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Treatment for HIV

Updated on March 18, 2021
Medically reviewed by
Barry S. Zingman, M.D.
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 take 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 beginning HIV treatment as soon as someone receives an HIV-positive diagnosis.

Left untreated, the chronic, or asymptomatic, stage of HIV lasts between 10 and 15 years for most people. HIV-positive people who do not take treatment have a higher risk of spreading HIV to others. Eventually, levels of HIV rise in the bodies of untreated HIV-positive people, and the condition progresses into its final phase, AIDS. AIDS is invariably fatal if untreated. If caught early enough, even those with AIDS may live long healthy lives from the treatments. Read more about the stages and symptoms of HIV.

Antiretroviral Treatment (ART)

HIV treatment is usually referred to as antiretroviral treatment, or ART. HIV is known as a retrovirus due to the process by which it hijacks the reproductive capacity of cells. Most viruses translate DNA into RNA, which tells the cell which proteins to produce. HIV is called a retrovirus due to its reversal of the process, translating its 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 is not 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 to contribute to medical knowledge about HIV and have a chance to gain access to a new, experimental treatment.

For more details about specific treatments for HIV, visit the Treatments A-Z.

Classes of ART Medications

There are eight 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, 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 ART medications prevent HIV from binding to its target immune cell, the CD4 cell.

The sole drug in the CCR5 antagonist class is Selzentry (maraviroc).

The only medication in the fusion inhibitor class is Fuzeon (enfuvirtide).

Integrase strand transfer inhibitors (INSTIs) include Tivicay (dolutegravir), bictegravir, elvitegravir, and Isentress (raltegravir).

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) include Edurant (rilpivirine), Pifeltro (doravirine), Sustiva (efavirenz), Viramune (nevirapine), and Intelence (etravirine).

Nucleoside reverse transcriptase inhibitors (NRTIs) include Viread (tenofovir disoproxil fumarate), Vemlidy (tenofovir AF), Emtriva (emtricitabine), Epivir (lamivudine) and Ziagen (abacavir).

The only medication in the post-attachment inhibitor class is Trogarzo (ibalizumab-uiyk).

Protease inhibitors (PIs) include Prezista (darunavir), Reyataz (atazanavir), and Lexiva (fosamprenavir).

Another kind of attachment inhibitor is Rukobia (fostemsavir).

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.

Combination ART drugs include:

  • Triumeq (abacavir/dolutegravir/lamivudine)
  • Truvada (emtricitabine/tenofovir disoproxil fumarate)
  • Atripla (efavirenz/emtricitabine/tenofovir disoproxil fumarate)
  • Genvoya (elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide fumarate)
  • Complera (emtricitabine/rilpivirine/tenofovir disoproxil fumarate)
  • Epzicom (abacavir/lamivudine)
  • Symtuza (darunavir/cobicistat/emtricitabine/tenofovir alafenamide)
  • Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide)

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 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, and 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.

Supportive Treatments

People with HIV may have a weakened immune system. Getting regular vaccinations for flu and 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 in women, anal cancer in men and women, and genital warts.

Depression and anxiety are common in HIV, as in all chronic conditions. 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 or 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.

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 food 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 for 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 such low levels that it is undetectable. 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 pre-exposure prophylaxis (PrEP). PrEP 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 one’s partner or child. Women with HIV should work with their doctors to establish a treatment regimen before and during pregnancy. If it is a male partner who is HIV positive, make sure that he is undetectable on ART before trying to get pregnant and throughout the 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.

Condition Guide

Barry S. Zingman, M.D. specializes in HIV/AIDS medicine and general infectious disease. Review provided by VeriMed Healthcare Network. Learn more about him here.
Kelly Crumrin is a senior editor at MyHealthTeams and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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