In 1981, the first known case of AIDS (acquired immunodeficiency syndrome) — the final stage of infection with HIV (human immunodeficiency virus) — was reported. Six years later, in 1987, the U.S. Food and Drug Administration (FDA) approved the first drug for the treatment of AIDS: zidovudine or azidothymidine (AZT).

Today, there are more than 30 FDA-approved drugs for the treatment of HIV infection.

With effective treatment, you can be HIV-positive and live a long, healthy life, with a very low risk of transmitting the virus to others.

You should start HIV treatment as soon as possible after diagnosis, according to the Centers for Disease Control and Prevention (CDC).

What Is Antiretroviral Therapy?

While there’s no drug currently available that can rid the body of HIV, thereby curing the viral infection, many people diagnosed with HIV now can live much longer with a combination of HIV medicines known as antiretroviral therapy (ART). With ART, most people can get the virus under control within six months, notes the CDC.

These drugs, when taken in a daily combination, suppress the virus by interfering with its ability to replicate in the body, and thereby significantly lower the amount of virus in your blood and body fluids.

Viral suppression generally means having less than 200 copies of HIV per milliliter of blood.

Being virally suppressed greatly reduces your chances of spreading HIV to your sexual partner. If you have an undetectable viral load (so low that a test can’t detect it), you effectively have no risk of spreading HIV through sex.

With a very low amount of HIV in your body, your immune system can remain robust enough to prevent the opportunistic infections and cancers that signal a progression of HIV to AIDS.

There are two types of drug regimens available that can prevent you from contracting HIV in the first place:

Pre-exposure prophylaxis, or PrEP, which reduces your risk of becoming infected with HIV when taken every day
Post-exposure prophylaxis, or PEP, which reduces your risk of becoming infected if you take it within 72 hours of being exposed to HIV

Different Types of Antiretroviral Drugs

There are eight classes of antiretroviral drugs for HIV, each of which act on a different step in HIV's replication cycle.

People generally take three drugs from two different classes. To be effective, these drugs need to be taken every day, according to the National Institutes of Health (NIH).

Adherence to this routine can be challenging, but taking these drugs is critical to keep your viral load as low as possible and to avoid drug resistance.

The classes of drugs include:

Nucleoside reverse transcriptase inhibitors (NRTIs), such as Retrovir (zidovudine), Ziagen (abacavir), and Emtriva (emtricitabine), which block reverse transcriptase, an enzyme that the virus needs to copy itself
Non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as Sustiva (efavirenz), Intelence (etravirine), and Viramune (nevirapine), which bind to and alter reverse transcriptase
CCR5 antagonists (also called entry inhibitors), such as Selzentry (maraviroc), which blocks CCR5, a receptor protein on the surface of CD4 cells (immune system cells) to which the virus binds in order to enter the cell
Fusion inhibitors, such as Fuzeon (enfuvirtide), which also block HIV's ability to enter CD4 cells
Protease inhibitors, such as Reyataz (atazanavir), Norvir (ritonavir), and Aptivus (tipranavir), which block protease, an enzyme HIV needs in order to mature, replicate, and infect new CD4 cells
Integrase strand transfer inhibitors (INSTIs), such as Tivicay (dolutegravir) and Isentress (raltegravir), which block integrase, an enzyme the virus uses to integrate its genetic material into its host cell's DNA
Attachment inhibitors, such as Rukobia (fostemsavir), which prevent HIV from entering CD4 cells
Post-attachment inhibitors, such as Trogarzo (ibalizumab), which belong to the larger groups of drugs known as entry inhibitors

According to the NIH, the first HIV regimen that a person is usually prescribed includes two NRTIs along with an INSTI, an NNRTI, or a protease inhibitor strengthened with a pharmacokinetic enhancer, such as Tybost (cobicistat), which can increase the effectiveness of the antiretroviral drugs (though it has no effect on the virus when used alone).

There are also fixed-dose combination antiretroviral medicines — single pills that contain multiple drugs. Fixed-dose combination drugs prevent drug resistance by ensuring that patients do not take drugs from only a single class. These medicines include:

In 2019, the FDA approved Dovato (dolutegravir and lamivudine), the first two-drug, fixed-dose regimen for adults with HIV who've never received treatment.

And in 2021, the first long-acting complete HIV treatment regimen was approved by the FDA. An injectable combination of cabotegravir (an integrase inhibitor) and rilpivirine (an NNRTI), it’s sold under the brand name Cabenuva and is administered once a month by a healthcare provider. This medicine is intended for patients who have already lowered their viral load.

Potential Side Effects of HIV Medication

HIV drugs have side effects, but the newer medicines have fewer and less severe complications than older HIV medication. The side effects of various HIV drugs are usually tolerable but can sometimes be serious.

They include:

Headache and dizziness
Diarrhea
Fatigue
Nausea and vomiting
Pain
Nerve problems
Rash
Unusual fat loss or fat buildup (lipodystrophy)
Insulin resistance
Bone loss (osteoporosis)
Lactic acidosis, a buildup of lactic acid in the bloodstream
Swelling of the mouth or tongue
Liver inflammation or damage

While some side effects may last just a few days, others can extend over a longer term. But it varies from person to person.

Talk with your doctor if the side effects you’re experiencing make you want to stop taking your medication. It’s critical to take these drugs every day, but it may be possible to change the particular ART medication you’re taking or to take additional medication to help with specific side effects.

How to Avoid Possible Drug Interactions on ART

Be sure to discuss all the drugs and supplements you're taking with your doctor, because antiretroviral drugs can interact with a wide range of other medicines.

Certain drugs or supplements may compromise the efficacy of HIV medication. These include, but are not limited to:

Acid-reducing agents and acid reflux medication, including antacids, proton pump inhibitors, and H2 antagonists
Drugs and supplements that affect p-glycoprotein or the enzyme CYP3A4, such as St. John's wort.

Although some antiretroviral drugs may have interactions with gender-affirming hormone therapy, the NIH recommends ART to all transgender people with HIV and advises that clinical effects should be monitored and hormone levels should be adjusted as needed.

According to the CDC, PrEP medication has not been reported to make hormone therapy (estrogens and anti-androgens) less effective, and hormone therapy hasn’t been reported to change the efficacy of PrEP.

COVID-19 and HIV

People with HIV should be sure to get vaccinated and boosted against COVID-19, says the U.S. Department of Health and Human Services, because of the increased risk of severe disease should they become infected.

Per the CDC, those with HIV are eligible for a booster if they were vaccinated five months prior with the Pfizer-BioNTech or Moderna shots, or two months prior with Johnson & Johnson.

People with advanced or untreated HIV are even more vulnerable to COVID-19 and require extra protection. The CDC recommends that those who are immunized with the two-dose Pfizer or Moderna vaccines receive a third dose as soon as 28 days after getting their second shot and potentially a fourth dose five months later.

There’s currently no evidence to suggest potential interactions between the vaccines and ART or PrEP.

Additional reporting by Deborah Shapiro.

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

A Timeline of HIV and AIDS. HIV.gov.
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living With HIV. ClinicalInfo.HIV.gov.
HIV Treatment. Centers for Disease Control and Prevention.
Newly Diagnosed With HIV. Centers for Disease Control and Prevention.
Protecting Others. Centers for Disease Control and Prevention.
FDA-Approved HIV Medicines. HIVinfo.NIH.gov.
FDA Approves First Two-Drug Complete Regimen for HIV-infected Patients Who Have Never Received Antiretroviral Treatment. U.S. Food and Drug Administration.
FDA Approves Cabenuva and Vocabria for the Treatment of HIV-1 Infection. U.S. Food and Drug Administration.
HIV Medicines and Side Effects. HIVinfo.NIH.gov.
HIV Treatment Overview. HIV.gov.
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living With HIV: Drug-Drug Interactions. ClinicalInfo.HIV.gov.
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living With HIV: Transgender People With HIV. ClinicalInfo.HIV.gov.
HIV Testing, Prevention, and Care for Transgender People. Centers for Disease Control and Prevention.
COVID-19 Vaccine Booster Shots. Centers for Disease Control and Prevention.
COVID-19 Vaccines for Moderately or Severely Immunocompromised People. Centers for Disease Control and Prevention.
What to Know About HIV and COVID-19. Centers for Disease Control and Prevention.

Ressourcen

A Timeline of HIV and AIDS. HIV.gov.
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living With HIV: What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient. ClinicalInfo.HIV.gov. June 3, 2021.
HIV Treatment. Centers for Disease Control and Prevention (CDC). May 20, 2021.
Newly Diagnosed With HIV. CDC. April 7, 2021.
Protecting Others. CDC. May 20, 2021.
FDA-Approved HIV Medicines. HIVInfo.NIH.gov. August 24, 2021.
FDA Approves First Two-Drug Complete Regimen for HIV-infected Patients Who Have Never Received Antiretroviral Treatment. U.S. Food and Drug Administration. April 8, 2019.
FDA Approves Cabenuva and Vocabria for the Treatment of HIV-1 Infection. U.S. Food and Drug Administration. January 27, 2021.
Side Effects of HIV Medicines. HIVInfo.NIH.gov. August 23, 2021.
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living With HIV: Drug-Drug Interactions. ClinicalInfo.HIV.gov. June 3, 2021.
Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living With HIV: Transgender People With HIV. ClinicalInfo.HIV.gov. December 18, 2019.
HIV Testing, Prevention, and Care for Transgender. CDC. March 23, 2021.
COVID-19 Vaccine Booster Shots. CDC. January 21, 2022.
COVID-19 Vaccines for Moderately or Severely Immunocompromised People. CDC. January 7, 2022.
What to Know About HIV and COVID-19. CDC. August 27, 2021.

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