Antiretroviral: Types & Treatments Overview

picture of Antiretroviral


Taking Antiretroviral Drugs

Taking antiretroviral drugs for HIV will not cure your infection. But it may allow you to stay healthy for a long time. And treatment can help prevent spreading the infection to other people.

Your willingness and ability to follow your antiretroviral therapy schedule exactly as prescribed is essential for successful treatment of your HIV infection. Not following your prescribed HIV therapy may cause treatment failures, such as:

  • Drug resistance. The virus that causes HIV can become resistant to antiretroviral drugs used to treat the infection.
  • Higher viral loads. This measures how much HIV is present in your blood.
  • Disease progression.

In the past a person had to take many pills several times a day, which was hard for some people. But over the past few years, this routine has become much simpler, and people take their medicine only once or twice a day. With the right knowledge and tools, you can successfully take your medicine as prescribed.

If you are at high risk for getting infected with HIV, you also may take antiretroviral medicine to help protect yourself from HIV infection. But to keep your risk low, you still need to practice safer sex even while you are taking the medicine.

Types of HIV/AIDS Antiretroviral Drugs

There are six major types of drugs used to treat HIV/AIDS. Called antiretrovirals because they act against the retrovirus HIV, these drugs are grouped by how they interfere with steps in HIV replication (PDF).

Entry Inhibitors interfere with the virus’ ability to bind to receptors on the outer surface of the cell it tries to enter. When receptor binding fails, HIV cannot infect the cell.

Fusion Inhibitors interfere with the virus’s ability to fuse with a cellular membrane, preventing HIV from entering a cell.

Reverse Transcriptase Inhibitors prevent the HIV enzyme reverse transcriptase (RT) from converting single-stranded HIV RNA into double-stranded HIV DNA―a process called reverse transcription. There are two types of RT inhibitors:

  1. Nucleoside/nucleotide RT inhibitors (NRTIs) are faulty DNA building blocks. When one of these faulty building blocks is added to a growing HIV DNA chain, no further correct DNA building blocks can be added on, halting HIV DNA synthesis.
  2. Non-nucleoside RT inhibitors (NNRTIs) bind to RT, interfering with its ability to convert HIV RNA into HIV DNA

Integrase Inhibitors block the HIV enzyme integrase, which the virus uses to integrate its genetic material into the DNA of the cell it has infected.

Protease Inhibitors interfere with the HIV enzyme called protease, which normally cuts long chains of HIV proteins into smaller individual proteins. When protease does not work properly, new virus particles cannot be assembled.

Multi-class Combination Products combine HIV drugs from two or more classes, or types, into a single product.

To prevent strains of HIV from becoming resistant to a type of antiretroviral drug, healthcare providers recommend that people infected with HIV take a combination of antiretroviral drugs in an approach called highly active antiretroviral therapy (HAART). Developed by NIAID-supported researchers, HAART combines drugs from at least two different classes.

For a complete listing of Food and Drug Administration (FDA)-approved antiretroviral drugs used to treat HIV/AIDS, see the FDA website.

When should I start treatment?

It is now recommended that people living with HIV start antiretroviral treatment straight away.

Without treatment, people living with HIV can become ill because of the damage HIV does to the immune system. The immune system is your body’s way of protecting itself from illnesses caused by germs, bacteria or infections.

Previously, the decision about when to start treatment depended on a CD4 count test, which looks at how many CD4 cells are in a small amount of blood.

The CD4 cells (also called T-helper cells) are an important part of the immune system because they fight a germ or infection. HIV attacks CD4 cells and reduces the number of them in your body. Without treatment, HIV slowly weakens the immune system, making it harder for your body to fight off illness or infection.

Other reasons to start treatment

Antiretroviral treatment also lowers your viral load, which makes it less likely that HIV will be passed on. For this reason, it is important that all women with HIV who are pregnant or breastfeeding, take treatment to prevent HIV being passed on to their baby. Anyone living with HIV who is in a relationship with someone who does not have HIV (a mixed-status relationship) should also consider treatment to prevent HIV transmission.

Being emotionally ready to start treatment

Perhaps the most important factor of all is whether you feel ready to start HIV treatment. Current HIV treatment has to be taken every day for the rest of your life. You might feel good about starting HIV treatment, because it is something you can do to stay healthy and strong. But it is also normal to feel worried about it, or to have questions. Give yourself time to prepare for taking HIV treatment every day.

In addition to talking to your doctor, you may find it helpful to talk to someone who has experience of taking HIV treatment. Many clinics have peer mentors, who can offer support and information, or can put you in touch with community organisations and peer support groups.