By Dr. Sora Song, pediatric resident at CHOC Children’s and Dr. Terez Yonan, adolescent medicine specialist at CHOC Children’s
HIV (Human Immunodeficiency Virus) is a virus that can spread through certain body fluids eventually attacking the body’s immune system and because of its potential severity, everyone who is sexually active should be aware of HIV symptoms and how to prevent HIV. HIV is a life-long illness, but people living with HIV have many different treatment options. Anyone who is HIV-negative and at risk of contracting the virus should know what they can do to decrease their chances of becoming infected. PrEP and PEP, in addition to practicing safe sex, are options available for preventing HIV infection.
HIV symptoms in men and HIV symptoms in women
How long it takes for HIV/AIDS symptoms to appear can vary from person to person. Some people could look and feel healthy for years while they are infected. It is possible to infect others with HIV even if you have no symptoms. This means that getting tested regularly is important, even if you feel fine.
When a person’s immune system is overwhelmed by AIDS, they might notice:
- Extreme weakness or fatigue
- Rapid weight loss
- Frequent fevers that last for weeks with no explanation
- Heavy sweating at night
- Swollen lymph glands
- Minor infections that cause skin rashes and mouth, genital and anal sores
- White spots in the mouth or throat
- Chronic diarrhea
- A cough that won’t go away
- Trouble remembering things
- Severe vaginal yeast infections that don’t respond to usual treatment
HIV prevention: PrEP
PrEP stands for pre-exposure prophylaxis. PrEP can stop HIV from infecting your body and spreading throughout your body. It is not a vaccine. PrEP is a pill that is actually a combination of two HIV medicines (tenofovir and emtricitabine) under the trade name Truvada®. This medicine has been approved for daily use. PrEP can cause side effects like nausea in some people but these generally improve over time. These side effects are not serious or life-threatening.
PrEP is taken before HIV exposure. It is taken every day. This is for people who don’t have HIV and are at very high risk for infection. It is recommended for those who:
- have a sex partner who is HIV positive
- have sex with a partner whose HIV status is unknown
- are not in a mutually monogamous relationship with a partner who tested HIV-negative
- have injected drugs or have shared needles in the past six months
For those at very high risk for HIV infection, PrEP can greatly lower your risk of infection if taken daily.
When used as directed, daily PrEP pills can reduce the risk of getting HIV from sex by more than 90 percent and from injection drug use by more than 70 percent. PrEP can be very effective if used as directed but is much less effective if not taken consistently. PrEP can only be prescribed by a health care provider. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other methods of prevention. PrEP should be used daily and for as long as there is risk for HIV infection.
HIV prevention: PEP
PEP stands for post-exposure prophylaxis. It is a method of HIV prevention after possible exposure. It should be started within 72 hours (three days) after possible exposure to HIV. PEP has little or no effect in preventing HIV infection if it is started later than 72 hours after HIV exposure.
Someone using PEP will take a combination of medicines, usually all in one pill, that fights HIV infection. This pill can cause some side effects like nausea, in some people. These side effects are not serious or life threatening. PEP is only used for 28 days after possible HIV exposure. It is not a substitute for other HIV prevention methods, such as pre-exposure prophylaxis (PrEP). Someone can switch to PrEP right away after completing PEP for continued HIV prevention.
PEP is for people who are HIV-negative or don’t know their status and, in the last 72 hours, may have been exposed to HIV:
- during sex
- at work through a needlestick or other injury
- by sharing needles
- during a sexual assault
PEP can help prevent HIV infection when taken correctly, but it is not 100 percent effective. If you may have been exposed to HIV in the last three days, or if you aren’t sure if you have been exposed to HIV or not, talk to your healthcare provider immediately. Start PEP as soon as possible to give it the best chance of working. Individuals should continue to use condoms with sex partners and practice safe drug injection practices (for example, using your own sterile needles) while taking PEP. These different methods can reduce the chances of transmitting HIV to others if you do become infected while you’re on PEP.
Testing while Preventing HIV
Anyone who uses PrEP or PEP needs to have close follow-up with their medical provider to get testing for HIV and other sexually transmitted infections. PrEP users should have repeat testing done on a routine basis because if someone becomes HIV positive, they need additional blood tests as well as different medications for HIV treatment. PEP users need to see their providers more often to ensure the medication is working.
Talk to your health care provider about whether PrEP or PEP is right for you.