- Drug Classes
- Treatment Factors
- Side Effects
- Pros & Cons
- Benefits & Risks
- Related Resources
HIV therapy is also known as antiretroviral therapy, highly active antiretroviral therapy, or antiretrovirals. Scientists have created medications that prevent HIV from replicating work to slow the progression of the disease.
There are 7 HIV drug classes based on how they fight HIV.
7 HIV drug classes
- Nucleoside reverse transcriptase inhibitors (NRTIs):
- These medications inhibit reverse transcriptase, an enzyme required by the virus to produce new viruses.
- NRTIs prevent the creation of new viruses by inserting themselves into the virus' DNA when it attempts to replicate itself.
- The first class of HIV medicines were NRTIs. An initial highly active antiretroviral therapy (HAART) regimen will typically be made up of two of these medications.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs):
- These medications bind to reverse transcriptase and alter the enzyme so that it no longer functions.
- An NNRTI may be used as the third medication in an initial HAART regimen.
- Protease inhibitors (PIs):
- These medications inhibit protease, another enzyme required by the virus for replication.
- PIs can be used as part of the first HAART regimen.
- They do, however, require the inclusion of a pharmacokinetic enhancer, which is a medication that amplifies the effects of PIs on HIV.
- Integrase strand transfer inhibitors (INSTIs):
- These medications stop HIV from replicating.
- To reproduce, HIV inserts its DNA into the DNA of CD4 cells. Integrase inhibitors suppress the HIV enzyme that facilitates the transmission.
- INSTIs can be used as the third medication in an initial HAART regimen.
- Entry inhibitors or chemokine coreceptor antagonists (CCR5s):
- These medications prevent the virus from entering the cell by blocking CCR5, a protein on the surface of CD4 cells. This keeps the infection from infiltrating.
- This protein is only found in specific strains of HIV. A blood test can inform your doctor whether your HIV strand will respond to this drug class.
- Fusion inhibitors:
- These medications keep HIV from fusing with the cell membrane of CD4 cells, thus preventing the virus from infiltrating the cell.
- These are not currently recommended as first-line therapy. They are instead an option for treatment-experienced individuals who need to switch regimens.
- Pharmacokinetic enhancers:
- These medications improve the efficacy of other medications.
- They achieve this by interfering with the breakdown of other drugs, which increases the amount of the drug in blood levels.
What are important factors in HIV treatment?
Important factors in HIV treatment include the following:
When you start therapy, you must take your medications on time. This is referred to as adherence. Adherence is essential for getting the most out of HIV medications because the drugs must be kept at certain levels in your body in order to combat the infection. If the drug level lowers, HIV may have an opportunity to fight back.
Skipping doses, not taking medications on time, and failing to follow meal requirements can all cause your drugs to be less effective or to stop working entirely.
You should witness a drop in viral load and an increase in CD4 cells after starting HIV medications. However, some people's viral loads grow with time, even as they continue to take HIV medications. When a medicine can no longer successfully fight HIV, it has become resistant to that drug.
If you develop resistance, you will almost certainly need to modify some of the medications in your regimen If your viral load increases while you are still taking HIV medications, your doctor should offer you a resistance test to determine which treatments aren't working and to help you pick ones that will.
It may be difficult to identify a treatment for certain people who have developed resistance to multiple HIV medications. The best strategy to combat resistance is to stick to your treatment schedule.
What are side effects of HIV treatments?
Side effects of HIV medications may vary from one drug to the next and from one person to the next. Common side effects of HIV treatment include:
- Muscle pain
- Joint discomfort
- Vivid nightmares
- Organ damage to the kidneys, liver, pancreas, and bone marrow.
Side effects of HIV drugs and HIV infection itself can occasionally increase the risk of cardiovascular disease and diabetes. Routine checkups are thus required, both to monitor the action of the drug and to identify any side effects. Treatment of illnesses other than HIV may have side effects that increase or decrease the efficacy of HIV medication.
Is there a cure for HIV?
Although there is no cure for HIV, the infection can be effectively managed with medication. People with HIV are treated with antiretroviral therapy (ART), which is highly efficient in lowering the quantity of virus in the blood to undetectable levels. People who use ART live a healthy life without the danger of sexually transferring the virus to their partners.
Pre-exposure prophylaxis and post-exposure prophylaxis drugs are particularly efficient in preventing HIV transmission in HIV-negative people.
What are the pros and cons of HIV treatments?
Advantages of HIV treatments
- Antiretroviral therapy (ART) prevents HIV from replicating in the body, which helps protect the immune system.
- For many people, ART can repair the immune system damage caused by HIV.
- ART reduces the risk of chronic HIV-related heart disease, cancer, renal disease. and other long-term health concerns.
- HIV increases the long-term risk of health problems such as heart disease, renal disease, and cancer. Keeping HIV suppressed helps reduce the risk of these diseases
- HIV treatment lowers the quantity of detectable virus in blood and sexual fluids, thus lowering the risk of transmission to others.
- ART can increase life expectancy.
Disadvantages of HIV treatments
- HIV or acquired immunodeficiency syndrome cannot be cured with ART.
- If an HIV-positive individual discontinues ART, the virus will begin replicating in the body again, and virus levels will increase and they will be infectious.
- ART can minimize the danger of transmission, but it is not known if it can entirely remove the risk of HIV transmission to others.
- In rare cases, ART for people with HIV will not alleviate symptoms.
- An HIV-infected individual who is feeling well and does not have HIV symptoms may feel worse on ART due to side effects such as nausea or headaches.
- Nonetheless, it is crucial to remember that ART offers significant long-term benefits for an HIV-positive person's health, even if they are not suffering symptoms initially.
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What are the benefits and risks of starting HIV treatment early?
Some doctors believe that starting therapy sooner with a CD4 count more than 350 and no symptoms is a good idea. There are benefits and risks to doing so:
- Maintaining a better CD4 cell count
- Preventing future immune system damage
- Reducing the risk of HIV and non-HIV health issues
- Lowering your risk of spreading HIV to others
- Experiencing drug-related adverse effects, including unknown long-term ill effects
- Drug resistance that may limit future treatment options
- Having to stay on therapy for a longer period
If you have been exposed to HIV, talk to your doctor about treatment options for you.
What are advancements in HIV treatment?
Based on current limitations in HIV therapy, scientists are investigating different approaches that may inhibit or cure HIV. Advancements in HIV treatments include:
- Long-lasting HIV medications:
- Given the tremendous improvement in HIV care provided by antiretroviral therapy (ART), current research focuses on producing antiretroviral medications with long-term benefits.
- In contrast to current existing pharmaceuticals that require daily administration, future long-lasting treatments are projected to require weekly, monthly, or even less frequent dosing.
- Long-term ART can take several forms, such as tablets, injections, patches, or implants.
- Furthermore, because such formulations are likely to have fewer side effects, they are expected to enhance treatment adherence and minimize treatment-related expenses.
- Neutralizing antibodies:
- Another significant strategy is to create broadly neutralizing antibodies that can help with HIV treatment in a variety of ways.
- These antibodies can directly attach to viruses and block them from entering cells, enhancing the rate of viral eradication.
- Furthermore, they can stimulate an immunological response in HIV-infected cells, ensuring viral eradication.
- Most crucially, by attaching to a critical viral component, the antibody can create a complex that can induce an immune response comparable to vaccination, thus aiding in the development of protection against future viral encounters.
- Studies have reported that a combination of complementary antibodies can successfully suppress HIV infection for an extended length of time.
- Although no vaccine exists to prevent HIV infection, researchers are working on therapeutic vaccinations that can be given to people who are already infected.
- These vaccinations prepare the body for long-term management of HIV infection by activating the immune system.
- A dual vaccination strategy has been devised, in which one vaccine targets the reservoir, whereas the other stimulates the production of antibodies that limit viral reproduction.
- HIV immunotherapy:
- Another important strategy involves drug-mediated viral reservoir activation and vaccine-mediated generation of an HIV-specific strong immune response.
- In this regard, the vaccination that induces antibody formation against the HIV protein 3S, which primes T cells to identify and destroy the virus more effectively, is the most promising.
- New drugs:
- In addition, new medications for daily ART are being developed. Nucleoside reverse transcriptase translocation inhibitors (inhibit HIV reverse transcriptase and impede DNA synthesis) and maturation inhibitors (halt viral maturation by targeting HIV lifecycle) are two medications under research.
- Furthermore, medications that bind to the viral surface protein (gp120) to prevent virus-mediated immune cell infection, as well as pharmaceuticals that block capsid (protein shell that covers the viral DNA), are being researched.
- The discovery of medications that can block viral replication by binding to a particular RNA sequence of the virus is the most promising. The primary purpose of this strategy is to target the latent HIV reservoir within the cells.
- Another key technique is to create medications that first activate the latent viral reservoir before eradicating the virus with standard ART.
- Gene editing:
- Another possibility is to insert a particular mutation into the human DNA that renders them immune to HIV infection.
- This mutation is found in about 1% of the world's population who are naturally resistant to HIV.
- This genetic mutation results in the creation of a structurally different immune cell surface protein (CCR5) than the wild-type protein.
- The virus is unable to connect to the changed protein, making it difficult for the virus to enter and infect the immune cell.
- Such alterations will be considerably easier to introduce in the future thanks to the CRISPR-Cas9 gene-editing technique.
Health Solutions From Our Sponsors
What is HIV treatment? https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html
HIV and AIDS: Medicines to Help You: https://www.fda.gov/consumers/free-publications-women/hiv-and-aids-medicines-help-you
HIV Drug Resistance: https://www.who.int/news-room/fact-sheets/detail/hiv-drug-resistance
Current and future priorities for the development of optimal HIV drugs: https://journals.lww.com/co-hivandaids/fulltext/2019/03000/current_and_future_priorities_for_the_development.12.aspx
Combination Antiretroviral Therapy for HIV Infection: https://www.aafp.org/afp/1998/0601/p2789.html
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How Do Integrase Strand-Transfer Inhibitors Work in Antiretroviral Therapy for HIV Infection?Integrase strand-transfer inhibitors (INSTIs) are one of the latest additions to the classes of drugs used in antiretroviral therapy (ART) for human immunodeficiency (HIV) infection. INSTIs are often a part of fixed-dose, single pill, combination drug formulations for ART. INSTIs can help prevent HIV from progressing into AIDS (acquired immunodeficiency syndrome).
How Effective Is ART for HIV Infection?Antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection is a treatment regimen used to reduce the amount of the virus in the body (viral load). There is no cure for HIV, but antiretroviral therapy given as a combination of different drugs can slow the progress of the infection and reduce the chances of transmission to others.
How Is HIV Currently Being Treated?Treatment for human immunodeficiency virus (HIV) is ongoing and consists of various antiviral medication combinations (antiretroviral therapy).
Human Immunodeficiency Virus (HIV)
HIV (human immunodeficiency virus) infection left untreated causes AIDS (acquired immunodeficiency syndrome).
- The human immunodeficiency virus (HIV) is a type of virus called a retrovirus, which can infect humans when it comes in contact with tissues that line the vagina, anal area, mouth, or eyes, or through a break in the skin.
- HIV infection is generally a slowly progressive disease in which the virus is present throughout the body at all stages of the disease.
- Three stages of HIV infection have been described.
- The initial stage of infection (primary infection), which occurs within weeks of acquiring the virus, often is characterized by the flu- or mono-like illness that generally resolves within weeks.
- The stage of chronic asymptomatic infection (meaning a long duration of infection without symptoms) lasts an average of eight to 10 years without treatment.
- The stage of symptomatic infection, in which the body's immune (or defense) system has been suppressed and complications have developed, is called the acquired immunodeficiency syndrome (AIDS). The symptoms are caused by the complications of AIDS, which include one or more unusual infections or cancers, severe loss of weight, and intellectual deterioration (called dementia).
- When HIV grows (that is, by reproducing itself), it acquires the ability to change (mutate) its own structure. These mutations enable the virus to become resistant to previously effective drug therapy.
- The goals of drug therapy are to prevent damage to the immune system by the HIV virus and to halt or delay the progress of the infection to symptomatic disease.
- Therapy for HIV includes combinations of drugs that decrease the growth of the virus to such an extent that the treatment prevents or markedly delays the development of viral resistance to the drugs.
- The best combination of drugs for HIV are those that effectively suppress viral replication in the blood and also are well tolerated and simple to take so that people can take the medications consistently without missing doses.
Is It Possible for HIV to Go Away on Its Own?When a person contracts the human immunodeficiency virus (HIV), they are infected for life; however, early treatment can help them live normal lives.
What Are NRTIs in Antiretroviral Therapy For HIV Infection?Nucleoside reverse transcriptase inhibitors (NRTIs) treat human immunodeficiency virus (HIV) infection. NRTIs were the first drugs developed to manage HIV and remain a mainstay of antiretroviral therapy (ART) combinations. HIV progressively weakens the immune system, leading to acquired immune deficiency syndrome (AIDS), when the body is no longer able to fight infection effectively. HIV has no cure and can only be controlled by lifelong medication.
How Do Protease Inhibitors Work in Antiretroviral Therapy for HIV Infection?Protease inhibitors are one of the classes of drugs in the combination of drugs used for antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection. Protease inhibitors may be one class of drugs included in the ART cocktail for HIV to prevent its progression into AIDS (acquired immunodeficiency syndrome), which may cause death from secondary infection or cancer after the collapse of the immune system.
Can I Test HIV Positive If My Viral Load is Undetectable?You can still test positive for the human immunodeficiency virus (HIV) even if your viral load is undetectable.
What Are NNRTIs In Antiretroviral Therapy for HIV Infection?Non-nucleoside reverse transcriptase inhibitors (NNRTIs) are one of the classes of drugs that form part of the antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection. An NNRTI drug may be part of a cocktail of ART drugs that each target HIV at different points in its replication cycle to help lower the level of virus in the body and prevent HIV from causing AIDS (acquired immunodeficiency syndrome). AIDS may lead to death from secondary infections after immune system collapse.
What Are the Single-Tablet ART Regimens for HIV Infection?Antiretroviral Therapy (ART) for HIV is usually tailored to suit individual requirements. Currently, seven classes of drugs are available individually, but can be combined for a complete ART regimen, which usually contains three different drugs targeting the virus at different stages of replication. ART regimens are increasingly combined in single-tablet formulations to help patients comply with treatment and avoid the disease progressing into AIDS (acquired immunodeficiency syndrome).
What Is the Difference Between HIV and AIDS?HIV is a virus that causes immunosuppression. The difference between HIV and AIDS is that HIV is the first stage of the viral illness while AIDS represents the progression of the illness.