HIV Treatment

What is HIV drug resistance?

As HIV multiplies in the body, it sometimes changes form, known as a mutation. Some HIV mutations can cause resistance to HIV medicines (called HIV drug resistance), which means that the virus will be resistant to all or some parts of a prescribed HIV medicine.

In some cases, HIV drug resistance can reduce the effectiveness of multiple drugs in a class of HIV medicines. For example, resistance to the nucleoside reverse transcriptase inhibitor (NRTI) emtricitabine can cause resistance to lamivudine or other NRTIs.

Drug resistance can develop over time in people with HIV or can be spread from person to person (called transmitted resistance), which includes perinatal transmission during pregnancy. This means that some people will have drug-resistant HIV even before they take HIV medicines.

For people who develop HIV drug resistance while taking HIV medicines, the original treatment regimen is unlikely to continue being effective. In other words, the original HIV medicines cannot prevent the drug-resistant HIV from multiplying, and the HIV treatment will fail unless a different treatment regimen is started.

On the other hand, people who acquire transmitted HIV resistance may not respond to certain treatment regimens, even if it is their first time taking HIV medicines. To prevent HIV from multiplying due to an ineffective treatment regimen, it is important to receive drug resistance testing as soon as possible after receiving an HIV diagnosis.

What is drug-resistance testing?

Drug-resistance testing identifies which, if any, HIV medicines will not be effective for a person with HIV. Drug-resistance testing evaluates resistance to common drug classes (such as protease inhibitors) using a sample of blood.

People with HIV should start taking HIV medicines as soon as possible after an HIV diagnosis. However, drug-resistance testing is usually performed before a person starts taking HIV medicines. Drug-resistance test results help determine which HIV medicines to include in a person’s first HIV treatment regimen.

Once HIV treatment is started, a viral load test is used to monitor whether the HIV medicines are working effectively. If viral load testing indicates that a person’s HIV treatment regimen is not effective, drug-resistance testing is repeated. The test results can identify whether drug resistance is the problem and, if so, can be used to select a new HIV treatment regimen.

How can a person taking HIV medicines reduce the risk of drug resistance?

Taking HIV medicines exactly as prescribed (called medication adherence) reduces the risk of drug resistance. Even occasionally skipping HIV medicines can allow HIV to multiply, which increases the risk that the virus will mutate and produce drug-resistant HIV.

Before starting HIV treatment, people with HIV should tell their health care provider about any issues that can make medication adherence difficult. For example, a busy schedule or lack of health insurance can make it hard to take HIV medicines consistently. Read the HIVinfo fact sheet HIV Treatment Adherence for a list of other common causes of poor medication adherence.

Health care providers can help find a suitable treatment regimen that increases the likelihood of medication adherence and reduces the risk of drug resistance.

For people who are actively engaging in sexual activity, the risk of transmitted drug resistance can be significantly reduced if their partner(s) take pre-exposure prophylaxis (PrEP). PrEP nearly eliminates the risk of sexual HIV transmission for partners, including the transmission of drug-resistant HIV. PrEP offers protection in the event of unnoticed or unexpected drug resistance.

The following HIVinfo resources offer more information on drug resistance and medication adherence:

• HIV Drug Resistance (infographic)
• Following an HIV Treatment Regimen: Steps to Take Before and After Starting HIV Medicines (fact sheet)
• Tips for HIV Treatment Regimen Adherence (infographic)

This fact sheet is based on information from the following sources:

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Adherence to the Continuum of Care
  • Drug-Resistance Testing

From the Department of Veterans Affairs:

• Just Diagnosed
• Treatment Decisions: Starting Therapy

From the National Institute of Allergy and Infectious Diseases:

• Starting and Staying on Antiretroviral Treatment

Also see the HIV Source collection of HIV links and resources.

FDA-Approved HIV Medicines – Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

NRTIs block reverse transcriptase, an enzyme HIV needs to make copies of itself.

FDA-Approved HIV Medicines – Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

NNRTIs block reverse transcriptase, an enzyme HIV needs to make copies of itself.

FDA-Approved HIV Medicines – Integrase Strand Transfer Inhibitors (INSTIs)

INSTIs block HIV integrase, an enzyme HIV needs to make copies of itself.

FDA-Approved HIV Medicines – Protease Inhibitors (PIs)

PIs block HIV protease, an enzyme HIV needs to make copies of itself.

Note: Although ritonavir is a PI, it is generally used as a pharmacokinetic enhancer as recommended in the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV and the Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection.

FDA-Approved HIV Medicines – Fusion Inhibitors

Fusion inhibitors block HIV from entering the CD4 T lymphocytes (CD4 cells) of the immune system.

FDA-Approved HIV Medicines – CCR5 Antagonists

CCR5 antagonists block CCR5 coreceptors on the surface of CD4 cells, preventing HIV from entering them.

FDA-Approved HIV Medicines – Attachment Inhibitors

Attachment inhibitors bind to the gp120 protein on the outer surface of HIV, preventing HIV from entering CD4 cells.

FDA-Approved HIV Medicines – Post-Attachment Inhibitors

Post-attachment inhibitors block CD4 receptors on the surface of CD4 cells, preventing HIV from entering them.

FDA-Approved HIV Medicines – Capsid Inhibitors

Capsid inhibitors interfere with the HIV capsid, a protein shell that protects HIV's genetic material and enzymes needed for replication.

FDA-Approved HIV Medicines – Pharmacokinetic Enhancers

Pharmacokinetic enhancers are used in HIV treatment to increase the effectiveness of an HIV medicine included in an HIV treatment regimen.

FDA-Approved HIV Medicines – Combination HIV Medicines

Combination HIV medicines contain two or more HIV medicines from one or more drug classes.

This fact sheet is based on information from the following sources:

From FDA:

• FDA-Approved Drugs
• HIV and AIDS: Medicines to Help You

From the National Library of Medicine:

• Drug information from the DailyMed website

Also see the HIV Source collection of HIV links and resources.

What should you do before starting an HIV treatment regimen?

Talking with your health care provider will help you understand why you are starting HIV treatment and why medication adherence is important. Medication adherence means sticking to an HIV treatment regimen—taking HIV medicines as scheduled and exactly as prescribed.

Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV. When taken as prescribed, HIV medicines help people with HIV live long, healthy lives. Adherence to an HIV treatment regimen also reduces the risk of drug resistance and HIV transmission.

What should you tell your health care provider before starting an HIV treatment regimen?

Tell your health care provider about other prescription and nonprescription medicines, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Other medicines or products you take may interact with HIV medicines, causing a drug interaction. A drug interaction may affect how an HIV medicine works or cause side effects. To learn more, read the HIVinfo What is a Drug Interaction? fact sheet.

Tell your health care provider about any issues that might make adherence difficult. For example, people who have difficulty swallowing pills or people who do not have health insurance may find it hard to stick to an HIV treatment regimen. Other issues could include a busy schedule, lack of transportation, lack of stable housing, HIV medicine side effects, substance use, and fear of judgment. To learn more, read the HIVinfo HIV Treatment Adherence fact sheet.   

Describe your daily schedule to your health care provider. You and your health care provider can work together to design an HIV medication schedule that fits in with your day-to-day routine.

Ask your health care provider for written instructions on how to follow your HIV treatment regimen. The instructions should include information about how, when, and how much of the medicine you should take.

What are the best ways to stick to an HIV treatment regimen?

To maintain adherence, try some of the following strategies:

• Use a 7-day pill box. Once a week, fill the pill box with your HIV medicines for the entire week.
• Take your HIV medicines at the same time every day.
• Set an alarm on your cell phone to remind you to take your medicines.
• Ask a family member or friend to remind you to take your medicines.
• Plan and prepare for changes in your daily routine, including weekends and holidays. If you are going away, pack enough medicine to last the entire trip.
• Use an app or a medicine diary (online or on paper) to record each medicine as you take it. Reviewing your diary will help you identify the times that you are most likely to forget to take your medicines.
• Keep all of your medical appointments. Be sure to refill your prescriptions before you run out of HIV medicines.

What should you do if you forget to take your HIV medicines?

Unless your health care provider tells you otherwise, take the medicine you missed as soon as you realize you missed a normal dose, unless it is almost time for the next dose. Do not take a double dose of an HIV medicine to make up for a missed dose.

Tell your health care provider if you are having difficulty following your treatment regimen. Do not forget to mention any side effects you are having. Side effects from HIV medicines (or from other medicines that you are taking) can interfere with medication adherence for any reason.

This fact sheet is based on information from the following sources:

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Adherence to the Continuum of Care

From the Health Resources and Services Administration:

• Guide for HIV/AIDS Clinical Care: HIV Treatment/Adherence

From HIV.gov:

• Tips on Taking Your HIV Medication Every Day

From the U.S. Department of Veterans Affairs:

• Frequently Asked Questions About HIV

Also see the HIV Source collection of HIV links and resources.

What are vaccines?

Vaccines protect people from diseases, such as influenza (flu), measles, and polio. Vaccines are given by needle injection (a shot), mouth (pill or solution), or nasal spray. The process of getting a vaccine is called vaccination.

When a person gets a vaccine, the body's immune system produces an immune response that protects the body against the disease. In this way, the immune system learns to defend the body if the person is later exposed to the disease.

Some vaccines, like the measles or polio vaccines, are nearly 100 percent effective in preventing disease. Others, like the COVID-19 or flu vaccines, reduce the severity of illness if the disease occurs.

Vaccines not only protect individuals from disease; they protect communities as well. When most people in a community are immunized against a disease, there is little chance of widespread infection or a disease outbreak.

Is there a vaccine against HIV?

Scientists have been researching HIV vaccines for nearly 40 years. Most of the HIV vaccine trials have been early-stage trials in which scientists look at whether the vaccine is safe and produces an immune response to HIV after vaccination.

Very few HIV vaccine trials have advanced to late-stage testing, where scientists determine whether the vaccine effectively stops HIV infection. So far, no HIV vaccines have proven consistently effective, and none have been approved for use outside of clinical trials.

Scientists are investigating new technologies to design vaccines that could prevent or treat HIV. For more information about experimental HIV vaccines, read the HIVinfo What is a Preventive HIV Vaccine? and What is a Therapeutic HIV Vaccine? fact sheets.

Although there are no vaccines to prevent or treat HIV, people with HIV can often benefit from vaccines against other diseases.

Which vaccines should people with HIV get?

People with HIV should speak with their health care provider to decide which vaccines are right for them. Children and adolescents with HIV should also follow vaccination guidance from a health care provider.

The recommended vaccines can vary depending on a person’s age, vaccine history, overall health, pregnancy status, and some HIV-related risk factors. According to the CDC, vaccines are available in the United States for the following infections—

• COVID-19
• Haemophilus influenzae type b (Hib)
• Hepatitis A
• Hepatitis B
• Herpes zoster (also called shingles)
• Human papillomavirus (HPV)
• Influenza (also called flu)
• Measles, mumps, and rubella (MMR)
• Meningococcal disease
• Mpox
• Pneumococcal disease
• Polio
• Respiratory syncytial virus (RSV)
• Rotavirus
• Tetanus, diphtheria, and pertussis
• Varicella (also called chickenpox)

Because HIV affects the immune system, vaccination is an important part of staying healthy. A health care provider can help determine which vaccines to receive and when.

The HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov provide vaccine recommendations for people with HIV. Separate guidance is available for children and adolescents and for adults and adolescents.

Are vaccines safe for people with HIV?

Most vaccines are safe and effective for people with HIV. Although some people may experience side effects from vaccines, these are generally minor and go away on their own in a few days. For example, some people experience soreness at the injection site or a mild fever. Severe reactions to vaccines are rare.

Some vaccines, such as the live attenuated vaccines, are not recommended for people with HIV because they can prompt a strong immune response and potentially cause infection. Inactivated vaccines are considered generally safe and acceptable for people with HIV.

Before getting a vaccine, talk to your health care provider about the benefits of the vaccine and possible side effects.

Do people with HIV need special vaccines before traveling?

Regardless of destination, all travelers should be up to date on routine vaccinations based on their health care provider’s recommendations. People who plan to travel outside the United States may need to be vaccinated against diseases that are present in other parts of the world:

• Cholera: Africa, the Americas, South and Southeast Asia
• Polio: Afghanistan, Pakistan
• Typhoid: Africa, Asia (especially South Asia), Latin America
• Yellow Fever: sub-Saharan Africa, tropical South America

If you have HIV, talk to your health care provider about any vaccines you may need before you travel outside the United States.

To prepare for your trip, read information from the CDC on Travelers with Weakened Immune Systems and the HIVinfo Traveling Safely With HIV fact sheet.

This fact sheet is based on information from the following sources:

From HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV:
  • Immunizations for Preventable Diseases in Adults and Adolescents With HIV

From CDC:

• Immunocompromised Travelers
• Yellow Book: Travel-Associated Infections and Diseases

From the U.S. Department of Health and Human Services (HHS):

• Vaccine Basics

Also see the HIV Source collection of HIV links and resources.

What is HIV treatment adherence?

For people with HIV, treatment adherence means:

• Starting HIV treatment
• Taking HIV medicines exactly as prescribed (also called medication adherence)
• Keeping all medical appointments

Adherence to treatment is a key part of staying healthy with HIV.

How soon should a person start treatment after testing positive for HIV?

Once someone gets diagnosed with HIV, it is best to see a health care provider as soon as possible to discuss HIV medicines and find the best treatment regimen for their specific needs. Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV and can help them live long, healthy lives. HIV medicines also reduce the risk of HIV transmission.

Because HIV requires lifelong treatment, it is important for people with HIV to regularly visit their health care provider. Health care providers periodically monitor people with HIV to make sure their treatment regimen is working effectively.

During regular medical appointments, health care providers can also recommend resources to help people deal with any issues that may interfere with medication adherence.

Why is medication adherence important?

Taking HIV medicines as they are prescribed prevents HIV from multiplying, which reduces the risk that HIV will mutate and produce drug-resistant HIV. Skipping HIV medicines allows HIV to multiply, which increases the risk of HIV drug resistance, treatment failure, and transmission to others.

Poor adherence to an HIV treatment regimen also allows HIV to destroy the immune system. A damaged immune system makes it hard for the body to fight off infections and certain cancers.

What are common causes of poor medication adherence?

Maintaining good medication adherence can be difficult for many reasons. The table below provides examples of barriers to medication adherence, with some potential solutions to help overcome those barriers.

Any barriers from the table above can make it hard to take HIV medicines consistently. A health care provider can help find a suitable treatment regimen that increases the likelihood of medication adherence.

Where can a person find resources to help with HIV treatment adherence?

Explore these HIVinfo and Centers for Disease Control and Prevention (CDC) resources to learn more about treatment adherence:

HIVinfo:

• Just Diagnosed: Next Steps After Testing Positive for HIV
• How to Find HIV Treatment Services
• Following an HIV Treatment Regimen: Steps to Take Before and After Starting HIV Medicines

CDC:

• Newly Diagnosed With HIV
• Patient Resources

This fact sheet is based on information from the following sources:

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Initiation of Antiretroviral Therapy
  • Adherence to the Continuum of Care

From the Health Resources and Services Administration:

• Guide for HIV/AIDS Clinical Care: HIV Treatment/Adherence

From HIV.gov:

• HIV Care Continuum

Also see the HIV Source collection of HIV links and resources.

What is the treatment for HIV?

The treatment for HIV is called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines (called an HIV treatment regimen) on a regular schedule, usually every day (pills) or once a month/every two months (injections).

ART is recommended for everyone who has HIV. ART cannot cure HIV, but these HIV medicines help people with HIV live long, healthy lives. ART also reduces the risk of HIV transmission.

How do HIV medicines work?

HIV attacks and destroys the infection-fighting CD4 T lymphocytes (CD4 cells) of the immune system. Loss of CD4 cells makes it hard for the body to fight off infections, including opportunistic infections and some HIV-related cancers.

HIV medicines prevent HIV from multiplying (making copies of itself), which reduces the amount of HIV in the body (called the viral load). Having less HIV in the body gives the immune system a chance to recover and produce more infection-fighting CD4 cells. Although there may still be HIV in the body, the additional CD4 cells keep the immune system strong enough to fight off infections.

By reducing the amount of HIV in the body, HIV medicines also reduce the risk of HIV transmission. One of the main goals of HIV treatment is to reduce a person’s viral load to an undetectable level. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV through sex, and a significantly lower risk of transmission through other means (such as shared needles).

When is it time to start taking HIV medicines? 

People with HIV should start taking HIV medicines as soon as possible after an HIV diagnosis. It is especially important for people with AIDS-defining conditions or within 6 months of HIV infection (called early HIV infection) to start HIV medicines right away.

Women with HIV who become pregnant and are not already taking HIV medicines should also start taking HIV medicines as soon as possible. It is important for people with HIV to take their HIV medicines as prescribed, which could be every day (pills) or every one or two months (injections).

What HIV medicines are included in an HIV treatment regimen?

There are many FDA-approved HIV medicines available for HIV treatment regimens. The HIV medicines are grouped into seven drug classes according to how they fight HIV.

The choice of an HIV treatment regimen depends on a person's individual needs. When choosing an HIV treatment regimen, people with HIV and their health care providers consider many factors, including possible side effects of HIV medicines and potential drug interactions.

What should people know about taking HIV medicines?

Taking HIV medicines keeps people with HIV healthy and prevents HIV transmission. Taking HIV medicines exactly as prescribed (called medication adherence) also reduces the risk of drug resistance.

However, sometimes HIV medicines can cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious. Overall, the benefits of HIV medicines far outweigh the risk of side effects.

In some cases, HIV medicines can interact with other medicines in an HIV treatment regimen or with other medicines a person is taking. Health care providers carefully consider potential drug interactions before recommending an HIV treatment regimen.

If you believe you are experiencing side effects from HIV medicines, it is important to consult with your health care provider before stopping or adjusting your normal treatment regimen.

Where can a person learn more about HIV treatment?

Read the other fact sheets in the HIVinfo HIV Treatment series to learn more about HIV treatment. Topics covered in this series include:

• When to Start HIV Medicines
• What to Start: Choosing an HIV Treatment Regimen
• HIV Treatment Adherence
• Drug Resistance
• What is a Drug Interaction?

This fact sheet is based on information from the following sources:

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Treatment Goals
  • Initiation of Antiretroviral Therapy
  • What to Start: Initial Combination Antiretroviral Regimens for People With HIV
  • Early (Acute and Recent) HIV Infection
  • Adverse Effects of Antiretroviral Agents

From the Centers for Disease Control and Prevention:

• Treating HIV

From the Department of Veterans Affairs:

• Treatment Decisions for HIV: Entire Section

From the National Institute of Allergy and Infectious Diseases:

• HIV/AIDS Treatment

Also see the HIV Source collection of HIV links and resources.

What is the next step after testing positive for HIV?

Testing positive for HIV often leaves a person overwhelmed with questions and concerns. It is important to remember that HIV can be treated effectively with HIV medicines.

Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV. HIV medicines help people with HIV live long, healthy lives and reduce the risk of HIV transmission.

After testing positive for HIV, it is important to see a health care provider as soon as possible, even if you do not feel sick. Prompt medical care and treatment with HIV medicines is the best way to stay healthy.

After testing positive for HIV, what can a person expect during their first visit with a health care provider?

A person’s first visit with a health care provider after testing positive for HIV includes a review of the person’s health and medical history, a physical exam, and several lab tests. The information collected during this visit is used to make decisions about HIV treatment.

During this session, the health care provider also explains the benefits of HIV treatment and discusses ways to reduce the risk of passing HIV to others.

Which lab tests are used to make decisions about HIV treatment?

A health care provider reviews a person’s lab test results to determine how far the person’s HIV infection has advanced (called HIV progression) and to decide which HIV medicines to recommend.

The following lab tests are used to make decisions about HIV treatment.

CD4 count
A CD4 count measures the number of CD4 cells in a sample of blood. CD4 cells are infection-fighting cells of the immune system. As HIV advances, a person’s CD4 count drops, which indicates increasing damage to the immune system. Treatment with HIV medicines prevents HIV from destroying CD4 cells. 

Viral load
A viral load test measures how much virus is in the blood (HIV viral load). As HIV progresses to acquired immunodeficiency syndrome (AIDS) (if untreated), a person’s viral load increases. HIV medicines prevent HIV from multiplying, which reduces a person’s viral load. A goal of HIV treatment is to keep a person’s viral load so low that the virus cannot be detected by a viral load test. This is known as having an undetectable viral load.

Once HIV treatment is started, the CD4 count and viral load are used to monitor whether the HIV medicines are controlling a person’s HIV.

Drug-resistance testing
Health care providers consider many factors when recommending HIV medicines, including a person’s drug-resistance test results. Drug-resistance testing identifies which, if any, HIV medicines will not be effective against a person’s strain of HIV.

The HIVinfo infographic What do my lab results mean? has more information about tests used to monitor HIV infection and treatment.

After testing positive for HIV, how soon do people start taking HIV medicines?

People with HIV should start taking HIV medicines as soon as possible after receiving an HIV diagnosis. However, before starting treatment, health care providers and people with HIV should discuss available HIV medicines.

Issues, such as lack of health insurance or an inability to pay for certain HIV medicines, can make it hard to take HIV medicines consistently. Health care providers can recommend resources to help people deal with any issues related to HIV treatment adherence before starting an HIV treatment regimen.

During a person’s first visit with a health care provider, is there time to ask questions?

Yes, an initial visit with a health care provider is a good time to ask questions. The following are some questions that people with newly diagnosed HIV typically ask:

• Because I have HIV, will I eventually get AIDS?
• What can I do to stay healthy and avoid getting other infections?
• How can I prevent passing HIV to others?
• How will HIV treatment affect my lifestyle?
• How should I tell my partner that I have HIV?
• Is there any reason to tell my employer and those I work with that I have HIV?
• Are there support groups for people with HIV?
• Are there resources available to help me pay for my HIV medicines?

Remember that your health care provider wants to help make sure you have the resources you need to manage your new HIV diagnosis, so do not hesitate to ask questions.

Where can someone find resources for a person just diagnosed with HIV?

The following are resources to share with someone with newly diagnosed HIV:

• How to Find HIV Treatment Services: An HIVinfo fact sheet listing HIV-related resources, including resources to help find a health care provider and get help paying for HIV medicines.
• Available Care and Services: A webpage from the Ryan White HIV/AIDS Program outlining the services available for people with HIV who are low-income and have inadequate health insurance.
• Living With HIV: A webpage from the Centers for Disease Control and Prevention (CDC) with information on living with an HIV diagnosis, including recommendations on how to share an HIV diagnosis with others.

This fact sheet is based on information from these sources: 

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Baseline Evaluation
  • Laboratory Testing for Initial Assessment and Monitoring of Patients With HIV Receiving Antiretroviral Therapy
  • Initiation of Antiretroviral Therapy

From the Department of Veterans Affairs:

• Just Diagnosed

Also see the HIV Source collection of HIV links and resources.

What are long-acting HIV medicines?

Long-acting HIV medicines are HIV medicines that stay in the body longer than traditional HIV medicines. Because they last longer, they can be taken less frequently.

Long-acting HIV medicines include:

• HIV treatment
  • Cabenuva: Two HIV medicines, cabotegravir and rilpivirine
  • Sunlenca: The HIV medicine lenacapavir
  • Trogarzo: The HIV medicine ibalizumab-uiyk
• HIV prevention (called pre-exposure prophylaxis or PrEP)
  • Apretude: The HIV medicine cabotegravir
  • Yeztugo: The HIV medicine lenacapavir

As of April 2026, these are the only long-acting medicines that are approved by the U.S. Food and Drug Administration (FDA) for HIV prevention or treatment. This fact sheet focuses on HIV treatment. View the HIVinfo Pre-Exposure Prophylaxis fact sheet to learn more about long-acting HIV prevention methods.

How are long-acting HIV medicines different?

Long-acting HIV medicines are different because they stay in the body and keep working for much longer than pills that need to be taken every day. Some long-acting treatment plans can reduce or even replace the need for daily pills, and others can be used along with everyday pills.

Instead of taking pills every day, long-acting HIV medicines are given as injections much less frequently. The current FDA-approved options are usually given on the following schedule:

• Cabenuva – Every one or two months
• Sunlenca – Every six months
• Trogarzo – Every two weeks

Unlike HIV medicines in pill form, long-acting HIV medicines are given by a healthcare provider at regular appointments. Research suggests that long-acting HIV medicines may help some people with taking their medicine as prescribed and on schedule. This is referred to as treatment adherence.

Treatment adherence is important for HIV medicines to work as well as possible. However, taking a pill every day does not work for everyone. Long-acting HIV medicines may help some people overcome barriers to daily treatment adherence, such as busy or unpredictable schedules that can make it difficult to take medicine every day. 

Scientists continue to study and monitor new long-acting medicines for HIV prevention and treatment to better understand how they may benefit different people, including those who prefer an option other than a daily pill. The HIV Treatment Adherence fact sheet provides more information on factors that may affect adherence.

Are long-acting HIV medicines safe?

Long-acting HIV medicines, like all other FDA-approved medicines, are considered safe and effective for most people. Before getting injections, most long-acting HIV medicines must be taken as pills for a short time (called an oral lead-in) to ensure the medicine is well-tolerated.

However, all medicines have the potential for some side effects. For long-acting HIV medicines, some common side effects include:

• Diarrhea
• Dizziness
• Fatigue
• Fever
• Headache
• Nausea
• Rash
• Sleep problems
• Soreness, swelling, or redness around the injection site

Less commonly, long-acting HIV medicines may cause more serious side effects like depression or liver problems. However, serious side effects are rare and can usually be managed with help from your healthcare provider.

In addition, many HIV medicines (including long-acting HIV medicines) may be prone to drug interactions if combined with other medicines, including over-the-counter medicines. For example, long-acting HIV medicines may interact with some antibiotics and anticonvulsants. See the HIVinfo fact sheet What is a Drug Interaction? for more information on drug interactions and HIV medicines.

Because there are generally not enough data to know whether these medicines are safe during pregnancy or while breastfeeding, they are often not recommended in these situations. If you are pregnant, planning a pregnancy, or breastfeeding, be sure to talk to your healthcare provider about the safest treatment options for you before starting any new medicines.

Should I switch to a long-acting HIV medicine?

Switching HIV medicines should occur only after consultation with a healthcare provider. If a daily HIV treatment regimen is working effectively and is tolerable, switching may not be necessary. Switching HIV treatment regimens may lead to drug resistance, which could limit treatment options in the future.

In addition, there are only a few long-acting HIV medicines available to choose from, with some options reserved for unique situations. For example, Trogarzo is typically prescribed when a person is resistant to multiple classes of HIV medicines. When this happens, commonly used HIV medicines do not work effectively, and Trogarzo is used as the next available option.

If you believe you are a good candidate for long-acting HIV medicine, talk to your healthcare provider to explore your options. Make sure to discuss your circumstances, lifestyle, preferences, and your full medical history so your provider can get a clear sense of what would work best for you.

Always consult your healthcare provider about taking any new medicines and any concerns related to an HIV treatment regimen. 

This fact sheet is based on information from the following sources:

From the National Institutes of Health:

• Long-acting HIV treatment benefits adults with barriers to daily pill taking and adolescents with suppressed HIV
• Long-acting antiretroviral therapy suppresses HIV among people with unstable housing, mental illnesses, substance use

From CDC:

• Considerations for long-acting antiretroviral therapy in older persons with HIV
• Treating HIV

From the World Health Organization:

• Guidelines on long-acting injectable cabotegravir for HIV prevention

Also see the HIV Source collection of HIV information and resources.

What is a drug interaction?

Medicines help us feel better and stay healthy. However, sometimes drug interactions can cause problems. Drug interactions refer to reactions that affect how a drug acts in the body, which may change how effective or safe a drug is. There are three types of drug interactions:

• Drug–drug interaction: A reaction between two (or more) drugs, including both prescription and over-the-counter drugs.
• Drug–food interaction: A reaction between a drug and a food, beverage, or dietary supplement.
• Drug–condition interaction: A reaction that occurs when taking a drug while having a certain medical condition. For example, if you have high blood pressure, taking a nasal decongestant may increase your risk of stroke or heart attack.

A drug interaction can affect drug activity levels or cause adverse events. People with HIV should be aware of potential drug interactions to make sure their HIV medicines work safely and effectively.

Do HIV medicines ever cause drug interactions?

Treatment with HIV medicines (called antiretroviral therapy or ART) helps people with HIV live long, healthy lives and reduces the risk of HIV transmission. However, drug interactions, especially drug–drug interactions, can complicate HIV treatment.

Drug–drug interactions commonly occur between different HIV medicines and between HIV medicines and other medicines. Before recommending an HIV treatment regimen, health care providers carefully consider potential drug–drug interactions between HIV medicines.

In addition, health care providers should also ask about other medicines a person may be taking. For example, some HIV medicines may make hormonal birth control less effective, so women using hormonal contraceptives may need to use an additional or different method of birth control to prevent pregnancy.

For more information about using birth control and HIV medicines at the same time, view the HIV and Birth Control infographic from HIVinfo.

While rare, some drug interactions can have more serious side effects. For example, some interactions can reduce kidney function, damage the liver, or cause changes to your heartbeat. These interactions can be prevented by talking to your health care provider about any medicines and supplements you take or plan to take.

Can drug-food interactions and drug-condition interactions affect people taking HIV medicines?

Yes, the use of HIV medicines can lead to both drug–food interactions and drug–condition interactions.

Both the amount and type of food (or supplement) can affect the absorption of some HIV medicines and increase or reduce the concentration of the medicine in the blood. Depending on the HIV medicine, the change in concentration may be helpful or harmful.

Some HIV medicines (such as rilpivirine) should be taken with food, while others (such as efavirenz) should be taken on an empty stomach. In addition, supplements with iron, calcium, and magnesium can affect some medicines in the integrase strand transfer inhibitor drug class.

Directions on how to take HIV medicines specify whether to take the medicine with food or on an empty stomach. Some HIV medicines (such as dolutegravir) can be taken with or without food because food does not affect their absorption.

Conditions, such as kidney disease, hepatitis, and pregnancy, can affect how the body processes HIV medicines. The dosing of some HIV medicines may need to be adjusted in people with certain medical conditions.

How can a person avoid drug interactions?

You can take the following steps to avoid drug interactions:

• Tell your health care provider about all prescription and nonprescription medicines you are taking or plan to take. Also tell your health care provider about any vitamins, nutritional supplements, and herbal products you take.
• Tell your health care provider about any other conditions you may have, such as high blood pressure or diabetes.
• Before taking a medicine, ask your health care provider or pharmacist the following questions:
  • What is the medicine used for?
  • How should I take the medicine?
  • While taking the medicine, should I avoid any other medicines or certain foods or beverages?
  • Can I take this medicine safely with the other medicines that I am taking? Are there any possible drug interactions I should know about? What are the signs of those drug interactions?
  • In the case of a drug interaction, what should I do?
• Take medicines according to your health care provider's instructions. Always read the information and directions that come with an HIV medicine. Drug labels and package inserts include important information about possible drug interactions.

If you believe you are experiencing a drug interaction of any type, be sure to contact your health care provider. Never stop taking an HIV medicine without talking to your health care provider.

This fact sheet is based on information from the following sources:

From the HIV Clinical Practice Guidelines at Clinicalinfo.HIV.gov:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Drug–Drug interactions
  • Considerations for Antiretroviral Use in Special Populations: HIV and the Older Person and Women With HIV

From the U.S. Food and Drug Administration:

• Drug Interactions: What You Should Know

From the National Institute on Aging:

• Taking Medicines Safely as You Age

Also see the HIV Source collection of HIV links and resources.

What is an HIV treatment regimen?

An HIV treatment regimen is a combination of HIV medicines used to treat HIV infection. HIV treatment (also called antiretroviral therapy or ART) begins with choosing a regimen. People on ART should take the HIV medicines in their HIV regimens exactly as prescribed, which is usually daily for pills and every one or two months for injections. ART helps people with HIV live long, healthy lives and reduces the risk of HIV transmission.

More than 50 HIV medicines are currently U.S. Food and Drug Administration (FDA)-approved to treat HIV infection. HIV medicines come in different forms, including:

• Single-tablet regimens: Multiple HIV medicines combined into one pill or tablet
• Multiple-tablet regimens: Multiple HIV medicines taken as two or more pills or tablets
• Co-packaged products: Two or more HIV medicines taken separately but packaged together
• Oral suspensions: One or more HIV medicines that are consumed in liquid form
• Injectables: One or more HIV medicines that are injected instead of consumed

The various HIV medicines are grouped into eight drug classes based on how they fight HIV.

What are the HIV drug classes?

The eight HIV drug classes are:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Protease inhibitors (PIs)
• Fusion inhibitors
• CCR5 antagonists
• Integrase strand transfer inhibitors (INSTIs)
• Post-attachment inhibitors
• Capsid inhibitors

Treatment regimens typically include HIV medicines from two or more drug classes. The choice of HIV medicines to include in a treatment regimen depends on a person’s individual needs, including previous treatment history.

Click here to see the HIVinfo fact sheet that lists the FDA-approved HIV medicines by drug class.

What factors are considered when choosing an HIV treatment regimen?

When choosing an HIV treatment regimen, people with HIV and their health care providers consider the following factors:

• Other diseases or conditions that the person with HIV may have, such as heart disease
• Possible side effects of HIV medicines
• Potential interactions between HIV medicines or between HIV medicines and other medicines the person with HIV is taking
• Results of drug-resistance testing (and other tests). To learn more, read the HIVinfo Drug Resistance fact sheet.
• Convenience of the treatment regimen. For example, a single-tablet regimen may be more convenient than a multiple-tablet regimen.
• Any issues that prevent good HIV treatment adherence. For example, a lack of health insurance or an inability to pay for HIV medicines can make it hard to take HIV medicines consistently.

The best HIV treatment regimen for a person depends on their individual needs. Some treatment regimens are considered safe and effective for most people with HIV, such as the single-tablet regimen of bictegravir, tenofovir alafenamide, and emtricitabine. In other cases, such as suspected drug resistance, a drug like bictegravir may need to be avoided.

How long does it take for HIV medicines to work?

Viral load is the amount of HIV in a person’s blood. One of the main goals of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test.

Once HIV treatment is started, it usually takes 3 to 6 months for a person’s viral load to reach an undetectable level. Although HIV medicines cannot cure HIV, having an undetectable viral load shows that the medicines are controlling a person’s HIV. Maintaining an undetectable viral load helps people with HIV live long, healthy lives while nearly eliminating the risk of HIV transmission through sex.

This fact sheet is based on information from the following sources:

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Adherence to the Continuum of Care
  • Antiretroviral Therapy to Prevent Sexual Transmission of HIV (Treatment as Prevention)
  • Treatment Goals
  • What to Start: Initial Combination Antiretroviral Regimens for People With HIV

From the Department of Veterans Affairs:

• Treatment Decisions for HIV: Entire Section

Also see the HIV Source collection of HIV links and resources.

When is it time to start taking HIV medicines?

Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV and should be started as soon as possible after HIV is diagnosed.

One of the main goals of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test.

Maintaining an undetectable viral load helps a person with HIV live a long, healthy life. People with HIV who maintain an undetectable viral load have a very low risk of transmitting HIV to a partner without HIV through sex.

To reduce their viral load, it is important for people with HIV to start taking HIV medicines as soon as possible. Starting HIV medicines right away is especially important for people with HIV who have certain conditions.

What conditions make it especially important to start HIV medicines right away?

Although everyone with HIV should take HIV medicines as soon as possible, the following scenarios make it especially important:

• Pregnancy
• Early HIV infection
• AIDS-defining conditions

Pregnancy

All pregnant women with HIV should take HIV medicines to protect their health and prevent perinatal transmission of HIV. Women with HIV who become pregnant and are not already taking HIV medicines should start taking HIV medicines as soon as possible and throughout pregnancy. Women who are already taking an effective HIV treatment regimen when they become pregnant can typically continue using the same regimen throughout pregnancy.

The risk of perinatal transmission of HIV during pregnancy and childbirth is lowest in those with an undetectable viral load. Maintaining an undetectable viral load also helps keep the mother-to-be healthy.

Early HIV Infection

Early HIV infection, also known as acute HIV infection, is the period up to 6 months after infection with HIV. During early HIV infection, a person’s viral load is often very high.

Studies suggest that even at this early stage of HIV infection, HIV medicines can begin to protect a person’s health. In addition, starting HIV medicines during early HIV infection significantly reduces the risk of HIV transmission.

AIDS-Defining Conditions

AIDS-defining conditions are certain infections and cancers that can be life-threatening in people with HIV. Having an AIDS-defining condition indicates that a person has the immune function of a person with acquired immunodeficiency syndrome (AIDS); promptly starting HIV medicines can improve immune function, reducing the risk of other serious infections.

Once a person starts taking HIV medicines, why is medication adherence important? 

Before starting HIV treatment, it is important to talk to your health care provider about any issues that can make sticking to an HIV treatment regimen exactly as prescribed (known as treatment adherence) difficult. For example, a busy schedule or lack of health insurance can make it hard to take HIV medicines consistently. Health care providers can recommend resources to help people deal with any issues that may interfere with adherence.

After starting an HIV treatment regimen, it’s important to maintain good medication adherence. Medication adherence is key to maintaining an undetectable viral load, which protects the immune system and reduces the risk of HIV transmission. Even missing occasional treatment doses can reduce the effectiveness of HIV medicines or lead to drug resistance.

Read the following HIVinfo fact sheets to learn more about medication adherence:

• HIV Treatment Adherence
• Following an HIV Treatment Regimen: Steps to Take Before and After Starting HIV Medicines

This fact sheet is based on information from the following sources: 

From the NIH Office of AIDS Research:

• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV:
  • Initiation of Antiretroviral Therapy
  • Early (Acute and Recent) HIV Infection
• Recommendations for the Use of Antiretroviral Drugs During Pregnancy and Interventions to Reduce Perinatal HIV Transmission in the United States:
  • Recommendations for Use of Antiretroviral Drugs During Pregnancy: Overview
  • Recommendations for Use of Antiretroviral Drugs During Pregnancy: People With HIV Who Are Taking Antiretroviral Therapy When They Become Pregnant
  • Recommendations for Use of Antiretroviral Drugs During Pregnancy: Pregnant People With HIV Who Have Never Received Antiretroviral Drugs (Antiretroviral-Naive)

Also see the HIV Source collection of HIV links and resources.