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Treatment for HIV

Medically reviewed by Elizabeth Cueto, M.D.
Updated on March 8, 2024

For people who have access to HIV medication and take it every day, as directed, HIV usually becomes a treatable long-term illness. Most people with HIV who consistently follow their HIV treatment regimen can expect to live a long, healthy life with a similar life expectancy as those who are HIV-negative. Adhering to the recommended treatment regimen also lowers the risk of infecting others. For these reasons, most doctors recommend that people begin HIV treatment as soon as they receive an HIV-positive diagnosis.

If an HIV infection is left untreated at the early stage, the chronic (or asymptomatic) stage that follows can last more than 10 years for many people. People who are HIV-positive and don’t take any treatment have a higher risk of spreading HIV to others.

Eventually, levels of HIV rise in untreated HIV-positive people, and the condition progresses into its final phase, AIDS. If left untreated, AIDS is fatal. If the disease is caught early enough, however, people with AIDS may recover and live long, healthy lives if they start and remain on treatment.

Antiretroviral Treatment

HIV treatment is usually referred to as antiretroviral treatment (ART), also known as antiretroviral therapy. The human immunodeficiency virus is known as a retrovirus because the virus tricks the cells into making copies of the virus instead of the cell itself. Most viruses translate DNA into RNA, which tells the cell which proteins to produce. As a retrovirus, HIV reverses the process by reverse-transcribing its own RNA into DNA and inserting it into the nucleus of the cell, which then produces more HIV particles. ART drugs work by interrupting the steps HIV takes to multiply inside the body.

When recommending an ART regimen, your doctor will consider your overall health and any other health conditions or medications you take. There are guidelines for which regimens are best to try first and which should be used later if the initial therapy isn’t effective. Generally, the safest regimens with the least risk for serious side effects are recommended before trying those with worse potential side effects.

Some people with HIV participate in clinical trials, which are research studies to determine the effectiveness of new therapies. Participating in these trials allows you to contribute to medical knowledge about HIV and gives you a chance to try a new, experimental treatment.

Classes of ART Medications

There are several drug classes of antiretroviral drugs, comprising more than 30 drugs. Most treatment regimens involve two drugs from one ART class and one drug from another class. Sometimes, treating someone with two different medicines at the same time can be effective.

Others may need four drugs. Combination regimens help prevent the virus from mutating (changing) to become resistant to drugs. Strains of HIV that don’t respond to the usual treatments are much harder to treat.

Taking medication as directed by your health care provider consistently without missing doses is the most important way to prevent HIV from developing drug resistance.

Most ART drugs used to treat HIV attack the virus in different ways to stop it from making copies of itself inside the body. Some prevent HIV from binding to its target immune cell, the CD4 cell. Classes of ART medications, and some drugs that fall within those categories, include the following:

  • The only drug in the CCR5 antagonist class is maraviroc (sold as Selzentry).
  • The only medication in the fusion inhibitor class is enfuvirtide (Fuzeon).
  • Integrase strand transfer inhibitors include dolutegravir (Tivicay), bictegravir, elvitegravir, cabotegravir (Apretude and Vocabria), and raltegravir (Isentress).
  • Non-nucleoside reverse transcriptase inhibitors include rilpivirine (Edurant), doravirine (Pifeltro), efavirenz (Sustiva), nevirapine (Viramune), and etravirine (Intelence).
  • Nucleoside reverse transcriptase inhibitors include tenofovir disoproxil fumarate (Viread), tenofovir alafenamide (Vemlidy), emtricitabine (Emtriva), lamivudine (Epivir), zidovudine (Retrovir), and abacavir (Ziagen).
  • The only drug in the attachment inhibitor class is fostemsavir (Rukobia).
  • The only medication in the post-attachment inhibitor class is ibalizumab-uiyk (Trogarzo).
  • Protease inhibitors include darunavir (Prezista), atazanavir (Reyataz), tipranavir (Aptivus), and fosamprenavir (Lexiva).

Combination ART Drugs

Newer HIV drugs combine two, three, or four antiretroviral medications from different classes into one pill (or injection). Combination drugs are often easier to remember to take than multiple pills.

Here are a few of the many combination ART drugs:

  • Abacavir/dolutegravir/lamivudine (Triumeq)
  • Emtricitabine/tenofovir disoproxil fumarate (Truvada)
  • Efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla)
  • Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate (Genvoya)
  • Emtricitabine/rilpivirine/tenofovir disoproxil fumarate (Complera)
  • Abacavir/lamivudine (Epzicom)
  • Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (Symtuza)
  • Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy)

Injectable ART Drugs

Several newer injectable ART treatments are available as well. Because people don’t have to take these treatments every day, it’s easier to keep up with their HIV treatment.

Ibalizumab, approved in 2019, is a lab-made monoclonal antibody used to treat HIV-1 infection, particularly in people who have limited treatment options due to resistance to other antiretrovirals. It works by stopping the virus from getting into CD4-positive T cells, which are a type of immune cell. It does this by sticking to the CD4 receptor on the cell, which blocks the virus from entering.

Cabotegravir/rilpivirine (Cabenuva) — approved in 2021 — is the first, and currently only, injectable combination ART drug. It is given once a month or once every two months as an injection instead of a daily pill.

Finally, lenacapavir (Sunlenca), first approved by the FDA in 2022, falls into a class called HIV-1 capsid inhibitors. The drug, available as a pill or an injection under the skin, stops HIV from multiplying by attacking its protective shell at various points in its life cycle.

Side Effects of ART Medications

Any medication can cause side effects. Each ART regimen has specific potential possible side effects, but most people don’t have side effects from newer ART combinations. However, women tend to experience more side effects from ART regimens compared to men. Some side effects are more common and some are extremely rare. Your doctor will develop a treatment plan and can help you assess the risks and benefits of each ART regimen as it relates to your medical history and condition.

If you experience side effects of ART severe enough to make you reluctant to keep taking the medication, talk to your doctor about switching ART medications. Switching to a regimen you can tolerate more easily is better than taking ART inconsistently or stopping treatment.

The more common side effects of certain ART drugs include tiredness, headache, dizziness, nausea, and difficulty sleeping. In many people, these side effects fade over the first few days or weeks as the body becomes used to the medication.

Some side effects might develop gradually after taking certain ART medications for many months or years. Long-term side effects of some ART drugs can include:

  • Weight gain
  • Kidney damage
  • Diabetes
  • Osteoporosis
  • Higher levels of fat in the blood
  • Psychological issues such as depression or suicidal thoughts or behavior

Some people notice that their body begins to store more fat in the abdomen as a side effect of ART medications. Most of these long-term side effects were much more common in the past, with earlier generations of ART. They are much less common now.

Injectable medications can also sometimes cause injection-site reactions, such as pain, bumps, swelling, and discoloration.

Lifestyle Changes for Better Health

People with HIV may have a weakened immune system. Along with taking HIV medicines, there are other steps to stay healthy.

Supportive Treatments

Getting regular vaccinations for flu, pneumonia, COVID-19, and tetanus-diphtheria can help prevent contracting common infectious diseases. People with HIV under age 26 (and some up to age 45) can talk to their doctor about getting an HPV vaccine to prevent human papillomavirus, which causes cervical cancer, anal cancer, oropharyngeal cancer, and genital warts.

As with many chronic (long-term) conditions, HIV can affect your mental health, leading to depression or anxiety. Some people take antidepressants to improve their mood and outlook. Almost all antidepressants are safe to take with ART medications and other drugs you take.

Some people with HIV report that they feel better when they use complementary and alternative treatments, such as nutritional or herbal supplements, probiotics, massage, or acupuncture. Most natural or alternative treatments haven’t been studied in rigorous clinical trials to establish their safety and effectiveness. Because some natural or complementary treatments can interfere with HIV medications or cause their own side effects, talk to your doctor before trying any alternative treatments.

Some health experts also recommend tools such as cognitive behavioral therapy or biofeedback to help process the challenging feelings that may come with an HIV diagnosis.

Diet and Nutrition

Like everyone else, people with HIV feel their best when they consistently eat a healthy, balanced diet. Most physicians who specialize in HIV recommend the same low-fat, high-fiber diet recommended by the American Cancer Society and American Heart Association. Eating well can help people with HIV strengthen their immune system, repair any damage HIV has inflicted, fight infections, and better absorb ART medications.

If you’re living with HIV, take extra care with food safety when preparing meals and avoid any food that might be contaminated. Food poisoning can affect people with HIV more intensely than those who are HIV-negative, and the effects can last longer.

Exercise

If you’re living with HIV, exercise can help you stay healthy and feel your best. Regular physical activity can increase strength and promote healthy weight, prevent heart disease, and reduce the risk of developing possible long-term side effects of ART, such as osteoporosis and diabetes. Getting regular exercise can also reduce stress and improve mood.

Regular exercise does not necessarily mean going to the gym or playing sports. Nearly any physical activity that increases your heart rate and makes you breathe more deeply can provide significant benefits to those with HIV.

Choose a type of physical activity that you enjoy and can regularly do. Activities such as gardening, swimming, cycling, and walking a pet can help you stay active and healthy. Incorporate social aspects by taking a dance class or walking with a friend. Be creative.

Protecting Others From HIV

After being on treatment for several months, many HIV-positive people can bring their viral load (the measure of HIV in their blood) down to undetectable levels that can’t be measured in blood tests, according to the Centers for Disease Control and Prevention (CDC). People with an undetectable viral load for at least six months straight don’t spread HIV to others as long as they continue consistently taking treatment.

Partners who are HIV-negative can take a treatment regimen known as preexposure prophylaxis (PrEP). PrEP is an HIV-prevention medication that reduces the risk of contracting HIV via sex with an infected partner by more than 90 percent. PrEP reduces the risk of contracting HIV from sharing needles with an infected person by more than 70 percent.

Using a new synthetic (latex or polyurethane) condom every time you have vaginal or anal sex is extremely effective for preventing HIV transmission. To be effective, the condom must be put on correctly before penetration begins. Note that “natural” condoms, such as those made from the intestinal membranes of lambs, do not prevent the transmission of HIV.

Taking ART can make it possible to have a healthy pregnancy without the risk of passing HIV to your partner or child. If you are HIV-positive and are pregnant or planning to conceive, work with your doctors to establish a treatment regimen before and during pregnancy. If you’re HIV-positive and your partner wishes to conceive, make sure you’re undetectable on ART first — and work to remain so throughout your partner’s pregnancy.

Is There a Cure for HIV?

Despite encouraging research toward finding a cure for HIV, there is no cure for HIV. The good news is that while HIV is not currently curable, it’s treatable. With the help of ART, the virus can be lowered to almost undetectable amounts in the body, so there’s less chance of passing it to others. Today’s medical treatments have turned HIV from a once-deadly diagnosis into a manageable long-term condition, letting people lead full and healthy lives.

Find Your Team

On myHIVteam, the social network for people with HIV and their loved ones, more than 40,000 members come together to ask questions, give advice, and share their stories with others who understand life with HIV.

What treatments have you tried for HIV? Which have been most effective for you? Share your tips and experiences in a comment below or on your Activities page.

References
  1. HIV Treatment: The Basics — HIVinfo.NIH.gov
  2. The Stages of HIV Infection — HIVinfo.NIH.gov
  3. Antiretroviral Therapy (ART) — ClinicalInfo.HIV.gov
  4. Retrovirus — National Human Genome Research Institute
  5. HIV and AIDS Clinical Trials — HIVinfo.NIH.gov
  6. What To Start: Choosing an HIV Treatment Regimen — HIVinfo.NIH.gov
  7. HIV Medicines and Side Effects — HIVinfo.NIH.gov
  8. Ibalizumab (Trogarzo) — Aidsmap
  9. FDA Approves First Extended-Release, Injectable Drug Regimen for Adults Living With HIV — U.S. Food and Drug Administration
  10. Cabenuva FDA Approval History — Drugs.com
  11. U.S. FDA Approves Gilead’s Long-Acting HIV Drug Sunlenca — Reuters
  12. Sunlenca — European Medicines Agency
  13. HIV Treatment — Centers for Disease Control and Prevention
  14. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV — ClinicalInfo.HIV.gov
  15. Vaccinations for Adults With HIV Infection — Immunize.org
  16. HIV and AIDS and Mental Health — National Institute of Mental Health
  17. A Review of the Use of Complementary and Alternative Medicine: Issues for Patient Care — AIDS Patient Care and STDs
  18. HIV and Nutrition and Food Safety — HIVinfo.NIH.gov
  19. Why Is a Good Diet Important for People With HIV? — HIV.gov
  20. Exercise and Physical Activity — HIV.gov
  21. HIV Treatment as Prevention — Centers for Disease Control and Prevention
  22. PrEP (Pre-Exposure Prophylaxis) — Centers for Disease Control and Prevention
  23. Protecting Others — Centers for Disease Control and Prevention
  24. HIV Medicines During Pregnancy and Childbirth — HIVinfo.NIH.gov
  25. HIV Drug Resistance — World Health Organization
  26. HIV and Women — Wolters Kluwer UpToDate

Updated on March 8, 2024
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Elizabeth Cueto, M.D. graduated from the National Polytechnic Institute in Mexico City. Learn more about her here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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