What to know about antiretroviral therapy for HIV

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In 1996, specialists introduced antiretroviral therapy in response to the low success rates among people taking only one HIV medication at a time.

The use of three-drug antiretroviral treatment marked a turning point, at which a diagnosis with a very poor outlook became a manageable health condition.

More recently, health authorities approved two-drug regimens for HIV treatment.

Antiretroviral therapy affects the body in two ways. First, it increases the number of immune cells in the body. It also decreases the number of virus cells.

These medications help keep a person healthy and prevent other infections. For a person taking effective antiretroviral therapy, HIV does not advance, and the virus does not pass to others.

Antiretroviral drugs have these effects:

• They stop the virus from multiplying in the blood.
• They reduce the amount of HIV in the blood.
• They increase the number of CD4 cells, which are immune cells that the virus targets.
• They prevent HIV from advancing to become AIDS or slow this advance.
• They stop the virus from transmitting to other people.
• They reduce the risk of severe complications.
• They increase survival rates.

Healthcare professionals typically prescribe a combination of three or more antiretroviral drugs. This approach has the highest likelihood of reducing the amount of HIV in the body.

However, a person might discuss the benefits of taking a single pill that contains several medications.

Antiretroviral therapy can reduce the viral load to such an extent that it is undetectable. This means that the HIV cannot pass on to another person, through any means. The shorthand for this is “undetectable = untransmittable,” or “U=U.”

The Centers for Disease Control and Prevention (CDC) recommend starting antiretroviral therapy as soon as possible after a diagnosis of HIV.

Beginning the treatment as soon as possible is important, even if several years have passed since the diagnosis and the person is still healthy. Without treatment, HIV can harm the immune system and may develop into AIDS.

When a person with HIV uses antiretroviral therapy according to instructions, it can help them live a full, healthy life.

People can find support and guidance about starting treatment from the American Academy of HIV Medicine. It also has a function that allows people in the United States to find care providers with various specialties in their area.

A person can also use this directory to locate Ryan White HIV/AIDS Program medical providers across the U.S. These are healthcare professionals who provide antiretroviral therapy, patient education, and mental health support.

There are seven classes of HIV drugs. They include:

• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• nucleoside reverse transcriptase inhibitors (NRTIs)
• post-attachment inhibitors
• protease inhibitors (PIs)
• CCR5 antagonists
• integrase strand transfer inhibitors (INSTIs)
• fusion inhibitors

Initial treatment regimens usually include two NRTIs and a third active antiretroviral drug, which may be in the INSTI, NNRTI, or PI class. They may sometimes include a booster, which may be cobicistat (Tybost) or ritonavir (Norvir).

The starting antiretroviral therapy regimen for adults and adolescents with HIV is usually one of the following:

• bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy)
• dolutegravir (Tivicay) plus tenofovir/emtricitabine (Truvada)
• dolutegravir, plus emtrictabine or lamivudine, plus tenofovir alafenamide or tenofir disoproxil fumarate
• dolutegravir/lamivudine

While the combinations above are typical, a doctor’s prescription depends on several factors, such as whether the person is pregnant.

Once the doctor finds a successful combination of drugs, the person’s viral load can become undetectable within 6 months. Antiretroviral therapy is not a cure for HIV, because even at undetectable levels, the virus remains in certain body tissues.

For antiretroviral therapy to work, a person needs to take it exactly as prescribed, without missing doses. This prevents HIV from resuming multiplying in the blood.

When discussing the best approach to treatment, a person should let the doctor know about anything that might make taking the medication difficult, such as a busy lifestyle or a lack of health insurance. The doctor can help address these issues.

Healthcare professionals take the following into consideration when recommending an antiretroviral treatment plan:

• other health conditions
• pregnancy
• possible side effects
• possible interactions between the HIV drugs and other medications
• the cost of HIV medications
• the feasibility of taking the treatment consistently according to guidelines

Learn more about the types of antiretroviral HIV drugs.

In the past, HIV medications caused many more side effects than they do now. And although current options may cause side effects in some people, in general, the benefits far outweigh the risks.

Most side effects only last a few days or weeks. They include:

• nausea
• fatigue
• trouble sleeping

However, some HIV medications can cause side effects that are not apparent for months or years. One example is high cholesterol, a risk factor for heart disease.

People who have other health conditions or take other medications may have an increased risk of side effects.

And it is important to note that HIV drugs may interact with a long list of other medications, including:

• antihistamines
• inhaled asthma medications
• indigestion medications
• statins
• erectile dysfunction medications
• herbal and alternative treatments, such as St. John’s wort

To prevent harmful interactions and make sure that medications are effective, it is crucial for people to tell their doctors about any other treatments or supplements that they take.

Antiretroviral therapy is HIV treatment that involves two or more drugs. While it does not cure the condition, it can reduce the amount of virus in the body to undetectable levels. At this point, the virus cannot pass to other people.

This treatment also boosts the immune system and reduces the risk that HIV will progress.

If a person takes the treatment exactly as prescribed, their viral load may be undetectable within 6 months.