Treatment for HIV involves taking medication, such as pills, that reduces the amount of the virus in the body. This is called antiretroviral therapy. Two other options, PEP and PrEP, can also help prevent HIV.
HIV is a type of virus called a retrovirus. In a person with HIV, antiretroviral therapy reduces the amount of the virus in the body to very low levels. When levels are so low that doctors consider them undetectable, the virus can no longer damage the body or transmit to others.
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To date, the Food and Drug Administration (FDA) have approved more than 20 medications to treat HIV.
Compared with earlier drugs, modern drugs used in antiretroviral therapy are more potent, less toxic, and easier to take as directed. They also produce fewer and less severe side effects.
This article describes the medications that the FDA have approved for treating and preventing HIV, along with their possible side effects. We also look at how healthcare providers choose an appropriate HIV regimen.
The aim of antiretroviral therapy is to reduce a person’s viral load, or the amount of the virus in the blood, to an undetectable level. If the viral load is decreasing, this indicates that the treatment is working.
Undetectable amounts of the virus cannot damage the immune system or pass on to others. To keep HIV levels undetectable, it is crucial to take medications consistently as prescribed and attend regular checkups.
Various classes of antiretroviral drugs target HIV at different stages of its life cycle — the stages at which it replicates and spreads in the body.
Below, learn about the different types of antiretroviral drug that currently have approval from the FDA.
Nucleoside reverse transcriptase inhibitors (NRTIs) prevent HIV from replicating by blocking an enzyme called reverse transcriptase. This reduces the viral load of HIV in a person’s body.
The list of NRTIs includes:
| Generic name | Brand name |
| abacavir | Ziagen |
| emtricitabine | Emtriva |
| lamivudine | Epivir |
| tenofovir disoproxil fumarate | Viread |
| zidovudine | Retrovir |
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) prevent HIV from replicating by binding to and altering reverse transcriptase, which HIV uses to replicate. This reduces the viral load of HIV in the person’s body.
The list of NNRTIs includes:
| Generic name | Brand name |
| doravirine | Pifeltro |
| efavirenz | Sustiva |
| etravirine | Intelence |
| nevirapine | Viramune, Viramune XR |
| rilpivirine | Edurant |
Protease inhibitors (PIs) prevent HIV from replicating by blocking an enzyme called protease. HIV needs this enzyme to replicate.
Examples of PIs include:
| Generic name | Brand name |
| atazanavir | Reyataz |
| darunavir | Prezista |
| fosamprenavir | Lexiva |
| ritonavir | Norvir |
| saquinavir | Invirase |
| tipranavir | Aptivus |
To replicate successfully, HIV must enter a cell in a process called fusion. Fusion inhibitors are drugs that prevent HIV from entering the white blood cells that it targets, called CD4 cells.
Enfuvirtide (Fuzeon) is an FDA-approved fusion inhibitor.
To enter a cell, HIV must first bind to a special receptor on the cell’s surface. One of these receptors is the CCR5 coreceptor.
CCR5 antagonists are drugs that block the CCR5 coreceptor, preventing HIV from attaching to and entering white blood cells. For this reason, doctors refer to CCR5 antagonists as “entry inhibitors.”
Maraviroc (Selzentry) is an FDA-approved CCR5 antagonist.
After entering a white blood cell, HIV can replicate by inserting, or integrating, its DNA into that of the cell. This process relies on an enzyme called integrase.
Integrase inhibitors disable the effects of the enzyme, thereby preventing HIV from inserting its DNA into the host cell. As a result, HIV is unable to make copies of itself.
Examples of integrase inhibitors include:
| Generic name | Brand name |
| dolutegravir | Tivicay |
| raltegravir | Isentress, Isentress HD |
Attachment inhibitors bind to a protein called g120, located on the surface of HIV cells. This prevents HIV from entering CD4 cells.
Fostemsavir (Rukobia) is an FDA-approved attachment inhibitor.
Post-attachment inhibitors are another type of entry inhibitor. These drugs block two kinds of receptor on the surface of white blood cells: the CCR5 and CXCR4 coreceptors.
As with CCR5 antagonists, these drugs prevent HIV from entering the cells, thereby preventing the virus from replicating.
Ibalizumab-uiyk (Trogarzo) is an FDA-approved post-attachment inhibitor.
Pharmacokinetic enhancers are not antiretrovirals, but they may complement antiretroviral therapy.
These drugs can boost the effects of some HIV medications.
Cobicistat (Tybost) is an FDA-approved pharmacokinetic enhancer.
Combination medications contain two or more HIV drugs from one or more drug classes within single pills.
A person with a recent HIV diagnosis usually starts treatment with a combination medication.
There are at least 22 types, and a healthcare provider should recommend a combination medication that best suits a person’s requirements after a careful discussion of the options.
The following are medication-based strategies for preventing HIV:
PEP
Post-exposure prophylaxis (PEP) is an emergency strategy that involves taking HIV medications within 72 hours of possible exposure. It is highly effective at preventing HIV when a person uses it as instructed.
PrEP
Pre-exposure prophylaxis (PrEP) is another HIV prevention method. It involves taking daily medication to reduce the risk of contracting HIV.
There are currently two FDA-approved PrEP agents, both of which are combinations of two HIV drugs in single pills:
HIV medications primarily work by stopping the virus from replicating.
The virus targets the immune system by invading and destroying white blood cells called CD4 cells. These play an important role in fighting infections and keeping the body healthy.
After invading a white blood cell, the virus uses the cell to replicate itself. This allows HIV to multiply within the body. Over time, the immune system loses strength and is less able to fight off infections and disease.
Antiretroviral drugs stop the virus from replicating. This helps protect the immune system and prevent disease.
When a person takes antiretroviral therapy effectively, the virus usually reaches undetectable levels in 3–6 months.
Due to modern advances in antiretroviral therapy, HIV-related complications, such as
Modern antiretroviral therapy has made it possible for people with HIV to have life spans similar to those of people without the infection.
The
Healthcare providers work with people to find an HIV regimen that best meets their needs.
As part of this process, a doctor may recommend drug-resistance testing. This identifies medications that may not be effective in treating a person’s HIV.
A healthcare provider may also take the following into account when recommending an HIV regimen:
- any other medical conditions, such as heart disease
- whether the person is pregnant or planning to be
- possible side effects of HIV medications
- possible drug interactions with other medications and supplements
- any issues that may make it difficult to take HIV medications consistently, such as a busy schedule, a lack of health insurance, or alcohol or drug use
- the cost of the medications
It is important to acknowledge the substantial inequities in healthcare across regions and populations. These can create barriers to accessing HIV medication, and the costs of these drugs can be prohibitively high.
Insurance, federal resources, and non-federal programs can help cover the costs. HIV.gov provide more information.
Like most drugs, antiretroviral drugs can have side effects. Most are mild, but some are serious. Modern drugs tend to cause fewer and less severe side effects than older drugs.
The side effects vary depending on the medication. Also, the same medicine can cause different side effects in different people.
Some side effects of antiretroviral therapy include:
Some side effects of antiretroviral therapy last a few days or weeks, such as nausea or fatigue. Others may not appear for a few months or years, such as high cholesterol.
This treatment can have additional adverse effects, including heart or kidney damage. This is one reason why it is crucial to attend regular checkups.
According to HIV.gov, the benefits of antiretroviral therapy far outweigh the risks posed by side effects. A healthcare provider can offer more information about specific side effects and how to manage them.
Antiretroviral medications significantly reduce levels of HIV in the body. If a person’s treatment is effective, the viral levels become undetectable within 3–6 months.
Having undetectable levels helps a person live a longer, healthier life and means that there is virtually no risk of the virus transmitting to others.
If a person cannot access effective treatment, the virus typically progresses to stage 3, known as AIDS, within 10 years. At this stage, the person’s immune system is badly damaged and they are susceptible to opportunistic infections and certain types of cancer.
It can be difficult to maintain a lifelong treatment plan. Speak with a healthcare provider about any challenges as soon as possible, as they can offer guidance and resources. HIV.gov also provide strategies for keeping up an HIV treatment regimen.