Antiretroviral therapy (ART) is the standard treatment for human immunodeficiency virus (HIV). It uses a combination of medicines to reduce the amount of HIV in the body, protect immune system function, and help people with HIV live longer, healthier lives. ART works by targeting different stages of the virus's life cycle.
HIV attacks CD4 cells, also known as helper T cells, which play an important role in the immune system. Without effective treatment, the virus can damage these cells over time, weakening the body's ability to fight infections and certain diseases.
Antiretroviral therapy works by interfering with the virus's ability to reproduce. Healthcare professionals generally prescribe a combination of medicines that target different stages of the HIV life cycle. This approach helps control viral replication and reduces the risk of drug resistance.
The primary goal of ART is to achieve and maintain viral suppression. When treatment works effectively, the amount of HIV in the blood can fall to an undetectable level on standard viral load tests. People who maintain an undetectable viral load through treatment do not sexually transmit HIV. This is commonly described as Undetectable Equals Untransmittable, or U=U.
Common principles of ART include:
Combination treatment: Several antiretroviral medicines are often combined to control HIV effectively.
Viral load monitoring: Blood tests measure the amount of HIV in the bloodstream and help assess treatment effectiveness.
Immune system protection: Successful treatment allows CD4 cell counts to recover or remain more stable.
Long term management: ART controls HIV but does not eliminate the virus completely, so ongoing treatment is necessary.
Antiretroviral medicines belong to different classes according to how they interfere with HIV replication. The choice of treatment depends on individual health needs, previous treatment history, potential drug interactions, resistance testing when appropriate, and other clinical factors.
Several medicine classes are used in HIV treatment.
Nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs): These medicines interfere with reverse transcriptase, an enzyme HIV uses to convert its genetic material into DNA.
Non nucleoside reverse transcriptase inhibitors (NNRTIs): These medicines block reverse transcriptase through a different mechanism, preventing effective viral replication.
Integrase strand transfer inhibitors (INSTIs): These medicines prevent HIV from inserting its genetic material into the DNA of human cells.
Protease inhibitors (PIs): These medicines interfere with protease, an enzyme HIV needs to produce mature, infectious viral particles.
Entry and attachment inhibitors: These medicines prevent HIV from attaching to or entering susceptible immune cells.
Capsid inhibitors: These medicines target the HIV capsid, a protein structure important to several stages of the viral life cycle.
Many modern treatment regimens combine medicines in a single tablet, although some people require multiple tablets or other treatment schedules. Long acting injectable treatments are also available for selected individuals who meet the relevant clinical criteria.
Taking medicines as prescribed is essential because missed doses or interruptions can allow HIV to multiply and may contribute to drug resistance. Possible side effects vary by medicine and may include nausea, headache, sleep disturbances, or other effects. Healthcare professionals can assess symptoms and determine whether treatment adjustments are appropriate.
Regular medical appointments help evaluate viral load, CD4 cell counts when indicated, medication tolerance, kidney and liver function when relevant, and potential interactions with other medicines.
With appropriate treatment and continued medical care, many people living with HIV can maintain viral suppression and protect their immune health over the long term. ART remains an important part of HIV management, alongside routine monitoring, preventive healthcare, and informed discussions with healthcare professionals.