What Are Medications and Treatment Options for HIV/AIDS?

Many drugs have become available to fight both the HIV infection and its associated infections and cancers. These drugs have been called highly active antiretroviral therapy (HAART). More commonly, they are simply referred to as ART. Although these medications do not cure HIV/AIDS, antiretrovirals have greatly reduced HIV-related complications and deaths.

Therapy is initiated and individualized under the supervision of a physician who is an expert in the care of HIV-infected patients. A combination of at least three ART drugs is needed to suppress the virus from replicating and boost the immune system. How these drugs are combined depends on the most current treatment guidelines, individual patient preferences, other medical conditions, past treatment history, and any resistance mutations in the individual's virus. Resistance mutations may already be present at the time of infection, thus most clinicians will test the patient's virus for resistance mutations prior to starting or changing a regimen.

The earliest class of highly active antiretroviral therapy, reverse transcriptase inhibitor drugs, inhibit the ability of the virus to make copies of itself. The following are examples:

Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs): These include medications such as zidovudine (AZT, Retrovir), didanosine (ddI, Videx), stavudine (d4T, Zerit), lamivudine (3TC, Epivir), abacavir (ABC, Ziagen), emtricitabine (FTC, Emtriva), tenofovir (TDF, Viread), and tenofovir alafenamide (TAF).

Combination NRTIs include tenofovir/emtricitabine (TDF/FTC, Truvada), emtricitabine/tenofovir alafenamide (TAF/FTC, Descovy), zidovudine/lamivudine (Combivir), abacavir/lamivudine (Epzicom or Kivexa), and abacavir/zidovudine/lamivudine (Trizivir).

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are commonly used in combination with NRTIs to help keep the virus from multiplying. Examples of NNRTIs are efavirenz (Sustiva), nevirapine (Viramune), delavirdine (Rescriptor), etravirine (Intelence), rilpivirine (Edurant), and doravirine (Pifeltro). Complete HIV treatment regimens that combine two NRTIs and one NNRTI in one pill taken once a day are available for convenience; these include Atripla (efavirenz/TDF/FTC), Complera (rilpivirine/TDF/FTC), Odefsey (rilpivirine/TAF/FTC), and doravirine/TDF/lamivudine (Delstrigo).

Protease inhibitors (PIs) interrupt virus replication at a later step in the HIV life cycle, preventing cells from producing new viruses. Currently, these include ritonavir (Norvir), darunavir (Prezista), and atazanavir (Reyataz). Using PIs with NRTIs reduces the chances that the virus will become resistant to medications. Atazanavir and darunavir are available in combination with cobicistat as atazanavir/cobicistat (Evotaz) and darunavir/cobicistat (Prezcobix). Cobicistat and ritonavir inhibit the breakdown of other drugs, so they are used as boosters to reduce the number of pills needed. A PI-based one-pill regimen is darunavir/cobicistat/TAF/FTC (Symtuza).

Older PIs no longer commonly used due to pill burden and side effects include lopinavir and ritonavir combination (Kaletra), saquinavir (Invirase), indinavir sulphate (Crixivan), fosamprenavir (Lexiva), tipranavir (Aptivus), and nelfinavir (Viracept).

Fusion and entry inhibitors are agents that keep HIV from entering human cells. Enfuvirtide (Fuzeon/T20) was the first drug in this group and was given in injectable form like insulin. Maraviroc (Selzentry) can be given by mouth and is used in combination with other ARTs.

Integrase strand transfer inhibitors (integrase inhibitors or integrases, INSTIs) stop HIV genes from becoming incorporated into the human cell's DNA and are very well tolerated. Raltegravir (Isentress) was the first drug in this class. Elvitegravir is part of two fixed-dose combinations (elvitegravir/cobicistat/TDF/FTC, Stribild) and (elvitegravir/cobicistat/TAF/FTC, Genvoya) taken as one pill once daily. Dolutegravir (Tivicay) is also available in a once-daily combination pill with two NRTIs, abacavir and lamivudine, called Triumeq. The newest INSTI is available in a one-pill combination as Biktarvy (biktegravir/TAF/FTC).

An INSTI/NNRTI combination is available as Juluca (dolutegravir/rilpivirine) and can be used to replace a three-drug regimen after six months of successful suppression of HIV virus that has no resistance.

ART may have a variety of side effects depending on the type of drug. An expert in infectious diseases and HIV treatment should be consulted if the patient needs concomitant treatment for opportunistic infections, hepatitis B, or hepatitis C. Some medications used to treat these conditions will negatively interact with ART drugs.

Birth defects are associated with both efavirenz and dolutegravir. Both should be avoided for PEP or treating HIV-infected women of childbearing age who are not using effective birth control.

Pregnant women who are HIV-positive should seek care immediately from an obstetrician (OB) to minimize the risk of mother-to-child transmission of the virus. ART reduces the risk of transmitting the virus to the fetus, and the mother may be treated by both the OB and an infectious-disease subspecialist. Therapy can also be given during childbirth, or to the baby in the perinatal period, in order to help prevent HIV infection in the newborn. There are certain drugs, however, that are harmful to the baby. Therefore, seeing a physician as early as possible before or during pregnancy to discuss ART medications is crucial.

Although it is important to receive medical treatment for HIV/AIDS, patients may use home remedies or alternative medicine along with standard HIV treatment to improve overall health. It is important to talk to your doctor before trying alternative therapies as some can interfere with the effectiveness of or cause negative effects with HIV drugs.