Antiretrovirals: HIV and AIDS Drugs

Medically Reviewed by Jonathan E. Kaplan, MD on January 20, 2023
6 min read

HIV medications can help lower your viral load, fight infections, and improve your quality of life. They can lower your chances of transmitting HIV, but if you take them incorrectly, you can still give HIV to others. They're not a cure for HIV.

The goals for these medicines are to:

  • Control the growth of the virus
  • Improve how well your immune system works
  • Slow or stop symptoms
  • Prevent transmission of HIV to others

The FDA has approved more than two dozen antiretroviral drugs to treat HIV infection. They're often broken into six groups because they work in different ways. Doctors recommend taking a combination or "cocktail" of at least two of them. This is called antiretroviral therapy, or ART.

Your doctor will let you know specifically how you should take your medications. You need to follow the directions exactly, and you shouldn't miss even one dose. If you miss doses, you could develop drug-resistant strains of HIV, and your medication may stop working.

Some other medicines and supplements don't mix well with HIV drugs, so make sure you tell your doctor about everything you're taking.

NRTIs force the HIV virus to use faulty versions of building blocks so infected cells can't make more HIV.

These are also called "non-nukes." NNRTIs bind to a specific protein so the HIV virus can't make copies of itself.

These drugs block a protein that infected cells need to put together new HIV virus particles.

These stop HIV from making copies of itself by blocking a key protein that allows the virus to put its DNA into the healthy cell's DNA. They're also called integrase strand transfer inhibitors (INSTIs).

Unlike NRTIs, NNRTIs, PIs, and INSTIs, which work on infected cells, these drugs block HIV from getting inside healthy cells.

Enfuvirtide, or ENF or T-20 (Fuzeon)

This is a new class of drugs that works by blocking the HIV-1 virus’ protein shell known as the capsid. Lenacapavir(Sunlenca) has a starting dose as oral tablets and subcutaneous injections, followed by maintenance injections every six months. It is given in combination with other antiretroviral(s) and is used by adults with HIV that is not adequately controlled by their current treatment regimen.

This is a new class of drug with just one medication, fostemsavir, or FTR (Rukobia). It targets the glycoprotein 120 on the surface of the virus, stopping it from being able to attach itself to the CD4 T-cells of your body’s immune system. It is for adults who have tried multiple HIV medications and whose HIV has been resistant to other therapies.  

Maraviroc, or MVC (Selzentry), also stops HIV before it gets inside a healthy cell, but in a different way than fusion inhibitors. It blocks a specific kind of "hook" on the outside of certain cells so the virus can't plug in.

This is a new class of antiviral medication specifically that works by blocking your body’s HIV-infected cells from spreading the virus to those that are uninfected. Ibalizumab-uiyk (Trogarzo) is given by intravenous infusion. It is used specifically for adults living with HIV who have tried multiple HIV medications and whose HIV has been resistant to other therapies. 

Ritonavir (RTV), taken in a low dose, increases blood levels of lopinavir (LPV) and the drug LPV/r (Kaletra). 

Cobicistat (Tybost) does the same thing in combination with atazanavir, darunavir, elvitegravir

Because these "drug boosters" can increase the levels of other drugs and cause potential harm, you should always tell your doctor about the medicines you are taking. 

Some drug manufacturers put together specific medicines into a single pill so they're easier to take, including:

Integrase strand transfer inhibitor (INSTI)-based:

Protease inhibitor (PI)-based:

Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based:

Nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-based:

Descovy and Truvada have also been approved as ways to prevent HIV infection for people who are at high risk. But if you take either of them, you have to practice safe sex, too.

PrEP stands for pre-exposure prophylaxis. That means you take these medications before (“pre-“) HIV gets into your system (exposure) to help protect against infection (prophylaxis). These medications work quite well, but they aren’t foolproof -- if taken by mouth, you need to take them every day for the best effect, and even then, they don’t work 100% of the time. A new form of PrEP can be taken by injection, every two months. 

Because PrEP may not work perfectly, especially if you don’t take it as directed, it’s best to take other steps to protect yourself when you can. For example, consider using a condom for extra protection if you have sex with people who might have HIV. Condoms will also help protect against other sexually transmitted infections (STIs).

PrEP medications for HIV include Truvada and Descovy (taken by mouth) and Apretude (taken by injection)..

People who inject drugs are often at higher risk for HIV, especially if they share needles or other tools. Gay and bisexual men are at higher risk from sexual activity, but heterosexual men and women can also get it from sexual activity.  Anyone who is at risk for getting HIV should consider using PrEP. 

PrEP can help protect both you and your baby if you plan to get pregnant from a partner with HIV. It helps block the virus from infecting you during pregnancy and while breastfeeding.

The best way to keep HIV symptoms and complications at bay is to maintain the doctor-prescribed schedule of antiviral medications without missing any doses. If you do this, you’ll help:

  • Strengthen your immune system
  • Lessen the chances of infection of any type
  • Lessen your chances of getting “treatment-resistant” HIV
  • Lessen your chances of passing HIV on to other people

You’re more likely to get certain infections if you have HIV, (the risk goes down if you take your HIV medications). These include:

  • Viral infections like herpes and shingles, treated with rest and antiviral meds
  • Bacterial infections like tuberculosis or pneumonia, treated with antibiotics
  • Fungal infections like thrush or pneumocystis pneumonia, treated with anti-fungal meds
  • Parasitic infections like toxoplasmosis, which may require long-term treatment in people with HIV.

If you don’t feel well with your regular medications or you have trouble keeping up with doses, talk to your doctor. Together, you may be able to adjust your medication types and dosages to better address any symptoms or side effects.