HIV treatment involves antiretroviral therapy (ART), a combination of medicines that helps control the human immunodeficiency virus. These medications reduce the amount of HIV in the blood, support immune system function, and help prevent progression to advanced HIV disease. Treatment selection depends on individual health conditions, previous medication exposure, potential drug interactions.
HIV, or human immunodeficiency virus, attacks CD4 cells, which play an important role in the immune system. Without effective treatment, HIV can weaken immune defenses and progress to acquired immunodeficiency syndrome (AIDS). Although there is currently no widely available cure, modern treatment can suppress the virus and help people with HIV live long, healthy lives. Antiretroviral therapy is recommended for people diagnosed with HIV, and treatment should begin as soon as practical after diagnosis, with appropriate clinical assessment.
Antiretroviral therapy works by targeting different stages of the HIV life cycle. Treatment usually combines multiple antiretroviral medicines to suppress viral replication and reduce the risk of drug resistance. The choice of medication depends on clinical guidelines, individual circumstances, and the results of relevant tests.
Common classes of HIV medications include:
Integrase strand transfer inhibitors (INSTIs): These medicines prevent HIV from inserting its genetic material into human cells. Dolutegravir and bictegravir are examples.
Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs): These medicines interfere with an enzyme HIV uses to copy its genetic material. Tenofovir, emtricitabine, and lamivudine are examples.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs): These medicines block reverse transcriptase through a different mechanism. Doravirine and rilpivirine are examples.
Protease inhibitors (PIs): These medicines interfere with the production of mature, infectious viral particles. Darunavir is one example.
Entry and attachment inhibitors: These medicines interfere with HIV entering susceptible cells. They may be considered in selected treatment situations.
Some medicines are combined into a single tablet to simplify treatment. The appropriate combination is determined by a qualified healthcare professional based on treatment history, resistance testing when indicated, kidney and liver function, other medications, and potential adverse effects.
An HIV treatment regimen generally contains a combination of antiretroviral medicines selected to achieve sustained viral suppression. Many initial regimens use an integrase inhibitor alongside two NRTIs. For eligible individuals, certain two-drug regimens or long-acting injectable treatments may also be appropriate under specific clinical conditions.
Important considerations when selecting or reviewing a regimen include:
Initial treatment: Clinicians commonly consider recommended integrase inhibitor based regimens, while reviewing medical history and baseline laboratory results.
Viral load monitoring: HIV viral load tests measure the amount of virus in the blood and help determine whether treatment is working.
CD4 cell monitoring: CD4 counts provide information about immune system function and may guide preventive care.
Drug resistance: Resistance testing can help clinicians select effective medicines, particularly when treatment failure or previous treatment exposure is a concern.
Drug interactions and side effects: Other medicines, supplements, pregnancy considerations, and existing health conditions can affect treatment decisions.
Adherence and follow up: Taking medicines as prescribed and attending regular appointments helps maintain viral suppression and identify problems early.
Clinical recommendations can differ according to national guidelines and individual circumstances. People receiving HIV treatment should not stop, change, or skip prescribed medicines without consulting their healthcare professional.
Effective antiretroviral treatment can reduce HIV viral load to an undetectable level. People who maintain an undetectable viral load through treatment do not sexually transmit HIV, a principle known as Undetectable Equals Untransmittable (U=U). Regular clinical follow up remains important even when viral load is undetectable.