HIV is transmitted through contact with blood, semen, breast milk, or other bodily fluids that contain the virus. HIV targets the immune system and invades T cells, which are white blood cells that fight infection.

After the virus invades the T cells, it replicates (makes copies of itself). Then the cells burst open. They release many viral cells that go on to invade other cells in the body.

This process destroys the immune system’s ability to fight infections and generally keeps the body from working well.

There’s currently no known cure for HIV. However, medications can help people living with HIV manage the condition and lead healthy lives. These drugs work by stopping HIV from replicating.

Here’s a list of drugs, known as antiretrovirals, that are currently approved by the Food and Drug Administration (FDA) to treat HIV.

There are many different classes of antiretroviral drugs used to treat HIV. The healthcare provider for a person living with HIV will decide on the best medications for that individual case.

This decision will depend on:

  • the person’s viral load
  • their T cell count
  • their strain of HIV
  • the severity of their case
  • how far the HIV has spread
  • other chronic health conditions, also known as comorbidities
  • other medications that they’re taking to avoid interactions between their HIV drugs and their other drugs

HIV is treated with at least two different medications, although those medications can sometimes be combined into one pill. This is because attacking HIV from multiple directions reduces the viral load more quickly, which has been shown to control HIV the best.

Taking more than one antiretroviral drug also helps prevent resistance to the drugs being used. This means a person’s medications may work better to treat HIV.

A person may be prescribed two to four individual antiretroviral drugs, or they may be prescribed a single combination drug in what’s sometimes known as a single-tablet regimen (STR). Combination HIV drugs pack multiple medications into the same pill, tablet, or drug form.

Integrase inhibitors stop the action of integrase. Integrase is a viral enzyme that HIV uses to infect T cells by putting HIV DNA into the human DNA.

Integrase inhibitors are usually among the first HIV drugs used in people who have recently contracted HIV. This is because they work well and have minimal side effects.

The following drugs are integrase inhibitors:

  • bictegravir (not available as a stand-alone drug, but available in the combination drug Biktarvy)
  • dolutegravir (Tivicay)
  • elvitegravir (not available as a stand-alone drug, but available in the combination drugs Genvoya and Stribild)
  • raltegravir (Isentress, Isentress HD)

These drugs belong to a well-established category of integrase inhibitors known as integrase strand transfer inhibitors (INSTIs). Other, more experimental categories of integrase inhibitors include integrase binding inhibitors (INBIs), but there are no FDA-approved INBIs to treat HIV.

NRTIs are sometimes 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 the body.

The following drugs are NRTIs:

As a stand-alone drug, tenofovir alafenamide fumarate has received full FDA approval to treat chronic hepatitis B but only tentative FDA approval to treat HIV. A person with HIV who takes tenofovir alafenamide fumarate will likely receive it as part of a combination HIV drug, not as a stand-alone drug.

Tenofovir disoproxil fumarate, emtricitabine, and lamivudine can treat hepatitis B as well.

Zidovudine was the first FDA-approved HIV drug. It’s also known as azidothymidine or AZT. Zidovudine is rarely used in adults now. It’s mainly given to babies born to HIV-positive mothers as a form of post-exposure prophylaxis (PEP).

Combination NRTIs

The following combination drugs are made up of either two or three NRTIs:

  • abacavir, lamivudine, and zidovudine (Trizivir)
  • abacavir and lamivudine (Epzicom)
  • emtricitabine and tenofovir alafenamide fumarate (Descovy)
  • emtricitabine and tenofovir disoproxil fumarate (Truvada)
  • lamivudine and tenofovir disoproxil fumarate (Cimduo, Temixys)
  • lamivudine and zidovudine (Combivir)

Descovy and Truvada may also be prescribed to some people without HIV as part of a pre-exposure prophylaxis (PrEP) regimen.

Rarely used NRTIs

The following NRTIs are rarely used and will be discontinued by their manufacturers in 2020:

  • didanosine (Videx, Videx EC)
  • stavudine (Zerit)

These drugs work in a similar way to NRTIs. They stop the virus from replicating itself in the body.

The following drugs are NNRTIs, or “non-nukes”:

  • doravirine (Pifeltro)
  • efavirenz (Sustiva)
  • etravirine (Intelence)
  • nevirapine (Viramune, Viramune XR)
  • rilpivirine (Edurant)

Rarely used NNRTIs

The NNRTI delavirdine (Rescriptor) is rarely used and was discontinued by its manufacturer in 2018.

Cytochrome P4503A is an enzyme in the liver that helps several functions in the body, including breaking down or metabolizing medications. Cytochrome P4503A inhibitors, also known as CYP3A inhibitors, increase the levels of certain HIV drugs (as well as other non-HIV drugs) in the body.

The following drugs are CYP3A inhibitors:

  • cobicistat (Tybost)
  • ritonavir (Norvir)

Cobicistat doesn’t have the ability to promote anti-HIV activity when it’s used alone, so it’s always paired with another antiretroviral.

Ritonavir can promote anti-HIV activity when it’s used alone. However, to achieve this, it must be used in much higher doses than people can typically tolerate. It’s prescribed alongside other HIV drugs as a booster drug: It helps to enhance the performance of the other drugs.

PIs work by binding to the enzyme protease. HIV needs protease 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.

Some PIs are only FDA-approved to treat hepatitis C, but these aren’t the same as those used to treat HIV.

The following drugs are PIs used to treat HIV:

  • atazanavir (Reyataz)
  • darunavir (Prezista)
  • fosamprenavir (Lexiva)
  • lopinavir (not available as a stand-alone drug, but available with ritonavir in the combination drug Kaletra)
  • ritonavir (Norvir)
  • tipranavir (Aptivus)

PIs are almost always used with either cobicistat or ritonavir, the CYP3A inhibitors. Ritonavir is both a CYP3A inhibitor and a PI.

Ritonavir is often used to boost other HIV medications.

Lopinavir isn’t available as a stand-alone drug. It’s only available in Kaletra, a combination HIV drug that also includes ritonavir.

Tipranavir is available as a stand-alone drug, but it must be given together with ritonavir.

Even if a PI can be given as a stand-alone drug, it should always be combined with other HIV medications (antiretrovirals) to create a complete regimen, or antiretroviral therapy.

Atazanavir and fosamprenavir are often given together with ritonavir, but in certain situations they don’t have to be. They can be used without a CYP3A inhibitor.

Atazanavir and darunavir can be used alongside cobicistat.

Rarely used PIs

The following HIV PIs are rarely used because they have more side effects:

  • indinavir (Crixivan)
  • nelfinavir (Viracept)
  • saquinavir (Invirase)

Indinavir is often given together with ritonavir, while saquinavir must be given together with ritonavir. Nelfinavir is always given without ritonavir or cobicistat.

Fusion inhibitors are another class of HIV medication.

HIV needs a host T cell to make copies of itself. Fusion inhibitors block the virus from entering a host T cell. This prevents the virus from replicating itself.

Fusion inhibitors are rarely used in the United States because other available drugs are more effective and better tolerated.

Only one fusion inhibitor is currently available:

  • enfuvirtide (Fuzeon)

Because HIV affects the immune system, researchers have been studying ways that biological drugs can prevent viral replication. Certain immune-based treatments have seen some success in clinical trials.

In 2018, the first immune-based therapy received FDA approval to treat HIV:

  • ibalizumab-uiyk (Trogarzo)

It belongs to a class of drugs known as post-attachment inhibitors. It prevents HIV from entering certain immune cells. This medication must be used with other antiretrovirals as part of an optimized background therapy, or optimized background regimen.

Chemokine coreceptor antagonists, or CCR5 antagonists, block HIV from entering cells. CCR5 antagonists are rarely used in the United States because other available drugs are more effective, and this medication requires special testing prior to its use.

Only one CCR5 antagonist is currently available:

  • maraviroc (Selzentry)

Fusion inhibitors, post-attachment inhibitors, and CCR5 antagonists are all a part of a larger class of HIV drugs known as entry inhibitors. All entry inhibitors work by blocking the virus from entering healthy T cells. These drugs are rarely used as first-line treatments for HIV.

The following drugs are entry inhibitors:

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

Combination drugs combine multiple medications into one drug form. This type of regimen is usually used to treat people who’ve never taken HIV medications before.

The following combination drugs only include a PI and a CYPA3A inhibitor:

  • atazanavir and cobicistat (Evotaz)
  • darunavir and cobicistat (Prezcobix)
  • lopinavir and ritonavir (Kaletra)

The CYPA3A inhibitor functions as a booster drug.

The following combination drugs only include NRTIs:

  • abacavir, lamivudine, and zidovudine (Trizivir)
  • abacavir and lamivudine (Epzicom)
  • emtricitabine and tenofovir alafenamide fumarate (Descovy)
  • emtricitabine and tenofovir disoproxil fumarate (Truvada)
  • lamivudine and tenofovir disoproxil fumarate (Cimduo, Temixys)
  • lamivudine and zidovudine (Combivir)

It’s much more common for combination drugs to be made up of medications from different drug classes than from the same drug class. These are known as multiclass combination drugs or single-tablet regimens (STRs).

Multiclass combination drugs or single-tablet regimens (STRs)

The following combination drugs include both NRTIs and NNRTIs:

  • doravirine, lamivudine, and tenofovir disoproxil fumarate (Delstrigo)
  • efavirenz, lamivudine, and tenofovir disoproxil fumarate (Symfi)
  • efavirenz, lamivudine, and tenofovir disoproxil fumarate (Symfi Lo)
  • · efavirenz, emtricitabine, and tenofovir disoproxil fumarate (Atripla)
  • emtricitabine, rilpivirine, and tenofovir alafenamide fumarate (Odefsey)
  • emtricitabine, rilpivirine, and tenofovir disoproxil fumarate (Complera)

Symfi and Symfi Lo are made up of the same generic medications. However, Symfi Lo contains a smaller dose of efavirenz.

The following combination drugs include NRTIs, an INSTI, and the CYP3A inhibitor cobicistat:

  • elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild)
  • elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide fumarate (Genvoya)

The following combination drugs include at least one NRTI and an INSTI:

  • abacavir, dolutegravir, and lamivudine (Triumeq)
  • bictegravir, emtricitabine, and tenofovir alafenamide fumarate (Biktarvy)
  • dolutegravir and lamivudine (Dovato)

The manufacturer of Biktarvy also refers to it as being “built on Descovy,” or as bictegravir plus Descovy.

The following combination drug includes an NNRTI and an INSTI:

  • dolutegravir and rilpivirine (Juluca)

The following combination drug includes NRTIs, a PI, and the CYP3A inhibitor cobicistat:

  • darunavir, cobicistat, emtricitabine, and tenofovir alafenamide fumarate (Symtuza)

Many HIV drugs can cause temporary side effects when first used. In general, these effects can include:

  • diarrhea
  • dizziness
  • headaches
  • fatigue
  • fever
  • nausea
  • rash
  • vomiting

These drugs may cause side effects for the first several weeks. If the side effects get worse or last longer than a few weeks, consider talking to a healthcare provider. They may suggest ways to ease the side effects, or they may prescribe a different drug altogether.

Less often, HIV drugs can cause serious or long-term side effects. These effects depend on the type of HIV drugs used. A healthcare provider can offer more information.

There’s no cure for HIV yet, but prescription medications can help slow the progression of the virus. Drugs can also improve HIV symptoms and make living with the condition more comfortable.

This medication list is a brief overview of the types of drugs that are available to treat HIV. Talk to a healthcare provider about all of these options. They can help you determine your best treatment plan.