HIV infection starts when the virus is transmitted through contact with infected body fluids, such as blood, semen, or breast milk. HIV targets the immune system and invades white bloods cells called T helper cells. These are cells that fight infection. By entering your body’s cells, the virus hides from your immune system. After the virus invades these cells, it replicates inside of them. Then the cells explode. They release many viral cells that go on to invade other normal cells. This process destroys your immune system’s ability to fight infections and generally keeps your body from working well.
Currently, there is no known cure for HIV. However, medications can help. They stop HIV from replicating so you can manage your condition and improve your quality of life. Medications do not prevent the spread of HIV to others.
Classes of drugs for HIV
There are many different types of drugs used to treat HIV. Your doctor will figure out the best medications for you. This decision will depend on your viral load and strain as well as the extent and severity of your infection.
Many people with HIV need to take more than one drug. Attacking HIV from multiple directions reduces the viral load more quickly. It also helps prevent resistance to the drugs being used. This means that your medications may work better to treat your HIV.
Multiclass combination drugs
Combination drugs combine medications from different groups into one drug form. You take these medications once per day. Each person’s dosage is different. These drugs include:
- efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla)
- emtricitabine/rilpivirine/tenofovir disoproxil fumarate (Complera)
- elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate (Stribild)
- abacavir/dolutegravir/lamivudine (Triumeq)
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
You may hear these drugs referred to as “nukes.” They work by interrupting the life cycle of HIV as it tries to copy itself. These drugs also have other actions that prevent HIV from replicating in your body. NRTI drugs include:
- abacavir (Ziagen)
- efavirenz/emtriacitabine/tenofovir disoproxil fumarate (Atripla)
- lamivudine/zidovudine (Combivir)
- emtriacitabine/rilpivirine/tenofovir disoproxil fumarate (Complera)
- emtricitabine (Emtriva)
- lamivudine (Epivir)
- abacavir/lamivudine (Epzicom)
- zidovudine (Retrovir)
- abacavir/lamivudine/zidovudine (Trizivir)
- emtricitabine/tenofovire disoproxil fumarate (Truvada)
- didanosine (Videx)
- didanosine extended release (Videx EC)
- tenofovir disoproxil fumarate (Viread)
- stavudine (Zerit)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
These drugs work in the same way as NRTIs. They stop the virus from replicating itself in your body. These drugs include:
- rilpivirine (Edurant)
- etravirine (Intelence)
- delavirdine mesylate (Rescriptor)
- efavirenz (Sustiva)
- nevirapine (Viramune)
- nevirapine extended-release (Viramune XR)
Protease inhibitors work by binding to protease. This is a protein that HIV needs to replicate in the body. When protease can’t do its job, the virus can’t complete the process that makes new copies. This reduces the number of viruses that can infect more cells.
Protease inhibitor drugs include:
- tipranavir (Aptivus)
- indinavir (Crixivan)
- atazanavir/cobicistat (Evotaz)
- saquinavir (Invirase)
- lopinavir/ritonavir (Kaletra)
- fosamprenavir (Lexiva)
- ritonavir (Norvir)
- darunavir/cobicistat (Prezcobix)
- darunavir (Prezista)
- atazanavir (Reyataz)
- nelfinavir (Viracept)
Some protease inhibitors are only approved by the U.S. Food and Drug Administration (FDA) to treat hepatitis C. But there drugs are also sometimes effective in treating HIV. This special use of these drugs I called “off-label use.” Off-label drug use means that a drug has been approved by the FDA for one purpose but it is used for another purpose that the FDA has not approved. A doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care. Doctors who are experienced at treating both HIV and hepatitis may choose to prescribe these drugs for people with HIV. These drugs include:
- Why did you prescribe an off-label use of this drug?
- Are there other approved drugs available that can do the same thing?
- Will my health insurance cover this drug for off-label use?
- Do you know what side effects I could have from this drug?
- simeprevir (Olysio)
- boceprevir (Victrelis)
- ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira Pak)
Entry inhibitors (including fusion inhibitors)
Entry inhibitors are another class of HIV medications. HIV needs a host T cell in order to make copies of itself. These drugs block the virus from entering a host T cell. This prevents the virus from replicating itself. These drugs also prevent the destruction of targeted cells. This action helps your immune system work better.
An example of an entry inhibitor includes:
- enfuvirtide (Fuzeon), which comes in an injectable form
Integrase inhibitors are a class of drugs that stop the action of integrase. This is a viral enzyme that HIV uses to infect CD4+ T cells. These drugs include:
Chemokine co-receptor antagonists (CCR5 antagonists)
CCR5 antagonists prevent the spread of HIV. These drugs block infection in one of two molecules found on the surface of each body cell. Because it only affects one molecule, this drug is usually used with other medications for full HIV treatment. An example of this type of drug includes:
- maraviroc (Selzentry)
Cytochrome P4503A (CYP3A) inhibitors
CYP3A is an enzyme that protects liver and gastrointestinal (GI) health. HIV can destroy this enzyme, leading to problems with your liver and GI tract. CYP3A inhibitors protect these enzymes to keep you healthy. These drugs affect your liver and come with the risk of jaundice. This may cause yellowing of your skin and the whites of your eyes. An example of this type of drug includes:
- cobicistat (Tybost)
Because HIV affects your immune system, researchers are studying ways that drugs can help boost immunity. Certain immune-based treatments have been successful in some people. Like some protease inhibitors, these drugs are used off-label for HIV. They are used along with other HIV medications. An example of an immune-based therapy includes:
- hydroxychloroquine sulfate (Plaquenil), which is a drug approved to treat autoimmune diseases such as lupus and rheumatoid arthritis
Many HIV drugs can cause temporary side effects at first. These effects include:
- muscle aches
According to AIDSInfo, you may have side effects for several weeks after starting a new medication. If these side effects get worse or last longer than a few weeks, talk to your doctor. Your doctor may suggest ways to ease your side effects or they may prescribe you another drug.
Average monthly costs
Talk to your doctor
There’s no cure for HIV yet, but prescription medications can help slow the progression of the virus. Drugs can also improve your symptoms and make living with HIV more comfortable. This medications list is a brief overview of the types of drugs that are available to treat HIV. Talk to your doctor about all of these options. With your help, your doctor can determine the best medications for you.
You asked, we answered
- Can HIV medications keep you from getting acquired immunodeficiency syndrome (AIDS)?
HIV medications can help slow or even stop the development of AIDS. But you must take the drugs for the rest of your life. Your doctor may change your medications if your HIV develops resistance and your viral load starts to increase. This could mean that your HIV infection is getting worse, which can lead to AIDS.- Healthline Medical Team