HIV Treatment

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 seven drug classes based on how they fight HIV.

The seven 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

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.

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.

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.

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.