Health
What Is HIV? Symptoms, Causes, Diagnosis, Treatment, and Prevention
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If you test positive for HIV, research shows that if you start taking medicine immediately (or even return to treatment after some time off) and stay on it, you can bring the amount of virus in your blood (your viral load) to undetectable levels, protect your immune system, and prevent transmission to others.
Agencies like the National Institutes of Health (NIH) recommend you start HIV treatment as soon as possible after diagnosis.
Talk to a healthcare provider about treatment choices and the resources that are available to you.
There are no-fee or low-cost programs that ensure that everyone, no matter their income or insurance status, can receive and stay on treatment.
Medication Options
There are more than 30 different HIV drugs, divided into eight classes. Known collectively as antiretroviral therapy (ART), they prevent the virus from replicating in different ways.
People typically take a combination of three drugs from at least two different classes, although new drug combinations require only two medicines, combined in one pill.
Most antiretroviral drugs need to be taken every day to work properly. Although it can be difficult to stick to this routine, it’s a must in order to keep your viral load (the amount of HIV in your body) low and avoid developing possible drug resistance.
In January 2021, the U.S. Food and Drug Administration (FDA) approved the first long-acting treatment for HIV. The once-a-month injection, administered by a healthcare provider, is a combination of cabotegravir and rilpivirine — sold under the brand name Cabenuva — and is meant for patients who have already lowered their viral load.
The shots could be especially beneficial for people who struggle with a daily pill schedule.
Side Effects of Medication
All medicines have potential side effects, and HIV medicines are no different. When you first start ART, you may experience:
- Anemia
- Diarrhea
- Headache
- Fatigue
- Nausea
- Nerve problems
- Rash
- Pain
When taken long term, certain HIV medicines can be associated with serious side effects, such as high cholesterol, lipodystrophy (gain or loss of body fat), diabetes, osteoporosis, or liver damage. However, the newer HIV medications have a much lower risk of these side effects and are safer to take. Ask your doctor what to expect and how to stay healthy.
According to the NIH’s Office of AIDS Research, ART is recommended for all transgender people with HIV, though some antiretroviral drugs may interact with gender-affirming hormone therapy. Be sure your doctor is aware of any other medications and supplements you’re taking and is monitoring you for any interactions.
Learn More About Treatment for HIV
Prevention of HIV
There are a number of strategies that can reduce your risk of becoming infected with HIV or greatly lower the odds that you will transmit the virus to an HIV-negative partner.
If you are using ART regularly and precisely as prescribed and have lowered your viral load to consistently undetectable levels (which usually takes up to six months, followed by ongoing care
), your risk of transmitting the virus to a sexual partner is essentially zero. Research shows this method of HIV prevention is 100 percent effective in preventing sexual transmission.
You can also reduce your risk of getting or transmitting HIV if you and your partner:
- Use HIV prevention medications, an approach called pre-exposure prophylaxis (PrEP)
- Take a combination of HIV medicines within 72 hours after you think you may have been exposed, an approach called post-exposure prophylaxis (PEP)
- Use condoms correctly and consistently
- Have a circumcised penis
- Never share drug injection equipment
- Limit your number of sexual partners
- Abstain from sex or choose less-risky sexual behaviors, such as oral sex or mutual masturbation instead of anal or vaginal sex
- Get checked and treated for other sexually transmitted diseases
HIV can be passed from mother to child at any point during pregnancy, but if you’re pregnant and have HIV, you can prevent this by making sure you take your HIV medicines as directed so that you have an undetectable viral load. By adhering to treatment throughout pregnancy, labor, and delivery, and if your baby takes HIV medicine two to six weeks after birth, you can lower the risk of transmission to 1 percent or less.
To understand your options for lowering your HIV risks, consider checking out the CDC’s Risk Reduction Tool.
PrEP (Pre-Exposure Prophylaxis)
The FDA has approved two oral medications to prevent HIV transmission: Truvada and Descovy. Both pills combine the medicine emtricitabine with a version of the drug tenofovir. When taken every day as directed, these medications have been found to be 99 percent effective in preventing sexual transmission of HIV and between 74 and 84 percent effective in preventing transmission of HIV through the shared use of injection equipment. Some people find it difficult to stick to a daily medication regimen, though.
In December 2021, the FDA approved the injectable drug cabotegravir (Apretude), a shot given once every two months. In clinical trials, Apretude was shown to be more likely to reduce the risk of HIV by 69 percent for cisgender men and transgender women who have sex with men, compared with the daily PrEP drug Truvada in pill form. For cisgender women at high risk of HIV, the injection reduced the risk of contracting the virus by 90 percent over treatment with daily oral Truvada.
PrEP is recommended for people at high risk of becoming infected with HIV. This includes people who have a sexual partner with HIV (especially someone with an unknown or detectable viral load), people dating someone in the first six months of HIV treatment (before they reach undetectable status), sexually active transgender people, people attempting to conceive with a partner who is living with HIV, and people who have had a sexually transmitted infection in the past year.
For transgender women, preliminary data suggests that PrEP medicines do not reduce the effectiveness of gender-affirming hormones.
But estrogen has been found to slightly reduce the levels of PrEP drugs. It’s not yet known whether that decreases PrEP’s effectiveness. Research is ongoing.
PEP (Post-Exposure Prophylaxis)
If you think you may have been exposed to HIV — for instance if a condom broke or you have experienced a sexual assault — you can also take medicine after the event to prevent yourself from acquiring HIV. If you visit a healthcare provider and begin taking the medicine within 72 hours of exposure, it can prevent any HIV in your system from setting up shop and proliferating. Emergency rooms are a common provider of PEP.
Once you start the medicine, you will take it for 28 days, until the medicine runs out. PEP is highly effective (though not 100 percent); the sooner it’s started, the better.
For people who frequently require PEP, doctors may suggest treatment with PrEP instead.
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