Signs and symptoms of HIV/AIDS
The stages of HIV infection are acute infection, latency and AIDS. Acute infection lasts for several weeks and may include symptoms such as fever, swollen lymph nodes, inflammation of the throat, muscle pain and mouth and esophageal sores; the latency stage involves few or no symptoms and can last anywhere from two weeks to twenty years or more, depending on the individual. AIDS, the final stage of HIV infection, is defined by low CD4+ T cell counts, various opportunistic infections and other conditions. Acute HIV infection, primary HIV infection or acute seroconversion syndrome is the second stage of HIV infection, it occurs after the incubation stage, before the latency stage and the potential AIDS succeeding the latency stage. During this period fifty to ninety percent of infected individuals develop an influenza or mononucleosis-like illness called acute HIV infection, the most common symptoms of which may include fever, pharyngitis, myalgia, malaise and esophageal sores, may include, but less headache and vomiting, ulcers in the mouth or on the genitals, enlarged liver/spleen, weight loss, night sweats and diarrhea and neurological symptoms.
Infected individuals may experience some, or none of these symptoms. The duration of symptoms varies, averaging 28 days and lasts at least a week; because of the nonspecific nature of these symptoms, they are not recognized as signs of HIV infection. If patients go to their doctors or a hospital, they will be misdiagnosed as having one of the more common infectious diseases with the same symptoms; as a consequence, these primary symptoms are not used to diagnose HIV infection, as they do not develop in all cases and because many are caused by other more common diseases. However, recognizing the syndrome can be important because the patient is much more infectious during this period. A strong immune defense reduces the number of viral particles in the blood stream, marking the start of secondary or chronic HIV infection; the secondary stage of HIV infection can vary between 20 years. During the secondary phase of infection, HIV is active within lymph nodes, which become persistently swollen, in response to large amounts of virus that become trapped in the follicular dendritic cells network.
The surrounding tissues that are rich in CD4+ T cells may become infected, viral particles accumulate both in infected cells and as free virus. Individuals who are in this phase are still infectious. During this time, CD4+ CD45RO+ T cells carry most of the proviral load. A small percentage of HIV-1 infected individuals retain high levels of CD4+ T-cells without antiretroviral therapy. However, most have detectable viral load and will progress to AIDS without treatment; these individuals are classified as long-term nonprogressors. People who maintain CD4+ T cell counts and have low or clinically undetectable viral load without anti-retroviral treatment are known as elite controllers or elite suppressors; the symptoms of AIDS are the result of conditions that do not develop in individuals with healthy immune systems. Most of these conditions are opportunistic infections caused by bacteria, viruses and parasites that are controlled by the elements of the immune system that HIV damages; these infections affect nearly every organ system.
People with AIDS have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas. Additionally, people with AIDS have systemic symptoms of infection like fevers, swollen glands, chills and weight loss; the specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives. Pneumocystis pneumonia is rare in healthy, immunocompetent people, but common among HIV-infected individuals, it is caused by Pneumocystis jirovecii. Before the advent of effective diagnosis and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not occur unless the CD4 count is less than 200 cells per µL of blood. Tuberculosis is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is not treatable once identified.
Multidrug resistance is a serious problem. Tuberculosis with HIV co-infection is a major world health problem according to the World Health Organization: in 2007, 456,000 deaths among incident TB cases were HIV-positive, a third of all TB deaths and nearly a quarter of the estimated 2 million HIV deaths in that year. Though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection, TB presents as a pulmonary disease. In advanced HIV infection, TB presents atypically with extrapulmonary disease a common feature. Symptoms are constitutional and are not localized to one particular site affecting bone marrow, bone and gastrointestinal tracts, regional lymph nodes, the central nervous system. Esophagitis is an inflammation of the lining of the lower end of the esophagus
Timeline of HIV/AIDS
This is a timeline of AIDS, including AIDS cases before 1980. 1900sResearchers estimate that some time in the early 1900s a form of simian immunodeficiency virus, SIV, was transmitted to humans in central Africa. This particular virus, group M of HIV-1, went on to become the pandemic strain of HIV, though others have been identified.1920s Scientists estimate that HIV was circulating in Kinshasa by the 1920s.1959 The first known case of HIV in a human occurs in a man who died in the Congo confirmed as having HIV infection. June 28, in New York City, Ardouin Antonio, a 49-year-old Haitian shipping clerk dies of Pneumocystis carinii pneumonia, a disease associated with AIDS. Gordon Hennigar, who performed the postmortem examination of the man's body, found "the first reported instance of unassociated Pneumocystis carinii disease in an adult" to be so unusual that he preserved Ardouin's lungs for study; the case was published in two medical journals at the time, Hennigar has been quoted in numerous publications saying that he believes Ardouin had AIDS.1960sHIV-2, a viral variant found in West Africa, is thought to have transferred to people from sooty mangabey monkeys in Guinea-Bissau.1964Jerome Horwitz of Barbara Ann Karmanos Cancer Institute and Wayne State University School of Medicine synthesize AZT under a grant from the US National Institutes of Health.
AZT was intended as an anticancer drug.1966Genetic studies of the virus indicate that, in or about 1966, HIV first arrived in the Americas, infecting one person in Haiti. At this time, many Haitians were working in Congo, providing the opportunity for infection.1968A 2003 analysis of HIV types found in the United States, compared to known mutation rates, suggests that the virus may have first arrived in the United States in this year. The disease remained unrecognized for another 12 years; this is, contradicted by the estimated area of time of initial infection of Robert Rayford, most infected around 1959.1969A St. Louis teenager, identified as Robert Rayford, dies of an illness that baffles his doctors. Eighteen years molecular biologists at Tulane University in New Orleans test samples of his remains and find evidence of HIV.1976The 9-year-old daughter of Arvid Noe dies in January. Noe, a Norwegian sailor, dies in April, it is determined that Noe contracted HIV/AIDS in Africa during the early 1960s.1977Danish physician Grethe Rask dies of AIDS contracted in Africa.
A San Francisco woman, believed to be a sex-worker, gives birth to the first of three children who were diagnosed with AIDS. The children's blood revealed an HIV infection; the mother died of AIDS in May 1987. Test results show she was infected no than 1977. French-Canadian flight attendant Gaëtan Dugas gets married in Los Angeles in order to get citizenship, he stays in Silver Lake, a section of Los Angeles, whenever he is in town.1978A Portuguese man known as Senhor José dies. It is believed that he was exposed to the disease in Guinea-Bissau in 1966.1979An early case of AIDS in the United States was of a female baby born in New Jersey in 1973 or 1974. She was born to a sixteen-year-old girl, an identified drug-injector, who had had multiple male sexual partners; the baby died in 1979 at the age of five. Subsequent testing on her stored tissues confirmed that she had contracted HIV-1. A thirty-year-old woman from the Dominican Republic dies at Mount Sinai Medical Center in New York City from CMV infection.
1980April 24, San Francisco resident Ken Horne is reported to the Center for Disease Control with Kaposi's sarcoma. In 1981, the CDC would retroactively identify him as the first patient of the AIDS epidemic in the US, he was suffering from Cryptococcus. A 36-year-old Danish homosexual male passes away in the Rigshospitalet in Copenhagen from Pneumocystis pneumonia. October 31, Gaëtan Dugas pays his first known visit to New York City bathhouses. December 23, a Brooklyn schoolteacher, dies of AIDS in New York City, he is the 4th US citizen known to die from the illness. A Zairian woman and a French woman die in late 1980 of Pneumocystis Pneumonia in the Claude Bernard Hospital in Paris.1981 May 18, Lawrence Mass becomes the first journalist in the world to write about the epidemic, in the New York Native, a gay newspaper. A gay tipster overheard his physician mention that some gay men were being treated in intensive-care units in New York City for a strange pneumonia. "Disease Rumors Largely Unfounded" was the headline of Mass's article.
Mass repeated a New York City public-health official's claims that there was no wave of disease sweeping through the gay community. At this point, the Centers for Disease Control had been gathering information for about a month on the outbreak that Mass's source dismissed. June 5, The CDC reports a cluster of Pneumocystis pneumonia in five gay men in Los Angeles. July 3, An article in The New York Times carries the headline: "Rare Cancer Seen in 41 Homosexuals"; the article describes cases of Kaposi's sarcoma found in forty-one gay men in New York City and San Francisco. July 4, The CDC reports clusters of Kaposi's sarcoma and Pneumocystis pneumonia among gay men in California and New York City. September, "AIDS poster boy" Bobbi Campbell becomes the 16th person in San Francisco diagnosed with Kaposi's sarcoma. October, first reported case in a 35-year-old gay man. Died shortly after. December 12, First known case reported in the United Kingdom. One of the first reported patients to have died of AIDS in the US is reported i
An HIV vaccine may have the purpose of protecting individuals who do not have HIV from being infected with the virus, or treating an HIV-infected person. There are two approaches to an HIV vaccine: an active vaccination approach in which a vaccine aims to induce an immune response against HIV. There is no licensed HIV vaccine on the market, but multiple research projects are trying to find an effective vaccine. There is evidence from humans. Some, but not all, HIV-infected individuals produce broadly neutralizing antibodies which keep the virus suppressed and these people remain asymptomatic for decades. Potential broadly neutralizing antibodies have been cloned in the laboratory and are being tested in passive vaccination clinical trials. Many trials have shown no efficacy but thus far, one HIV vaccine regimen, RV 144, has been shown to prevent HIV in some individuals in Thailand; the urgency of the search for a vaccine against HIV stems from the AIDS-related death toll of over 35 million people since 1981.
In 2002, AIDS became the primary cause of death due to an infectious agent in Africa. Alternative medical treatments to a vaccine exist. For the treatment of HIV-infected individuals, Highly Active Antiretroviral Therapy medication has been demonstrated to provide many benefits to HIV-infected individuals, including improved health, increased lifespan, control of viremia, prevention of transmission to babies and partners. HAART must be taken lifelong without interruption to be effective, cannot cure HIV. Options for the prevention of HIV infection in HIV-uninfected individuals include safer sex, antiretroviral strategies and medical male circumcision. Vaccination has proved a powerful public health tool in vanquishing other diseases, an HIV vaccine is considered as the most and the only way by which the HIV pandemic can be halted. However, HIV-1 remains a challenging target for a vaccine. In 1984, after the confirmation of the etiological agent of AIDS by scientists at the U. S. National Institutes of Health and the Pasteur Institute, the United States Health and Human Services Secretary Margaret Heckler declared that a vaccine would be available within two years.
However, the classical vaccination approach, successful in the control of other viral diseases - priming the adaptive immunity to recognize the viral envelope proteins - have failed to work against HIV. Many factors make the development of an HIV vaccine different to other classic vaccines: Classic vaccines mimic natural immunity against reinfection as seen in individuals recovered from infection. Most vaccines protect against disease, not against infection. Most effective vaccines are live-attenuated organisms; the epitopes of the viral envelope are more variable than those of many other viruses. Furthermore, the functionally important epitopes of the gp120 protein are masked by glycosylation and receptor-induced conformational changes making it difficult to block with neutralizing antibodies; the ineffectiveness of developed vaccines stems from two related factors: First, HIV is mutable. Because of the virus' ability to respond to selective pressures imposed by the immune system, the population of virus in an infected individual evolves so that it can evade the two major arms of the adaptive immune system.
Second, HIV isolates are themselves variable. HIV can be categorized into multiple subtypes with a high degree of genetic divergence. Therefore, the immune responses raised by any vaccine need to be broad enough to account for this variability. Any vaccine that lacks this breadth is unlikely to be effective; the difficulties in stimulating a reliable antibody response has led to the attempts to develop a vaccine that stimulates a response by cytotoxic T-lymphocytes. Another response to the challenge has been to create a single peptide that contains the least variable components of all the known HIV strains; the typical animal model for vaccine research is the monkey the macaque. Monkeys can be infected with the chimeric SHIV for research purposes. However, the well-proven route of trying to induce neutralizing antibodies by vaccination has stalled because of the great difficulty in stimulating antibodies that neutralise heterologous primary HIV isolates; some vaccines based on the virus envelope have protected chimpanzees or macaques from homologous virus challenge, but in clinical trials, humans who were immunised with similar constructs became infected after exposure to HIV-1.
There are some differences between SIV and HIV that may introduce challenges in the use of an animal model. The animal model can be useful but at times controversial. There is a new animal model resembling that of HIV in humans. Generalized immune activation as a direct result of activated CD4+ T cell killing - performed in mice allows new ways of testing HIV behaviour. NIAID-funded SIV research has shown that challenging monkeys with a cytomegalovirus -based SIV vaccine results in containment of virus. Virus replication and dissemination occurs within days after infection, whereas vaccine-induced T cell activation and recruitment to sites
Social activism against the spread of HIV/AIDS and in support of effective treatment has taken place in multiple nations across the world over the past several decades. In terms of the complex history of HIV/AIDS in human beings, widespread criticism by regular individuals against public health organizations have escalated into protest movements due to slow treatment responses. Methods of demonstration have included the hanging of political leaders in effigy, pamphleteer activities, placard waving, public marches, sit-ins, the like. HIV/AIDS activism has drawn its numbers from active patients who struggle with their health themselves as well as the friends and family of those diagnosed; these networks have swollen in size and thus influence by taking in sympathetic outsides existing within the same broader social community. For example, the South African fight against HIV/AIDS began among patients only to grow to a concern among most of the nation's gay men and to a broader coalition of South Africans fighting for anti-disease treatment as a part of a socio-economic right to healthcare.
Methods of protest have included the hanging of political leaders in effigy, pamphleteer activities, Placard waving, public marches, sit-ins, many other such activities. Sometimes, sit-ins will escalate to demonstrations known as die-ins, during which protests will lie in various motionless poses to simulate being dead. In the U. S. the iconography of the pink triangle and the slogan "Silence=Death" together is common. Activists placed versions of the image across New York City during the worst times of the HIV/AIDS crisis in the 1980s. It's since been printed in other types of media; the widespread belief in various misconceptions about HIV/AIDS has resulted in a serious handicap holding back treatment in certain parts of Africa. Activists have worked in a variety of different nations to promote effective treatment and to fight back against the myth. One particular example that's drawn international media attention is the'virgin cleansing myth', with some communities in Africa believing that sex with a un-experienced partner can cure either AIDS or the underlying HIV infection itself.
Activist Betty Makoni is one particular individual who has worked to dispel the myth. In terms of social activism against governments, the controversial 2014 Anti-Homosexuality Bill of Uganda, which aimed at making homosexual sex a criminal offense, earned condemnation from individual activists as well as from groups such as The Global Fund to Fight AIDS, Tuberculosis and Malaria. Said organization stated that excluding marginalised groups would compromise efforts to stop the spread of AIDS in Uganda, a social problem to the point that a full 5.4% of the adult population had been infected with HIV by the year 2007. Struggles against HIV/AIDS have been a persistent problem in South Africa with over five million of the nation's people being HIV positive as of 2004 data. In the shadow of the collapsed apartheid system, the country-wide debate on the disease has focused on the intense conflict between social activists aligned with the Treatment Action Campaign and the nation's government. Official support for AIDS denialism and the administering of what has been seen as inadequate access to HIV treatment outraged activists who viewed the government's policies as a denial of their basic right to life.
Efforts by the TAC and associated individuals proved success when, in September 2003, the South African Cabinet instructed the country's health ministry to create a comprehensive HIV treatment and prevention plan. Commentators have considered the TAC campaign as one of the most successful if not the most successful example of civil society pushing for human rights in South Africa since the end of apartheid. HIV prevalence varies drastically from country to country inside Africa. For example, UNAIDS research in 2007 found that 23.9% of adults in Botswana had been inflected in comparison to the values of 12.5% in Mozambique and 2.8% in Rwanda. The South Africa and Zimbabwe had values of 18.1% and 15.3%, respectively. While the initial timeline of when and how HIV/AIDS crossed over into being a human infection is unclear, the timeline of early HIV/AIDS cases being under scientific dispute, the disease's spread in the United States began to reach a critical mass in the late 1970s and early 1980s period.
Because of the long incubation period of HIV, which can go on for over a decade while symptoms of AIDS appear, HIV was not noticed at first by health professionals. The low incidence made detection more tricky. By the time the first reported cases of AIDS were found in large U. S. cities such as New York City, the prevalence of HIV infection had passed 5% in some communities. The AIDS epidemic began on 5 June 1981, when the U. S. Centers for Disease Control and Prevention issued findings in its Morbidity and Mortality Weekly Report newsletter of unusual clusters of pneumocystis pneumonia caused by a form of pneumocystis carinii; the report looked at five homosexual men in the Los Angeles area. Publications such as the San Francisco Chronicle and the Los Angeles Times gave the CDC's findings news coverage. June 1981 additionally saw the first AIDS patient getting received into care under the aegis of the U. S. National Institutes of Health. By August 1981
World AIDS Museum and Educational Center
The World AIDS Museum and Educational Center, located at 1201 NE 26th St. in Wilton Manors, opened on May 15, 2014. The AIDS Museum and Educational Center began as a HIV support group, Pozitive Attitudes, at the Pride Center in Fort Lauderdale; the facilitator of that group was Steve Stagon and it was his idea to create an AIDS museum, in south Florida because Broward County and Miami-Dade County are "the epicenter of the AIDS crisis in America." A non-profit corporation was set up and fundraising began. After various local exhibits in churches and the Pride Center, once they had enough funding they choose the location on 26th Street. On Nov 07, 2013, Magic Johnson visited the World AIDS Museum and dedicated the space, 22 years to the day he announced his HIV status. Doors opened to the public in May 2014; the World AIDS Museum and Educational Center has a main gallery featuring the historical timeline of the AIDS epidemic, 2 art galleries, a research library. They do traveling exhibits and educational programs in the schools.
The current Executive Director is Requel Lopes. Author and AIDS activist Larry Kramer, who spoke there on March 9, 2017, remarked: What an amazing and outstanding place this is!... Now they have funding from the state, can...host groups of students. The exhibition, beautifly installed, among much else a GMHC room, an ACT UP room, a Keith Haring room; the history of hiv/AIDS timeline is extensive, I learned a few thngs myself. The docent is exceptionally knowledgeable.... The board members are exceptionally committed.... They take pride in claiming; this museum beats anything in San Francisco or New York. Spread the word that this place exists! The AIDS Museum is a nonprofit organization based in Newark, New Jersey with a collection of art related to AIDS and art by artists living with HIV, it was founded in December 2004. Among the museum's exhibits have been: an exhibit of art by HIV-positive artists titled "Eyes of Mercy", was held from November 11 through December 1, 2006 at Seton Hall University in South Orange, NJ.
The museum co-organized an exhibit titled "Edge of Light: Art in the Age of AIDS" at the Paul Robeson Center Gallery at Rutgers Newark, which ran from July 2007 until December 2007. The World Culture Open Gallery was the site of a collaborative project called "Positive Still: Artists Respond to AIDS" featuring, among other artwork, five pieces from the AIDS Museum's permanent collection; the AIDS Museum has no permanent location. Its Web site lists no activities since 2011, although it still has an active phone number and the Web site. There is another being developed in South Africa. World AIDS Museum and Educational Center Web site Newark AIDS Museum website
Prevention of HIV/AIDS
HIV prevention might refer to practices done to prevent the spread of HIV/AIDS. HIV prevention practices may be done by individuals to protect "their own health" and the health of those in their community, or may be instituted by governments or other organizations as "public health policies"; some considered pharmaceutical interventions for the prevention of HIV might include the use of: Of these, the only universally medically proven method for preventing the spread of HIV during sexual intercourse is the correct use of condoms, condoms are the only method promoted by health authorities worldwide. For HIV-positive mothers wishing to prevent the spread of HIV to their children during birth, antiretroviral drugs have been medically proven to reduce the likelihood of the spread of the infection. Scientists worldwide are researching other prevention systems. Increased risk of contracting HIV correlates with infection by other diseases other sexually transmitted infections. Medical professionals and scientists recommend treatment or prevention of other infections such as herpes, hepatitis A, hepatitis B, hepatitis C, human papillomavirus, syphilis and tuberculosis as an indirect way to prevent the spread of HIV infection.
Doctors treat these conditions with pharmaceutical interventions. As of September 2013, condoms are available inside prisons in Canada, most of the European Union, Brazil, South Africa, the US state of Vermont. Social strategies do not require any drug or object to be effective, but rather require persons to change their behaviors to gain protection from HIV; some social strategies which people consider include: Each of these strategies has differing levels of efficacy, social acceptance, acceptance in the medical and scientific communities. Populations which receive HIV testing are less to engage in behaviors with high risk of contracting HIV, so HIV testing is always a part of any strategy to encourage people to change their behaviors to become less to contract HIV. Over 60 countries impose some form of travel restriction, either for short- or long-term stays, for people infected with HIV. Persuasive messages delivered through health advertising and social marketing campaigns which are designed to educate people about the danger of HIV/AIDS and simple prevention strategies are an important way of preventing HIV/AIDS.
These persuasive messages have increased people's knowledge about HIV. More information sent out through advertising and social marketing proves to be effective in promoting more favorable attitudes and intentions toward future condom use, though they did not bring significant change in actual behaviors except those were targeting at specific behavioral skills. In the meantime, research in health communication found that importance of advocating critical skills and informing available resources are higher for people with lower social power, but not true for people with more power. African American audiences need to be educated about strategies they could take to efficiently manage themselves in health behaviors such as mood control, management of drugs, proactive planning for sexual behaviors. However, these things are not as important for European Americans. Consistent condom use reduces the risk of heterosexual HIV transmission by about 80% over the long-term. Where one partner of a couple is infected, consistent condom use results in rates of HIV infection for the uninfected person below 1% per year.
Some data support the equivalence of female condoms to latex condoms, but the evidence is not definitive. The use of the spermicide nonoxynol-9 may increase the risk of transmission because it causes vaginal and rectal irritation. A vaginal gel containing tenofovir, a reverse transcriptase inhibitor, when used before sex, reduces infection rates by 40% among African women. Circumcision in sub-Saharan Africa reduces the risk of HIV infection in heterosexual men between 38 and 66% over two years. Based on these studies, the World Health Organization and UNAIDS both recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007. Whether it protects against male-to-female transmission is disputed and whether it is of benefit in developed countries and among men who have sex with men is undetermined. For men who have sex with men there is some evidence that the penetrative partner has a lower chance of contracting HIV; some experts fear that a lower perception of vulnerability among circumcised men may result in more sexual risk-taking behavior, thus negating its preventive effects.
Women who have undergone female genital cutting have an increased risk of HIV. Programs encouraging sexual abstinence do not appear to affect subsequent HIV risk in high-income countries. Evidence for a benefit from peer education is poor. Comprehensive sexual education provided at school may decrease high risk behavior. A substantial minority of young people continue to engage in high-risk practices despite HIV/AIDS knowledge, underestimating their own risk of becoming infected with HIV, it is not known if treating other sexually transmitted infections is effective in preventing HIV. Early treatment of HIV-infected people with antiretrovirals protected 96% of partners from infection. Pre-exposure prophylaxis with a daily dose of tenofovir with or without emtricitabine is effective in a number of groups, including men who have sex with men, couples where one is HIV positive, young heterosexuals in Africa. Universal precautions within the health-care environment are believed to b
Pre-exposure prophylaxis is the use of drugs to prevent disease in people who have not yet been exposed to the disease-causing agent. The term refers to the use of antiviral drugs as a strategy for the prevention of HIV/AIDS. PrEP is one of a number of HIV prevention strategies for people who are HIV negative but who have higher-than-average risk of contracting HIV, including sexually active adults at increased risk of HIV, people who engage in injection drug use, serodiscordant sexually active couples; the only drug that any health organization recommends for HIV/AIDS PrEP is Truvada, the brand name of the Gilead Sciences drug combination of tenofovir/emtricitabine. Patients on PrEP take Truvada every day and must agree to see their healthcare provider at least every three months for follow-up testing; when used as directed, PrEP has been shown to be effective, reducing the risk of contracting HIV by 92%. PrEP is intended for use along with other risk reduction strategies such as condoms because people taking PrEP are still at some risk of contracting HIV those who do not take PrEP and because people on PrEP remain at risk for other types of sexually transmitted infection.
In the United States, federal guidelines recommend the use of PrEP for HIV-negative adults with the following characteristics: sexually active in the last 6 months and NOT in a sexually monogamous relationship with a tested HIV-negative partner, who...is a man who has sex with men, who... has had anal sex with another man in the past 6 months without a condom, or... has had a sexually transmitted infection in the past 6 months or is a sexually active adult, who... is a man who has sex with both men and women, or... has sex with partners at increased risk of having HIV without consistent condom use or anyone who has injected illicit drugs in the past six months, shared recreational drug injection equipment with other drug users in the past six months, or, in treatment for injection drug use in the past six monthsOther government health agencies from around the world have devised their own national guidelines for how to use PrEP to prevent HIV infection in those at high risk, including Botswana, Kenya, South Africa, the United Kingdom and Zimbabwe.
Lab testing is required before starting PrEP, including a test for HIV. Once PrEP is initiated, patients are asked to see their provider at least every three to six months. During those visits, healthcare providers may want to repeat testing for HIV, test for other sexually transmitted infections, monitor kidney function, and/or test for pregnancy. PrEP has been shown to be effective at reducing the risk of contracting HIV in individuals at increased risk. However, PrEP is not 100% effective at preventing HIV in people who take the medication as prescribed. There have been several reported cases of people who despite taking PrEP became infected with HIV. People taking PrEP are recommended to use other risk reducing strategies along with PrEP, like condoms. If someone on PrEP contracts HIV, they may experience the Signs and symptoms of HIV/AIDS. Research has shown that PrEP is safe and well tolerated for most patients, although some side effects have been noted to occur; some patients experience a "start-up syndrome" involving nausea, and/or stomach issues, which resolve within a few weeks of starting the PrEP medication.
Research has shown that the use of Truvada as PrEP has been associated with mild declines in kidney function. These declines were mild, stabilized after several weeks of being on the drug, reversed once the drug was discontinued. Fat redistribution and accumulation has been observed in patients receiving antiretroviral therapy older antiretrovirals, including fat reductions in the face and buttocks and increases in visceral fat of the abdomen and accumulations in the upper back. Research and study outcome analysis suggests that emtricitabine/tenofovir does not have a significant effect on fat redistribution or accumulation when used as pre-exposure prophylaxis in HIV negative individuals; as of early 2018 these studies have not assessed in detail subtle changes in fat distribution that may be possible with the drug when used as PrEP, statistically significant - though transient - weight changes have been attributed to detectable drug concentrations in the body. Anecdotal evidence does not suggest significant reductions in facial or gluteal region adipose tissue and among PrEP users.
Truvada was only approved by the US Food and Drug Administration to treat HIV in those infected. In 2012, the FDA approved the drug for use as PrEP, based on growing evidence that the drug was safe and effective at preventing HIV in populations at increased risk of infection. In 2012, the World Health Organization issued guidelines for PrEP and made similar recommendations for its use among men and transgender women who have sex with men; the WHO noted that "international scientific consensus is emerging that antiretroviral drugs, including PrEP reduce the risk of sexual acquisition and transmission of HIV regardless of population or setting." In 2014, on the basis of further evidence, the WHO updated the recommendation for men who have sex with men to state that PrEP "is recommended as an additional HIV prevention choice within a comprehensive HIV prevention package." In November 2015 the WHO expanded this further, on the basis of further evidence, stated that it had "broadened the recommendation to include al