Treatments and drugs

By Mayo Clinic Staff

There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each of the classes of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two different classes to avoid creating strains of HIV that are immune to single drugs. The classes of anti-HIV drugs include:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs). NNRTIs disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
  • Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
  • Protease inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
  • Entry or fusion inhibitors. These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
  • Integrase inhibitors. Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.

When to start treatment

Current guidelines indicate that treatment should begin if:

  • You have severe symptoms
  • Your CD4 count is under 500
  • You're pregnant
  • You have HIV-related kidney disease
  • You're being treated for hepatitis B

Treatment can be difficult

HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can include:

  • Nausea, vomiting or diarrhea
  • Abnormal heartbeats
  • Shortness of breath
  • Skin rash
  • Weakened bones
  • Bone death, particularly in the hip joints

Co-diseases and co-treatments
Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV medications. Talk to your doctor about other conditions you're receiving medication for. There are also known interactions between anti-HIV drugs and:

  • Contraceptives and hormones for women
  • Medications for the treatment of tuberculosis
  • Drugs to treat hepatitis C

Treatment response

Your response to any treatment is measured by your viral load and CD4 counts. Viral load should be tested at the start of treatment and then every three to four months during therapy. CD4 counts should be checked every three to six months.

HIV treatment should reduce your viral load to the point that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it. You can still transmit HIV to others when your viral load is undetectable.

Aug. 11, 2012