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Treatment for HIV

Updated on October 17, 2022
Medically reviewed by
Manuel Penton, M.D.
Article written by
Emily Wagner, M.S.
Article written by
Kelly Crumrin

For people who have access to HIV treatment and take it every day, as directed, HIV usually becomes a treatable chronic illness. Most HIV-positive people 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 all of 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 10 or more years for many people. People who are HIV-positive and who 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. AIDS is invariably fatal if untreated. 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. HIV is known as a retrovirus due to the process by which it hijacks the way cells reproduce. Most viruses translate DNA into RNA, which tells the cell which proteins to produce. As a retrovirus, HIV reverses the process, translating a cell’s RNA into DNA and inserting it into the nucleus of the cell, which then reproduces more HIV. ART drugs disrupt one or more aspects of HIV’s replication process.

When recommending an ART regimen, your doctor will take into account your overall health and any other health conditions you have or medications you take. There are guidelines in place 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 eight drug classes of ART medications, comprising more than 30 drugs. Most treatment regimens involve two drugs from one ART class and one drug from another class. In some cases, people may be well treated with a two-drug combination; others may need four drugs. Combination regimens help prevent the virus from mutating to become drug-resistant. Drug-resistant strains of HIV are much harder to treat.

Taking medication as directed by your health care provider every single day is another important way to prevent HIV from developing drug resistance.

Most ART drugs work in different ways to prevent HIV from replicating in cells. 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 sole 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 (INSTIs, for short) include dolutegravir (Tivicay), bictegravir, elvitegravir (Vitekta), cabotegravir (Apretude and Vocabria), and raltegravir (Isentress).

  • Nucleoside reverse transcriptase inhibitors (NRTIs) 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).

Combination ART Drugs

Newer HIV drugs combine two, three, or four antiretroviral medications from different classes into one pill. 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)

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

Side Effects of ART Medications

Any medication can cause side effects. Each ART regimen has specific potential side effects associated with it, but most people do not have side effects from newer ART combinations. Some side effects are more common, while 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 medication 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.

Lifestyle Changes for Better Health

People with HIV may have a weakened immune system. Along with taking HIV medicines, HIV-positive people can take other steps to stay healthy.

Supportive Treatments

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

As with many chronic 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 have not been studied in rigorous clinical trials to establish their safety and effectiveness. Since some natural or complementary treatments can interfere with HIV medications or cause their own side effects, it is important to 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.

People with HIV should 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

Exercise can help HIV-positive people stay healthy and feel their best. Regular physical activity can increase strength and promote a healthy weight, stave off 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.

It is important to choose a type of physical activity you will 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 going for walks 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 virus in their blood) down to undetectable levels that cannot be measured in blood tests. It has been convincingly shown that people with an undetectable viral load (UVL) for at least six months straight do not 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 for contracting HIV via sex with an infected partner by more than 90 percent. PrEP reduces the risk for 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 get pregnant, work with your doctors to establish a treatment regimen before and during pregnancy. If you’re HIV-positive and trying to get your partner pregnant, 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 at present no cure for HIV. The good news is that while HIV is not currently curable, it is treatable.

Find Your Team

On myHIVteam, the social network for people with HIV and their loved ones, more than 35,000 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.

All updates must be accompanied by text or a picture.
Manuel Penton, M.D. is a medical editor at MyHealthTeam. Learn more about him 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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