To date, in South Africa alone, there are an estimated 4.5 million people receiving antiretroviral (ARV) therapy. This places South Africa as the country with the largest ARV therapy programme in the world. As a result, there are an increasing number of reports on the occurrence of ARVs in South African waters. Achieving efficient and bio-friendly methods for the removal of these pollutants is considered as a concern for environmental researchers. This study aims at studying the efficiency of a moving bed biofilm reactor (MBBR) system for removing ARVs from wastewater. A continuous-flow laboratory scale system was designed, built, installed, and operated at a carrier filling rate of 30%, an organic loading rate of 0.6 kg COD/m3.d-1 OLR, a hydraulic retention time of 18h, and a 27.8 mL/min flow rate. The systems were monitored over time for the elimination of conventional wastewater parameters i.e., Biological Oxygen Demand, Chemical Oxygen Demand, and nutrients. The results showed that the MBBR system as a bio-friendly method has high efficiency in removing Nevirapine, Tenofovir, Efavirenz, Ritonavir and Emtricitabine from the synthetic influent sample with an average removal of 62%, 74%, 94%, 94% and 95%, respectively, after 10 days of operation.