Table of ContentsView AllTable of ContentsWhat Is Antiretroviral Therapy?How It WorksSide EffectsTestsOther TreatmentsTalk to Your DoctorFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is Antiretroviral Therapy?
How It Works
Side Effects
Tests
Other Treatments
Talk to Your Doctor
Frequently Asked Questions
Without treatment, it takes an average of eight to 10 years before HIV weakens your immune system to the point that you have acquired immunodeficiency syndrome (AIDS), the most advanced stage of infection.
While HIV cannot be cured, it can be treated with a group of drugs known asantiretrovirals. When used in combination, antiretroviral drugs prevent the virus from making copies of itself. By doing so, the virus can be suppressed to levels where it can do the body little harm. This article will discuss how antiretrovirals work to help people with HIV.
Verywell / Theresa Chiechi
Antiretroviral therapy (ART)involves using two or more antiretroviral drugs to suppress the virus to undetectable levels in the blood. This treatment can slow the progression of the disease to a point at which you can live a long, healthy life.
The benefits of anundetectable viral loadare threefold:
How Long Does It Take for HIV Symptoms to Show?
How Retroviruses Work
The different classes of antiretrovirals are named after the specific stage of the replication cycle they inhibit (block). The five broad categories are:
There are also pharmacokinetic enhancers used in ART that boost the concentration of antiretrovirals so that they remain effective for a longer period of time, even if you miss a dose.
To fully suppress HIV to undetectable levels, two or more antiretroviral drugs must be used incombination therapy. To date, there is no single antiretroviral drug that alone can fully and durably suppress HIV.
Antiretroviral drugs need to be taken daily to maintain a consistent, suppressive level of medications in the bloodstream. In 2021, a new injectable drug, calledCabenuva(cabotegravir + rilpivirine), was introduced that requires two injections monthly or every two months to achieve the same level of viral control.
How HIV Is Treated
Drugs List
As of 2022, there are 26 individual antiretroviral agents approved for the treatment of HIV. Many are formulated into fixed-dose combination (FDC) drugs comprised of two or more antiretrovirals.
FDC drugs are attractive because they offer greater ease of use. There are currently 22 FDC drugs approved for the treatment of HIV, some of which only require one pill daily to achieve viral control.
While all drugs can cause side effects, current antiretrovirals tend to cause far fewer side effects than drugs of the past. Even so, side effects can occur and, in rare cases, be severe.
Short-term side effects may include headache, fatigue, nausea, diarrhea, insomnia, and even a mild rash. These tend to resolve within a few weeks as your body adapts to treatment.
Among the concerns:
When to Call 911Call 911 if you have signs of asevere allergic reactionafter starting or switching to a new HIV drug. These include:Sudden, severe hives or rashShortness of breathWheezingRapid or irregular heartbeatSwelling of the face, tongue, or throatDizziness or faintingNausea or vomitingDiarrheaA feeling of impending doom
When to Call 911
Call 911 if you have signs of asevere allergic reactionafter starting or switching to a new HIV drug. These include:Sudden, severe hives or rashShortness of breathWheezingRapid or irregular heartbeatSwelling of the face, tongue, or throatDizziness or faintingNausea or vomitingDiarrheaA feeling of impending doom
Call 911 if you have signs of asevere allergic reactionafter starting or switching to a new HIV drug. These include:
Side Effects of HIV Drugs You Should Know
Once you have been diagnosed with HIV, your doctor will advise to you start treatment immediately to bring the virus under control. You will not only be counseled on how to take your drugs correctly (including dietary restrictions) but also advised on ways to maintain optimal adherence.
You will also be given baseline blood tests, called a CD4 count and viral load, against which your response to treatment will be measured. You will be asked to return every three to six months to have these blood tests repeated.
CD4 Count
The CD4 count measures the number ofCD4 T-cellsin your blood.CD4 T-cells are responsible for instigating the immune response and are the very cells that HIV targets for infection. As HIV kills off more and more of these cells, the body becomes less able to defend itself against otherwise harmlessopportunistic infections.
The CD4 count measures the status of your immune system based on the number of CD4 T-cells in a cubic millimeter (cells/mm3) of blood. A CD4 count is broadly categorized as follows:
With early ART, the CD4 count should increase to normal to near-normal levels. People who delay treatment until the disease is advanced generally have a harder time rebuilding their immune system.
Barriers to Boosting CD4 Counts
Viral Load
The viral load measures the actual number of viruses in a sample of blood. The viral load can run well into the millions if left untreated. If treated appropriately, the viral load can be reduced to undetectable levels.
Undetectable does not mean that the virus is gone. Although the virus may not be detectable with blood tests, there will be many hidden in the tissues throughout the body known as viral reservoirs. If ART is stopped, these latent viruses can reactivate and lead to a rebound in the viral load.
The viral load can also help determine if a treatment is failing due to drug resistance. Drug resistance most often occurs when you don’t take your drugs as prescribed. But it can also develop naturally after many years of treatment. If drug resistance occurs, the viral load will gradually creep up even if you are taking your drugs as prescribed.
When the viral load indicates that a treatment has failed, your doctor will begin the process of selecting a new combination of drugs for you.
RecapThe CD4 count is a measure of your immune status. The viral load is a measure of the amount of HIV in your blood. Although the CD4 count can vary from person to person, the viral load should remain undetectable while you are on ART.
Recap
The CD4 count is a measure of your immune status. The viral load is a measure of the amount of HIV in your blood. Although the CD4 count can vary from person to person, the viral load should remain undetectable while you are on ART.
How HIV Is Diagnosed
There are no other medications other than antiretrovirals that can control HIV.
Even so, there are drugs a doctor may prescribe along with ART if you are at risk of an opportunistic infection. These preventive medications, referred to aprophylactics, are commonly prescribed when your CD4 count is below 200 or 100.
These may include daily oral antibiotics to prevent severe infections likepneumocystis pneumonia (PCP)ormycobacterium avium complex (MAC).
Healthy lifestyle practices are also advised, irrespective of your CD4 count. This helps reduce the risk of non-HIV-associated illnesses—such as heart disease and certain cancers—that occur earlier and more frequently in people with HIV.
Healthy lifestyle choices for people with HIV include:
HIV and AIDS: A Complete Guide
The choice of ART relies heavily on the results of a genetic resistance testthat helps determine which antiretrovirals work best based on your virus’s genetic profile. But it is not the sole factor involved in the selection of ART.
As you will be the one taking the pills every day, you will want medications with the greatest tolerability and the greatest ease of use. Both help improve adherence.
With that said, never stop treatment without first speaking with your doctor.
Summary
Antiretroviral therapy is used to control HIV. It relies on drugs that inhibit points of the viral replication cycle so the virus cannot make copies of itself and infect immune system cells. Antiretroviral drugs are usually given daily in the form of a pill, which may contain a combination of drugs. These medications may have side effects.
If an individual isn’t responding to antiretroviral therapy or isn’t able to adhere to taking the medications, another drug combination may be used.
A Word From Verywell
Antiretroviral therapy has advanced to where people living with HIV enjoy long, healthy lives with minimal side effects or impact on lifestyle. With that said, the drugs only work if you take them, and that is where many people fall short.
According to the Department of Health and Human Services (HHS), fewer than 60% of people living with HIV in the United States achieve and sustain an undetectable viral load. Moreover, of the estimated 1.2 million people living with the disease in the United States, roughly 1 in 7 remain undiagnosed.
If you have trouble paying for your medications or doctor’s visits, some programs can help. These include co-pay and patient assistance programs that can reduce your out-of-pocket costs to zero.
There are also federally funded programs under the Ryan White Act that can assist with medications and other costs of care. Speak with your doctor or a certified social worker experienced with HIV.
4 Tips for Making HIV Drugs More Affordable
No. Although a small handful of people have had no signs of HIV after experimental stem cell transplants—including Timothy Ray Brown (known as the “Berlin Patient,” considered the first person cured of HIV/AIDS)—the procedure carries a high risk of death and has not worked for everyone who has undergone the transplant.Learn MoreAre We Near a Cure for HIV?
No. Although a small handful of people have had no signs of HIV after experimental stem cell transplants—including Timothy Ray Brown (known as the “Berlin Patient,” considered the first person cured of HIV/AIDS)—the procedure carries a high risk of death and has not worked for everyone who has undergone the transplant.
Learn MoreAre We Near a Cure for HIV?
HIV is only genetic in that there is a multitude of genetic variants (versions). Some HIV variants are resistant to different antiretroviral drugs and can be passed from one person to the next through sex or shared needles.Genetic resistance testing is used to determine which variants a person has and which HIV drugs are most effective against them.
HIV is only genetic in that there is a multitude of genetic variants (versions). Some HIV variants are resistant to different antiretroviral drugs and can be passed from one person to the next through sex or shared needles.
Genetic resistance testing is used to determine which variants a person has and which HIV drugs are most effective against them.
As more and more of these cells are destroyed over the course of years, the body becomes less able to defend itself against potentially serious opportunistic infections.
Learn MoreHow Long Can I Live If I Get HIV?
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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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