HIV & AIDS Health Center

The most effective treatment for HIV is highly active antiretroviral therapy (HAART)-a combination of several antiretroviral medicines that aims to control the amount of virus in your body. Other steps you can take include keeping your immune system strong, taking medicines as prescribed, and monitoring your CD4+ (white blood cells) counts to check the effect of the virus on your immune system. If HIV is not treated, it eventually progresses to AIDS, the last and most severe stage of HIV infection. People with AIDS are more likely to develop certain illnesses, called opportunistic infections. Examples include Pneumocystispneumonia and some cancers. These illnesses are common in people who have weakened immune systems.

Treatment to prevent infection (postexposure prophylaxis)

Health care workers who are at risk for HIV because of an accidental needlestick or other exposure to body fluids may need medicine to prevent infection.⁶ Medicine may also prevent HIV infection in a person who has been raped or was accidentally exposed to the body fluids of a person who may have HIV.⁷ This type of treatment is usually started within 72 hours of the exposure.

Initial treatment

If you are diagnosed with HIV infection during the initial symptoms of early HIV (acute retroviral syndrome), discuss the use of highly active antiretroviral therapy (HAART) with your doctor. Information about treatment of early HIV from clinical trials suggests that treatment of early HIV with antiretroviral medicines have long-term benefits.⁵

HAART medicines that are most often used to treat HIV infection include:

• Nucleoside/nucleotide reverse transcriptase inhibitors, such as tenofovir, emtricitabine, and abacavir.
• Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, nevirapine, or etravirine.
• Protease inhibitors (PIs), such as atazanavir, ritonavir, or darunavir.
• Fusion and entry inhibitors, such as enfuvirtide and maraviroc.
• Integrase inhibitors, such as raltegravir.

The U.S. National Institutes of Health recommends one of the following programs for people who begin treatment for HIV:⁵

• Efavirenz + tenofovir + emtricitabine
• Ritonavir-boosted atazanavir + tenofovir + emtricitabine
• Ritonavir-boosted darunavir + tenofovir + emtricitabine
• Raltegravir + tenofovir + emtricitabine

The decision whether to start HAART before your health starts to decline is complicated. Consider the potential benefits and risks of early treatment and discuss all the issues with your doctor before starting HAART.

• Benefits. Early treatment of HIV may:⁵
  • Decrease the severity of early HIV symptoms.
  • Affect the rate at which the disease progresses.
  • Reduce the rate at which the virus multiplies in the body.
  • Preserve immune system function.
  • Lower the risk of drug resistance with complete viral suppression.
  • Reduce the risk of HIV spreading. Even with early treatment, the risk of HIV transmission still exists. Antiretroviral therapy cannot substitute for prevention measures, such as condom use and safer sex practices.
  • Extend life.⁸
• Risks. Early treatment of HIV may:⁵
  • Cost a lot and cause side effects.
  • Lead to drug resistance to antiretroviral medicines, which may limit future treatment options.
  • Result in the need for continuing therapy indefinitely.
  • Reduce future medicine options when HIV disease risk is highest.