Antiretrovirals: HIV and AIDS Drugs

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.

Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

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

Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

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

Protease Inhibitors (PIs)

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

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Integrase Inhibitors

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).

Fusion Inhibitors

Unlike NRTIs, NNRTIs, PIs, and INSTIs -- which work on infected cells -- these drugs help block HIV from getting inside healthy cells in the first place.

Enfuvirtide, or ENF or T-20 (Fuzeon)

CCR5 Antagonist

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.

Post-Attachment Inhibitor or Monoclonal Antibody

This is a new class of antiviral medication specifically for adults living with HIV who have tried multiple HIV medications and whose HIV has been resistant to current available therapies. Ibalizumab-uiyk (Trogarzo) blocks your body’s HIV infected cells from spreading the virus into those which are uninfected. It is administered by IV.

Pharmacologic enhancers, or "Drug Boosters"

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

Cobicistat (Tybost) does the dsame thing in combnation 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. 

Fixed-Dose Combinations

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

Integrase strand transfer inhibitor (INSTI)-based:

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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.

WebMD Medical Reference Reviewed by Jonathan E. Kaplan, MD on October 22, 2019

Sources

SOURCES:

UpToDate: "Overview of antiretroviral agents used to treat HIV."

AIDSinfo Drug Database.

NIAID: "Treatment of HIV Infection."

American Academy of Family Physicians: "How to Take Your Medicines for HIV," "Medicines for People Who Are HIV Positive."

U.S. Dept. of Health and Human Services: "HIV and Its Treatment: What You Should Know," "Approved Medications to Treat HIV Infection."

Hammerl. JAMA, Aug. 16, 2006.

New Mexico AIDS Education and Training Center: "Taking Current Antiretroviral Drugs," "Other Antiretroviral Drugs in Development," "Immune Therapies in Development.

FDA: "First of a Kind in HIV Treatment."

AIDSinfo: "Fusion Inhibitor," "CCR5 Antagonist."

AIDS Treatment Data Network: "Drugs Used to Treat HIV."

Johns Hopkins Medicine: "Antiretroviral Therapy: Initial Regimen."

AIDS.gov: "Pre-Exposure Prophylaxis (PrEP)."

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