An HIV diagnosis is no longer the death sentence it once was. Thirty years ago, doctors had little more than comforting words to offer people who had been diagnosed with the virus.

But today, while there remains no cure for HIV or AIDS, remarkable advancements in treatments and clinical understanding of how the virus progresses are allowing people with HIV to live longer, fuller lives. Let’s look at where HIV treatment is today, the effects new therapies are having, and where treatment may be headed in the future.

The main treatment for HIV today is antiretroviral drugs. These drugs don’t cure HIV. Instead, they suppress the virus and slow its progression in the body. They don’t eliminate the virus from the body, but in many cases, they can suppress it to undetectable levels.

If an antiretroviral medication is successful, it can add many healthy, productive years to a person’s life and reduce the risk of transmission to others.

The most commonly prescribed antiretroviral medications approved by the U.S. Food and Drug Administration (FDA) can be divided into four classes. They are:

  • reverse transcriptase inhibitors
  • protease inhibitors
  • entry or fusion inhibitors
  • integrase inhibitors

Reverse transcriptase (RT) inhibitors

RT inhibitors interrupt the life cycle of an HIV-infected cell as it tries to replicate itself. There are two types of RT inhibitor: NNRTIs and NRTIs.

NNRTIs

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) prevent HIV from making copies of itself. Commonly used NNRTIs include:

  • efavirenz (Sustiva)
  • rilpivirine (Endurant)
  • etravirine (Intelence)

NRTIs

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) keep HIV-infected cells from making copies of themselves by interrupting the reconstruction of the virus’s DNA chain. The most commonly used NRTIs include:

The most commonly used combination NRTIs include:

  • emtricitabine/tenofovir disoproxil fumarate (Truvada)
  • emtricitabine/tenofovir alafenamide (Descovy)
  • abacavir/lamivudine (Epizicom)

Protease inhibitors (PIs)

Protease inhibitors (PIs) disable protease, a protein that HIV needs to make copies of itself. PIs include:

  • atazanavir (Reyataz)
  • darunavir (Prezista)
  • lopinavir (Kaletra, in combination with ritonavir)
  • ritonavir (Norvir)
  • saquinavir (Invirase, Fortovase)
  • indinavir (Crixivan)
  • nelfinavir (Viracept)
  • fosamprenavir (Lexiva, Telzir)
  • tipranavir (Aptivus)

Entry or fusion inhibitors

Entry or fusion inhibitors block HIV from entering CD4 T cells. These inhibitors include:

  • maraviroc (Selzentry)
  • enfuvirtide (Fuzeon)
  • ibalizumab (Trogarzo)

Integrase inhibitors (INSTIs)

Integrase inhibitors disable integrase, a protein that HIV uses to infect CD4 T cells. INSTIs include:

  • bictegravir (combined with tenofovir alafenamide and emtricitabine in the brand-name drug Biktarvy)
  • dolutegravir (Tivicay)
  • elvitegravir (combined with cobicistat, tenofovir disoproxil fumarate, and emtricitabine in the brand-name drug Stribild, or with tenofovir alafenamide and emtricitabine in the brand-name drug Genvoya)
  • raltegravir (Isentress) and raltegravir HD (Isentress HD)

HIV can mutate and become resistant to a single medication. Therefore, most doctors today prescribe several HIV medications together. A combination of three or more antiretroviral drugs is called highly active antiretroviral therapy (HAART). HAART is the typical initial treatment prescribed today for people with HIV.

HAART is a powerful therapy. When it was first introduced in the late 1990s, AIDS-related deaths in the United States were cut by almost half within three years.

The most common HAART treatments today consist of two NRTIs and either an INSTI, an NNRTI, or a boosted protease inhibitor.

Advances in medications are also making adherence to HAART much easier. These advances have reduced the number of pills a person must take, and reduced the side effects for many people using HAART.

Adherence is key

  • Adherence means sticking with a treatment plan. Adherence is critical for HIV treatment. If a person with HIV doesn’t take their medications as prescribed, the drugs could stop working for them and the virus could start spreading in their body again.

One key advancement that’s making adherence easier for people on HAART is the development of combination pills. These medications are now the most commonly prescribed drugs for people with HIV who haven’t been treated before.

Combination pills contain multiple drugs within one pill. Currently, there are seven combinations containing three or more antiretroviral drugs.

Atripla, which was approved in 2006, was the first effective combination tablet. However, it’s used less often now due to its side effects such as sleep disturbances and mood changes.

INSTI-based combination tablets are the regimens recommended now for most people with HIV. This is because they’re effective and cause fewer side effects than other regimens.

Current combination medications include:

Triumeq:

  • 50 mg dolutegravir
  • 600 mg abacavir
  • 300 mg lamivudine

Biktarvy:

  • 50 mg bictegravir
  • 25 mg tenofovir alafenamide fumarate
  • 200 mg emtricitabine

Genvoya:

  • 150 mg elvitegravir
  • 150 mg cobicistat
  • 10 mg tenofovir alafenamide fumarate
  • 200 mg emtricitabine

Stribild:

  • 150 mg elvitegravir
  • 150 mg cobicistat
  • 200 mg emtricitabine
  • 300 mg tenofovir disoproxil fumarate

Atripla:

  • 600 mg efavirenz
  • 300 mg tenofovir disoproxil fumarate
  • 200 mg emtricitabine

Complera:

  • 25 mg rilpivirine
  • 300 mg tenofovir disoproxil fumarate
  • 200 mg emtricitabine

Odefsey:

  • 25 mg rilpivirine
  • 25 mg tenofovir alafenamide fumarate
  • 200 mg emtricitabine

Symfi:

  • 600 mg efavirenz
  • 300 mg lamivudine
  • 300 mg tenofovir disoproxil fumarate

Symfi Lo:

  • 400 mg efavirenz
  • 300 mg lamivudine

300 mg tenofovir disoproxil fumarate

Though these combination pills are a promising advancement, they may not be a good fit for every person with HIV. These options should be discussed with a healthcare provider.

Each year, new therapies are gaining more ground in treating and possibly curing HIV and AIDS. For instance, nanosuspensions of antiretrovirals, which would be taken every 4 to 8 weeks, are being investigated for both HIV treatment and prevention. These medications could improve adherence and reduce the number of pills people need to take.

Also, a weekly injection for people who have become resistant to HIV treatment is in clinical trials. And there’s ongoing work on a potential HIV vaccine.

To find out more about HIV medications that are currently available and those that may come in the future, talk to a healthcare provider or pharmacist. Clinical trials, which are used to test drugs in development, may also be of interest. Search here for a local clinical trial that may be a good fit.