Currently, there's no cure for HIV/AIDS. Once you have the infection, your body can't get rid of it. However, there are many medications that can control HIV and prevent complications. These medications are called antiretroviral therapy (ART). Everyone diagnosed with HIV should be started on ART, regardless of their stage of infection or complications.
ART is usually a combination of three or more medications from several different drug classes. This approach has the best chance of lowering the amount of HIV in the blood. There are many ART options that combine three HIV medications into one pill, taken once daily.
Each class of drugs blocks the virus in different ways. Treatment involves combinations of drugs from different classes to:
- Account for individual drug resistance (viral genotype)
- Avoid creating new drug-resistant strains of HIV
- Maximize suppression of virus in the blood
Two drugs from one class, plus a third drug from a second class, are typically used.
The classes of anti-HIV drugs include:
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) turn off a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), rilpivirine (Edurant) and doravirine (Pifeltro).
- Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are faulty versions of the building blocks that HIV needs to make copies of itself. Examples include abacavir (Ziagen), tenofovir (Viread), emtricitabine (Emtriva), lamivudine (Epivir) and zidovudine (Retrovir). Combination drugs also are available, such as emtricitabine/tenofovir (Truvada) and emtricitabine/tenofovir alafenamide (Descovy).
- Protease inhibitors (PIs) inactivate HIV protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista) and lopinavir/ritonavir (Kaletra).
- Integrase inhibitors work by disabling a protein called integrase, which HIV uses to insert its genetic material into CD4 T cells. Examples include bictegravir sodium/emtricitabine/tenofovir alafenamide fumar (Biktarvy), raltegravir (Isentress) and dolutegravir (Tivicay).
- Entry or fusion inhibitors block HIV's entry into CD4 T cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
Starting and maintaining treatment
Everyone with HIV infection, regardless of the CD4 T cell count or symptoms, should be offered antiviral medication.
Remaining on effective ART with an undetectable HIV viral load in the blood is the best way for you to stay healthy.
For ART to be effective, it's important that you take the medications as prescribed, without missing or skipping any doses. Staying on ART with an undetectable viral load helps:
- Keep your immune system strong
- Reduce your chances of getting an infection
- Reduce your chances of developing treatment-resistant HIV
- Reduce your chances of transmitting HIV to other people
Staying on HIV therapy can be challenging. It's important to talk to your doctor about possible side effects, difficulty taking medications, and any mental health or substance use issues that may make it difficult for you to maintain ART.
Having regular follow-up appointments with your doctor to monitor your health and response to treatment is also important. Let your doctor know right away if you're having problems with HIV therapy so that you can work together to find ways to address those challenges.
Treatment side effects
Treatment side effects can include:
- Nausea, vomiting or diarrhea
- Heart disease
- Kidney and liver damage
- Weakened bones or bone loss
- Abnormal cholesterol levels
- Higher blood sugar
- Cognitive and emotional problems, as well as sleep problems
Treatment for age-related diseases
Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related heart, bone or metabolic conditions, for example, may not interact well with anti-HIV medications. It's important to talk to your doctor about your other health conditions and the medications you're taking.
If you are started on medications by another doctor, it's important to let him or her know about your HIV therapy. This will allow the doctor to make sure there are no interactions between the medications.
Your doctor will monitor your viral load and CD4 T cell counts to determine your response to HIV treatment. These will be initially checked at two and four weeks, and then every three to six months.
Treatment should lower your viral load so that it's undetectable in the blood. That doesn't mean your HIV is gone. Even if it can't be found in the blood, HIV is still present in other places in your body, such as in lymph nodes and internal organs.