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HIV and AIDS Treatment & Care

 Fight AIDS in the first 100 days march in Washington D.C. in November 2008

People with HIV can live long and healthy lives with access to treatment. Since HIV was first reported substantial progress in the research and development of antiretroviral drugs has been made. There are now more than 20 approved antiretroviral drugs. Despite this, people with HIV face many barriers to accessing affordable, effective HIV treatment.

Taking HIV treatment requires effort and commitment as drugs must be taken at exact times each day. Some people may experience serious side-effects or may not respond to certain drugs. Treatment, care and support can help people to adhere to treatment and address any problems they may have with their treatment regimen.

What is HIV antiretroviral drug treatment?

Tenofovir tabletsThis is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a person’s life.

The aim of antiretroviral treatment is to keep the amount of HIV in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV might have caused already.

The drugs are often referred to as: antiretrovirals, ARVs, anti-HIV or anti-AIDS drugs.

What is combination therapy?

Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART).

If only one drug was taken, HIV would quickly become resistant to it and the drug would stop working. Taking two or more antiretrovirals at the same time vastly reduces the rate at which resistance would develop, making treatment more effective in the long term. Our starting, monitoring and switching HIV treatment page has more about drug resistance.

What does combination therapy usually consist of?

The leading recommendations for antiretroviral treatment were published by the World Health Organisation (WHO) in 2013. 1 For adults and adolescents, they recommend starting on a first line therapy of two nucleoside reverse-transcriptase inhibitors (NRTIs) plus a non-nucleoside reverse-transcriptase inhibitor (NNRTI). The favoured recommendation is a fixed-dose combination (just one pill) of:

  • TDF - Tenofovir
  • 3TC - Lamivudine or FTC - Emtricitabine
  • EFV - Efavirenz

Speak to your health care provider about the most suitable available option for you. See our Treatment for Children page for specific recommendations for children.

The choice of drugs to take can depend on a number of factors, including the availability and price of drugs, the number of pills, the side effects of the drugs, the laboratory monitoring requirements and whether there are co-blister packs or fixed dose combinations available. Most people living with HIV in the developing world still have very limited access to antiretroviral treatment and often only receive treatment for the diseases that occur as a result of a weakened immune system. Such treatment has only short-term benefits because it does not address the underlying immune deficiency itself.

First and second line therapy

At the beginning of treatment, the combination of drugs that a person is given is called first line therapy. If after a while HIV becomes resistant to this combination, or if side effects are particularly bad, then a change to second line therapy is usually recommended.

Second line therapy recommendations by WHO suggest two NRTIs and a ritonavir-boosted protease inhibitor (PI). 2

Our starting, monitoring and switching HIV treatment page has more information about changing HIV treatment.

How many HIV and AIDS drugs are there?

There are more than 20 approved antiretroviral drugs but not all are licensed or available in every country. See our drugs table for a comprehensive list of antiretroviral drugs approved by the American Food and Drug Administration.

The groups of antiretroviral drugs

There are five groups of antiretroviral drugs. Each of these groups attacks HIV in a different way.

Antiretroviral drug classAbbreviationsFirst approved to treat HIVHow they attack HIV
Nucleoside/Nucleotide Reverse Transcriptase InhibitorsNRTIs,
nucleoside analogues,
nukes
1987NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself.
Non-Nucleoside Reverse Transcriptase InhibitorsNNRTIs,
non-nucleosides,
non-nukes
1997NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.
Protease InhibitorsPIs1995PIs inhibit protease, which is another protein involved in the HIV replication process.
Fusion or Entry Inhibitors 2003Fusion or entry inhibitors prevent HIV from binding to or entering human immune cells.
Integrase Inhibitors 2007Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells.

NRTIs and NNRTIs are available in most countries. Fusion/entry inhibitors and integrase inhibitors are usually only available in resource-rich countries.

Protease inhibitors are generally less suitable for starting treatment in resource-limited settings due to the cost, number of pills which need to be taken, and the particular side effects caused by protease drugs.

More information

Choosing when to start antiretroviral treatment is a very important decision. Once treatment has begun it must be adhered to, in spite of side effects and other challenges. Many factors must be weighed up when deciding whether to begin treatment, including the results of various clinical tests. These issues are addressed in the starting, monitoring and switching HIV treatment page.

References

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