections (STIs), including chlamydia, gonorrhea, and syphilis

A blood test to measure kidney function (for those prescribed oral PrEP medications)

A blood test to measure cholesterol and triglyceride levels (for those prescribed oral PrEP medications)

What happens at the first follow-up appointment?

Your provider will have you come in for a follow-up appointment between 2-4 weeks. This appointment is an opportunity to discuss your experience with the medication so far, including side effects. It’s also a good time to share any other concerns, such as financial difficulties or medication adherence. Your provider will likely be able to refer you to resources.

What happens at ongoing follow-up appointments?

If you are taking oral PrEP, you will have follow-up appointments every three months. At these appointments, your doctor will:

Conduct an HIV test and assess you for symptoms of acute HIV infection to confirm that you still do not have HIV.

Provide a prescription or refill authorization of daily oral PrEP medication for no more than 90 days.

Discuss any challenges with medication adherence and answer any questions you may have.

Conduct screening for other STIs including syphilis, gonorrhea, or chlamydia.

At the six-month mark, your doctor will likely measure kidney function. (Kidney testing may be more frequent depending on individual health factors.)

They may also ask about your interest in continuing with or stopping the medication. It is important to always consult with a provider before discontinuing or restarting PrEP so that they can evaluate your overall health and review lab work.

What if I have difficulty affording PrEP or related medical care?

PrEP continues to become more accessible. In addition to the availability of generic PrEP options and expanded health insurance coverage of PrEP, the following resources can help lower the costs of HIV prevention medication.

Many states have patient assistance programs to help people with a variety of insurance statuses access PrEP and related medical services at little to no cost. Read our previous blog for more on how to apply for state-funded PrEP assistance programs.

Many medication manufacturers offer patient assistance programs to offset the cost of medication. For example, Gilead, the manufacturer of brand-name Truvada, has the Gilead Advancing Access® program, which offers a copay card for those with insurance and a Medical Assistance Program for those who are uninsured.

The Ready, Set, PrEP program provides PrEP at no cost to eligible individuals without insurance coverage of prescription medications.

Alto is here every step of the way to make it as easy as possible to follow the treatment plan your doctor recommends. Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with oral PrEP and continue treatment.

We’re available to answer any questions you may have between your follow-up appointments. In addition, we will coordinate with your doctor and your insurance provider, if applicable, to ensure that you’re receiving the best PrEP option for your needs at the best price.

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

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.

HIV treatment has transformed drastically since the virus was first discovered in the U.S. more than four decades ago. While there is no cure, HIV — short for human immunodeficiency virus — has become a manageable chronic health condition like many others.

The Evolution of HIV Medication

Today, the majority of HIV cases in the U.S. do not progress into AIDS, the most advanced stage of HIV. Not only that, but also 57% of individuals living with HIV are not at risk of transmitting the virus to others.

That’s a testament to the effectiveness of antiretroviral therapy (ART), the frontline treatment for HIV. ART is a combination of medications that keep HIV from replicating, stopping the progression of the virus and preventing transmission.

Take a look at the evolution of treatment for HIV and learn how ART works.

Early HIV medication and the introduction of ART

HIV 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. As the virus replicates and spreads, it destroys your CD4 cells, a type of white blood cell that plays a role in your immune system.

The first antiretroviral HIV/AIDS medication, azidothymidine (AZT), was approved to treat HIV in 1987. AZT blocked proteins that allowed the virus to replicate and spread. A so-called “monotherapy” consisting of a single medication, it had promising results in early clinical trials but ultimately proved ineffective in slowing the progression of HIV. This was due in large part to the fact that HIV can quickly change into new forms that are resistant to an individual medication.

The introduction of ART in 1995 was a significant breakthrough. By combining multiple HIV medications, it helped prevent the virus’ resistance to a single medication.

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. This both preserves the strength of your immune system and protects the health of your sexual partners. Many people living with HIV are able to achieve an undetectable viral load within six months of starting ART.

There are several FDA-approved ART therapies available by prescription. Each medication included in the therapy plays a critical role. Collectively, these medications prevent the virus from replicating, reduce your viral load, increase your CD4 count, and restore your immune system.

Currently, there are five types of medications included in ART therapies.

Nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcription inhibitors (NNRTIs), and protease inhibitors (PIs) prevent HIV from replicating.

Entry or fusion inhibitors prevent HIV from penetrating CD4 cells.

Integrase inhibitors (INSTIs) target a critical step in the replication of the virus, preventing replication after HIV has entered a CD4 cell.

Most of today’s HIV treatment protocols combine three medications from two or more of the five classes above. Medical advancements continue to simplify ART, with medication protocols that consist of a single daily pill or a monthly injection.

Your provider will closely monitor your body’s response to your protocol. Thanks to the variety of options, it is easy to make adjustments as needed if you experience side effects or don’t achieve the desired results.

HIV treatment is critical for anyone living with the virus, regardless of how long they have had it. If you have been diagnosed with HIV, starting ART as quickly as possible is the most important thing you can do to protect your health and others.

There are several ways to find a healthcare provider for HIV treatment.

If you have a primary care provider, ask if they offer HIV treatment or can give you a referral.

If you tested for HIV at a clinic, ask if they offer HIV treatment or can give you a referral.

Use HIV.gov’s search tool to find HIV treatment services near you.

Some HIV medications can prevent transmission of the virus to a developing baby. If you or your partner is pregnant, or if you are considering starting a family, let your healthcare provider know so they can recommend the best treatment option.

Taking ART as prescribed in the long term is critical to its effectiveness. That includes not only taking the medication itself, but also attending follow-up appointments and completing lab tests.

If you are having trouble staying on track with treatment, ask your provider or pharmacist for suggestions. Many individuals find it helpful to combine their HIV medication with another daily habit such as brushing their teeth, or to set a reminder on their phone. The Alto app has medication management reminders to help you continue with your treatment.

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

PrEP, or pre-exposure prophylaxis, can lower risk of sexual transmission of HIV by 99% when taken as prescribed. It also 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.

Read Debunking Common Myths about PrEP for more on getting started with 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 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.

Financial resources for HIV treatment and prevention

For many individuals, cost is a barrier to both starting and continuing to take ART and PrEP as prescribed. Fortunately, HIV prevention medication and treatment continue to become more accessible, with generic PrEP options and expanded health insurance coverage of PrEP and ART.

The following resources can also help reduce the cost of HIV treatment and prevention medication:

Patient assistance programs and copay savings cards from medication manufacturers

State-funded PrEP drug assistance programs

Get support navigating HIV treatment and prevention medication

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started and stay on track with ART, PrEP, or PEP. We will coordinate with your healthcare and insurance providers to ensure that you’re receiving the best option for your needs at the best price.

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

Resources for Affording HIV Medication

The HIV treatment and prevention landscape continues to evolve, with many effective medications. Antiretroviral therapy (ART), the frontline treatment for HIV since 1997, is a combination of medications that lower the amount of HIV in your bloodstream. When taken as prescribed every day, ART can help individuals with HIV achieve and maintain an undetectable viral load. As a result, more than half of all those living with HIV in the U.S. are not at risk of transmitting the virus to others.

On the prevention front, 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%.

For many individuals, cost is a barrier to both starting and continuing to take ART and PrEP as prescribed. Fortunately, HIV prevention medication and treatment continue to become more accessible, with generic PrEP options and expanded health insurance coverage of PrEP and ART. In addition, the following resources, including patient assistance programs and copay savings cards from medication manufacturers, can help reduce the cost of HIV treatment and prevention medication.

Read on to learn more about eligibility for these programs, and revisit our previous post on state-funded PrEP drug assistance programs.

Many pharmaceutical companies have patient assistance programs (PAPs) to offset the cost of prescription medications for individuals without insurance or with insufficient insurance coverage. If Alto is your pharmacy partner for HIV treatment or prevention, your medication protocol may include medications manufactured by Gilead, which offers the PAP outlined below.

If your medications are manufactured by a different company, contact them directly to learn about any available financial assistance including PAPs.

Gilead's Advancing Access® Patient Assistance Program

Gilead's Advancing Access Patient Assistance Program provides medication free of charge to individuals without insurance who meet program eligibility criteria. There are several ways to learn if you are eligible:

Call 1-800-226-2056 (Monday-Friday, 9 am to 8 pm EST)

Print the enrollment form and submit it via fax

Copay savings cards from pharmaceutical manufacturers can help offset the cost of prescription medications for individuals with insurance. If Alto is your pharmacy partner for HIV treatment or prevention, your medication protocol may include medications manufactured by Gilead or ViiV Healthcare, which offer the copay savings cards below.

If your medications are manufactured by a different company, contact them directly to learn about any available financial assistance including copay savings cards.

Gilead’s Advancing Access copay savings card

Gilead also offers a copay savings card for individuals with insurance to reduce the cost of copays. Those who are enrolled in any state or federally funded prescription medication program such as Medicare Part D and Medicaid, or who are in the Medicare Part D prescription coverage gap, are not eligible.

Learn more about program eligibility and terms and conditions.

The ViiVConnect Savings Card Program helps eligible individuals with commercial insurance save on copay costs for select ViiV Healthcare medications. Those who are enrolled in any state or federally funded prescription medication program such as Medicare Part D and Medicaid, or who are in the Medicare Part D prescription coverage gap, are not eligible.

If you do not have insurance coverage of prescription medications, contact 1-844-588-3288 to learn about additional financial assistance opportunities from ViiV.

Created to help individuals living with chronic health conditions access the treatment they need, the PAN Foundation offers financial assistance for medication costs, copays, and insurance premiums.

Learn what financial assistance you are eligible for.

Learn more about program eligibility and the application process.

Your financial well-being is our priority

At Alto, we understand how stressful it can be to navigate insurance coverage benefits and savings opportunities. We prioritize your financial wellness, working with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make ART or PrEP as affordable as possible. In addition to automatically applying coupon savings, we’ll connect you with any outside programs that require you to apply directly.

We also offer free, same-day delivery to make it as easy as possible to stay on track with treatment, and our dedicated HIV support team is here to answer any questions you may have about ART or PrEP. Reach out any time via phone at 1-800-874-5881, or in-app messaging.

An HIV diagnosis is the beginning of a lifelong health journey, and it’s understandable to experience many different emotions as you process this information. Remember that HIV is manageable, like many other chronic health conditions, and with treatment, you can live a full and active life. Though it may feel overwhelming to take action right after a diagnosis, getting started on HIV medication as soon as possible is critical to protecting your health and others. Here are the most important steps to take as you move forward.

Next Steps After an HIV Diagnosis

More than half of all individuals living with HIV in the U.S. are not at risk of transmitting the virus to others. This is a testament to the effectiveness of antiretroviral therapy (ART), the frontline treatment for HIV.

ART is a combination of medications that stops the progression of HIV and reduces your viral load — the amount of HIV in your blood — to a very low level. When taken as prescribed every day, these medications can help you maintain an undetectable viral load, which preserves the strength of your immune system and protects the health of your sexual partners. Many people living with HIV are able to achieve an undetectable viral load within six months of starting ART.

Finding a healthcare provider for HIV treatment

There are several ways to find a healthcare provider for HIV treatment. If you already have a primary care provider, they may have the experience and knowledge to treat your HIV. If not, they will likely be able to give you a referral. Similarly, if you were tested for HIV at a clinic, ask if they offer ongoing HIV treatment or can refer you elsewhere. You can also use HIV.gov’s search tool to find HIV treatment services near you.

There’s a lot of information to take in when first starting HIV treatment. Having open conversations with your doctor about your questions and concerns can help you feel empowered about your health. It may help you to prepare a list of questions before your first appointment. Here are some suggestions to use as a starting point.

How will you decide which ART medications are best for me?

How will I know if the medication is working?

What is the frequency of follow-up testing and blood work?

Are there things I cannot do because I am HIV positive?

How does HIV affect my reproductive health? (if relevant)

Learning more about HIV and preventing transmission

Living with HIV often feels more manageable when you’re equipped with facts and confident in your understanding of the condition. In addition to asking questions during doctor’s appointments, explore trusted resources like the CDC's website and HIV.gov to familiarize yourself with the basics of HIV treatment and prevention.

Many individuals are concerned about the risk of potentially transmitting HIV to a partner. There are things you can do to prevent transmission and keep your sexual partners safe. Being consistent with HIV treatment in the long term can virtually eliminate your risk of transmitting HIV to others so long as you maintain an undetectable viral load. This is why one of the most important things you can do, for both your health and others, is to start ART as soon as possible. In addition, your partner or partners may want to speak with their doctors about PrEP, an HIV prevention medication that can lower risk of sexual transmission of HIV by 99% when taken daily. Many individuals who have an HIV-positive partner take PrEP for HIV prevention.

You may be wondering who to tell about your HIV diagnosis. While sharing your HIV status with sexual partners may feel uncomfortable or scary, it will allow them to take steps to protect their health. Some states have laws that require you to share your HIV status with sexual partners. These laws also account for the risk of HIV transmission through intravenous drug use and require you to disclose your HIV status with anyone you share drugs or needles with, if relevant.

Sharing your HIV status with all of your healthcare providers is also important. It will allow them to provide individualized health recommendations, coordinate with the rest of your care team, and take appropriate precautions during blood draws and other procedures.

Many individuals living with HIV find it helpful to share their status with close friends and family as they process their diagnosis. Each person’s experience of HIV is unique, and deciding if and when to tell loved ones about your status is a personal choice. It can be helpful to hear how others decided to share their HIV status. The CDC has a collection of stories about life with HIV, and Positive Spin is another resource highlighting personal experiences of HIV.

The stress of living with any chronic condition can impact your mental and emotional well-being, and those with HIV have a higher chance of developing mental health disorders such as depression.

It’s important to take your mental health as seriously as your physical health and seek any support you need. Use your HIV treatment provider as a resource. They may be able to recommend treatment or prescribe medication, if needed, or refer you to a psychiatrist or psychologist for additional support.

Navigate HIV treatment with Alto by your side

Our pharmacists have deep expertise in HIV treatment and prevention and can help you get started with antiretroviral therapy. We will coordinate with your doctor and your insurance provider, if applicable, to ensure that you’re receiving the best option for your needs at the best price. To learn more, reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

Vaccines — which were first developed in 1796 for smallpox and continue to evolve with new research and technology — build on your immune system’s natural function to protect you from serious diseases. Just like white blood cells and the other components of your immune system, vaccines help you develop immunity, but without the initial illness and risk of health complications. Here’s a look at how vaccines work.

The Science Behind Vaccines

Your immune system has a natural way of defending you from the viruses and bacteria that cause illness. As these germs multiply rapidly and infect your body, an army of white blood cells fights back, producing antibodies that attack the invaders.

The first time you are infected by a specific virus or bacteria, your immune system often cannot destroy the germ quickly enough to prevent you from becoming sick. After you’ve recovered, certain immune cells hold onto the memory of the infection. This allows them to mobilize quickly if they encounter the same germ again, preventing illness in the future. Immunity, your body’s resistance to certain types of infection, is the outcome of this process.

To understand how vaccines work, it’s helpful to know how your immune system naturally fights an infection. B-lymphocyte white blood cells produce blood proteins called antibodies, which attack antigens — the part of the invading germ that triggers an immune response. T-lymphocyte white blood cells attack already infected cells in the body. After the infection has ended, a few T-lymphocytes, or memory cells, remain to ensure a fast immune response should the same germ reappear.

Vaccines imitate infections, triggering the process of building immunity to a specific disease without causing illness. Your immune system responds to these imitation infections the same way it would to an actual infection. Detecting antigens from the vaccine, your immune system produces antibodies and T-lymphocyte cells. The imitation infection leaves your body with T-lymphocyte memory cells and B-lymphocytes, which will know how to quickly fight that antigen in the future. This prevents you from becoming sick if you are exposed to the virus or bacteria that cause the disease.

It typically takes several weeks for your body to produce T-lymphocyte and B-lymphocyte cells in response to a vaccine, which is why in most cases you will not immediately develop immunity. This means that you could become infected with a disease and develop symptoms shortly after vaccination, so it’s important to take necessary precautions until you become fully immune to the virus or bacteria. The healthcare professional administering your vaccine will inform you of the anticipated timeline for immunity.

Sometimes the imitation infection created by a vaccine causes mild symptoms such as a fever. These side effects are normal and indicate that your body is building immunity.

While all vaccines arrive at the end result of immunity, there are several paths for getting there. When deciding which type of vaccine to create for a disease, researchers consider a variety of factors, including the immune system’s response to the germ that causes the disease, the population likely to receive the vaccine, and the regions of the world where it will be used. These are the seven types of vaccines commonly used in the U.S.

Live vaccines use a weakened version of the living virus or bacteria that causes a disease. They are most similar to the natural infection and produce long-lasting immunity. The weakened form of the germ does not lead to serious disease, like that caused by the wild form of the germ, for most individuals with strong immune systems. However, live vaccines aren’t safe for those who are immunocompromised, including children undergoing cancer treatment. Examples of live vaccines include the measles, mumps, and rubella (MMR) vaccine and the chickenpox vaccine.

Inactivated vaccines are produced by inactivating, or killing, the germ that causes a disease. Examples include the polio, hepatitis A, and flu vaccines. They don’t provide as strong of immunity as live vaccines, so additional doses, also referred to as booster shots, are often needed for ongoing protection.

Toxoid vaccines target a toxin, a harmful substance produced by a germ, rather than the entire germ itself. They contain a weakened version of the toxin to be targeted called a toxoid, which teaches your immune system how to fight off the natural toxin. Similar to the germs used in live vaccines, toxoids are weakened to a point where they do not cause illness. These vaccines are used to prevent diseases caused by toxin-producing bacteria such as diphtheria and tetanus.

Subunit vaccines use portions of a virus or bacteria called subunits rather than the entire germ. Vaccines for diphtheria, tetanus, and pertussis, or whooping cough, are combined into the DTaP vaccine. The pertussis component is a subunit vaccine.

Conjugate vaccines fight a specific type of bacteria whose antigens are more difficult for a child’s immune system to detect due to their outer coating. The vaccines link the coating to stronger antigens that the immune system can more easily respond to. Like subunit vaccines, these vaccines are more targeted and only use part of the germ. Examples of conjugate vaccines include the haemophilus influenzae type B (Hib) vaccine.

Viral vector vaccines produce immunity to a virus by using a modified version of a different virus to deliver instructions to your immune cells. The modified version of the other virus is referred to as a vector virus. Recent Ebola vaccines have used this technology, and the Johnson & Johnson COVID-19 vaccine is also a viral vector vaccine.

mRNA vaccines help your body produce a protein that triggers an immune response and the development of antibodies. This technology was used to create the Pfizer-BioNTech and Moderna COVID-19 vaccines.

Read ‘What the COVID-19 Vaccine Means for Those With HIV’

All vaccines in the United States require approval by the Food and Drug Administration (FDA) and are held to rigorous safety and effectiveness standards. The vaccine approval process starts with lab tests, which may take years in some cases. The FDA analyzes the results to determine if the vaccine should be tested with people. If the vaccine moves forward, the next step is clinical trials where the vaccine is tested on volunteers.

Clinical trials typically begin with a smaller group of 20 to 100 volunteers before including thousands more. The trials gather information about vaccine safety, the typical immune response, and dosing. If any safety concerns emerge during this stage, the FDA must address them before it can authorize the vaccine.

Vaccine manufacturers are required to continuously monitor vaccine safety after approval and test every batch produced to ensure effectiveness, quality, and purity. These test results are reviewed by the FDA, which also conducts an inspection of the factory where the vaccine was produced. If you experience severe side effects after vaccination, contact your healthcare provider so that they can report potential concerns to the Centers for Disease Control and Prevention (CDC)’s vaccine monitoring database.

COVID-19 mRNA vaccines were developed and approved more quickly than a typical vaccine given the urgent nature of the pandemic. This expedited timeline was made possible by significant investment from governments and companies in the vaccine development process and decades of research on mRNA vaccine technology. These vaccines were as thoroughly vetted for quality and safety as any other vaccine.

Many vaccines are received during childhood, like the polio, chickenpox, and MMR vaccines, but there are others you may need as an adult. The CDC recommends the zoster vaccine, which prevents shingles, for adults ages 50 and older and the pneumonia vaccine for those over 65. Other vaccines may be recommended based on additional factors including job or school requirements, travel, and health conditions. Check in with your doctor about which vaccines you need.

The CDC also recommends an annual flu vaccine for everyone 6 months and older. New versions of flu vaccines are developed annually in anticipation of circulating flu virus strains, so health experts recommend getting one every year to prepare for cold and flu season. It’s especially important to be proactive about flu vaccination if you are over the age of 65 or have a chronic condition such as COPD or diabetes.

For detailed vaccine recommendations by age group, reference the CDC’s recommended immunization schedules for children and adolescents and adults.

At Alto, a pharmacist is your partner in health. If you take medication, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible. And our team of pharmacists is available to chat whenever questions come up. 

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

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. 

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

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.

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