Treatment for HIV has come a long way.
The first drugs to treat HIV were approved in the 1980s. They were sometimes successful in delaying the onset of AIDS, but side effects were serious and intolerable for many people.
The introduction of the first antiretrovirals in the 1990s changed the HIV treatment landscape.
Since then, the Food and Drug Administration (FDA) has approved more than 30 HIV medications. Antiretroviral therapy, or ART, has changed the way we think about and live with HIV. What was once an almost certain fatal virus has become one that may be chronic but is generally manageable.
With so many options, there’s a lot to consider when deciding on your HIV medication regimen.
ART drugs stop HIV from replicating, which reduces the amount of virus in your body. The medications target specific enzymes the virus needs to reproduce. The goal is to reduce the amount of virus in your blood. This is known as the viral load.
Within 6 months of starting treatment, it’s possible to get your viral load down to an undetectable level. This is not a cure, but maintaining an undetectable viral load helps you live a healthier, longer life. An undetectable viral load also means there’s no risk of transmitting HIV through sexual contact.
Treatment typically involves two or three drugs from at least two different classes. This combination of medications is called an HIV treatment regimen. It’s important that these medications are taken every day, exactly as prescribed.
Nucleoside reverse transcriptase inhibitors (NRTIs)
NRTIs block an enzyme called reverse transcriptase to prevent HIV from duplicating itself. NRTIs include:
- abacavir (Ziagen)
- emtricitabine (Emtriva)
- lamivudine (Epivir)
- tenofovir disoproxil fumarate (Viread)
- zidovudine (Retrovir)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
NNRTIs bind to and later change reverse transcriptase to stop HIV from replicating. These medications include:
- doravirine (Pifeltro)
- efavirenz (Sustiva)
- etravirine (Intelence)
- nevirapine (Viramune)
- rilpivirine (Edurant)
Protease inhibitors (PIs)
PIs block protease and prevent immature HIV from becoming a mature virus. These drugs include:
- atazanavir (Reyataz)
- darunavir (Prezista)
- fosamprenavir (Lexiva)
- ritonavir (Norvir)
- saquinavir (Invirase)
- tipranavir (Aptivus)
Integrase strand transfer inhibitors (INSTIs)
INSTIs block integrase, an enzyme it needs for reproduction.This group of medications includes:
- cabotegravir (Vocabria)
- dolutegravir (Tivicay)
- raltegravir (Isentress)
Entry inhibitors stop the virus from entering human cells. These medications include:
- fusion inhibitor: enfuvirtide (Fuzeon)
- CCR5 antagonist: maraviroc (Selzentry)
- attachment inhibitor: fostemsavir (Rukobia)
- post-attachment inhibitor: ibalizumab-uiyk (Trogarzo)
Pharmacokinetic enhancers are drugs that slow the breakdown of other drugs. This process helps medications stay in your body longer so they’re more effective. Some HIV treatment regimens may include:
- cobicistat (Tybost)
- ritonavir (Norvir)
Choosing an HIV treatment regimen can feel like an overwhelming task. But the
The high number of HIV medications available today means treatment can be tailored to your individual needs. The goal is to provide a regimen that’s potent, safe, and easy to follow, so you can achieve and maintain control of the viral load.
- Other health conditions. Certain drugs may be safer than others if you have coexisting health conditions, such as heart disease, for example. If you’re pregnant or plan to become pregnant, your regimen may need to be adjusted.
- Resistance testing. There are many strains of HIV. A blood test can identify the specific strain, which will help determine which drugs won’t be effective.
- Drug interactions. Tell your doctor about all the medications you take. Certain drugs can interact with HIV medications.
- Potential side effects. Side effects are different for everyone. You can think about which ones are most likely to interfere with your lifestyle.
- Convenience. Some drug combinations are available in a single pill, while some regimens call for multiple pills every day.
- Cost. Your doctor can help review the costs of each drug, health insurance, and prescription assistance programs.
- daily dosing frequency and number of pills
- drug interactions
- side effects, such as nausea and diarrhea
- long-term effects, such as fat redistribution and effects on the liver, kidneys, and heart
- neurological and psychological effects
- insurance restrictions and out-of-pocket costs
The same study found that involvement in treatment decisions, along with open communication and a good doctor-patient relationship, is important to people living with HIV.
Adherence to a treatment regimen is a vital factor in maintaining your health. That’s why it’s important to communicate any concerns with your healthcare team. Think about the role you want to play in HIV treatment decisions, and make that clear.
If you don’t have a good relationship with your doctor, you may want to consider working with someone new.
Deciding on your initial HIV treatment regimen is the first step. After that, it’s important to be aware of side effects and potential changes to your health.
If you’re having difficulty following your treatment regimen, it’s important to speak with your doctor before you start missing doses.
Open communication with your doctor will help keep you on track and healthy.