Resource Center on Starting HIV Treatment

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HIV Medications

What You Need to Know About HIV Medications

David Malebranche, M.D., M.P.H.
HIV antiretrovirals scattered on a flat surface
NIAID

    One of the most important things you can do when you’re living with HIV, whether you’ve just received a diagnosis or are a long-term survivor, is take your HIV medications regularly. HIV meds, also called antiretroviral therapy or ART, slow down how fast HIV reproduces in your body. If ART works correctly, it can almost completely stop HIV from reproducing, even though it is not a cure.

    Until we have a cure for HIV, the foundation of keeping the virus at bay and living your best life is taking antiretroviral therapy. A lot has changed since the early days of HIV medications in the 1990s; HIV treatment now is more powerful, safer, and easier to take than it’s ever been.

    We’re here to help walk you through how treatment works today and what the future is likely to bring.

    How Do HIV Medications Work?

    Here’s a quick breakdown:

    • HIV, as a virus, needs a living host to reproduce.
    • HIV uses proteins called enzymes to help get into T cells, which are a type of immune system cell.
    • Once HIV gets inside a T cell, it uses the cell to make more copies of itself.
    • ART works by blocking a lot of these enzymes.
    • Different HIV meds work in different ways: Some stop the virus from using the T cell to make more copies of itself, while others prevent HIV from entering T cells in the first place.

    The medications used to fight HIV are taken in multi-drug combinations that focus on stopping HIV at a few different points of its reproductive cycle. This way, if one of the medications can’t fully stop HIV at one step (for example, entering the T cell), there is another waiting to halt it at a different step (for example, copying its genetic material).

    HIV, HIV Meds, and Your Immune System

    One of the most important concepts to understand when it comes to your HIV medications is about your immune system and what is actually happening in your body when you are living with HIV:

    • Because your body sees HIV as a foreign invader, your immune system responds by sending T cells (among other things) to fight it.
    • This fight causes a persistent and chronic state of inflammation in your entire body, including your joints, heart, brain, kidneys, and a host of other organs.
    • Over time, this heightened state of inflammation can lead to health problems of their own (aside from the long-term effects of HIV itself), including early arthritis, higher risk of stroke and heart attacks, fragility of bones, and overall frailty.

    The goal of being on HIV medications is to lower the amount of HIV in the body and bloodstream, which helps the immune system not have to fight so much. As a result, it won’t produce as much of the widespread inflammation that can eventually be destructive to your body.

    Think of it this way: Your body’s immune system will naturally be doing everything it can to combat the virus. But with the virus using that same immune system to make copies of itself and eventually destroy it, taking approved HIV medications is the best way to help your body in this daily struggle.

    This video on how HIV treatment works, featuring David Malebranche, M.D., is part of the #AskTheHIVDoc series by Greater Than AIDS, a public outreach program run by the Kaiser Family Foundation.

    Which HIV Medications Should I Take?

    When it comes to thinking about which HIV medications you should take, it can be a bit confusing and overwhelming—especially if you're newly diagnosed and have never had to take ART before. As mentioned earlier, there are many classes of medications that slow down HIV at different points of its life cycle. These meds are usually combined in easy-to-take, once-a-day pills. Only question is: Which one is best for you?

    First off, educate yourself about the various recommended ART regimens and be prepared to have an active discussion with your health care provider about what option may be best for you.

    There are many things you should consider when making this decision:

    • Have you had an HIV drug resistance test, and do you know what medications will work best?
    • What are the potential side effects of the different ART regimens?
    • Are you starting meds for the first time, or are you considering changing your meds?
    • What other medical conditions do you have?
    • What other (non-HIV) medications are you taking? Will there be any interactions?
    • What is your daily life and work schedule like, and how might that affect the timing of your doses?
    • What home and life conditions will help you take the medications daily as you should?

    Choosing which HIV medication regimen you should take can be a challenging thing. Good news is, today there are more options than ever. Empower yourself by doing some research up front, and develop an idea of which medications you think would best work for you. Remember that your HIV medications should fit comfortably into YOUR life, not vice versa.

    What About HIV Medication Side Effects?

    Many years ago, HIV medications used to have a lot of side effects, and they were often severe. But the meds people commonly use today are much, much safer.

    There are always potential side effects with every medication we take, including over-the-counter pain medications, drugs that control fevers, and treatments for high blood pressure. HIV drugs are no different.

    The key word to remember is “potential” side effects. Complications from HIV medications are not guaranteed to happen, and if they do, they are not the same for everyone. Before you say “no” to taking a medication because someone you know had a bad reaction or you remember an old report about toxic HIV drugs, do more research: talk to your medical team, as well as other people living with HIV. A medication that didn’t work for one person may be your saving grace.

    HIV Meds Used to Be Very Toxic

    There’s a lot of misinformation floating on the internet and social media about the toxicity of current HIV medications. Truth is, it’s the older HIV meds—like AZT (a.k.a. zidovudine or Retrovir), d4T (a.k.a. stavudine or Zerit) and others that were commonly used in the 1990s and early 2000s—that had many side effects. Nausea, headaches, a metallic taste in the mouth, diarrhea, low blood counts, and nerve damage were just some of the common complications we used to see from those medications.

    In fact, many people living with HIV back then used to comment that taking HIV meds felt like they were substituting one disease for another: While ART slowed down the virus and helped people them live longer, they now had to deal with all the toxicity from those early medications.

    The Worst HIV Medication Side Effects Are in the Past

    The good news is, current formulations and combinations of ART are very safe and well tolerated by most people. They’re also much less of a hassle to take: Many do not have to be taken with food or certain amounts of water as previous regimens did.

    Some of the potential side effects we see now with some people on ART include weight gain and increases in cholesterol. Reports you may have seen about regarding serious kidney damage and destructive bone loss, while a possibility, are unlikely to happen with the vast majority of people who are on ART.

    In many cases, an astute health care team can help identify whether you’re potentially at risk for one of these more serious side effects, and ensure you take a different HIV treatment regimen that’s safer for you.

    In this video from Greater Than AIDS, David Malebranche, M.D., offers information and advice on dealing with HIV medication side effects.

    How Have HIV Meds Improved Over the Years?

    In addition to fewer and less serious side effects, we really have come a long way with the science of ART. Here’s how HIV treatment has changed in the U.S. over time in some very important ways:

    • 1980s: Almost no treatment was available. The first HIV medication, AZT (also called Retrovir or zidovudine), was approved in 1987. It had to be taken several times a day and had many side effects.
    • 1990-1995: Four new drugs were developed that fight HIV in the same part of its life cycle as AZT does. They also had to be taken frequently, had many food or water restrictions, and carried a lot of side effects.
    • 1996-2005: Drug development accelerated, and 17 new medications were released, providing many new options. Most importantly, most of these drugs worked in a different way than the older ones, and the concept of a "triple-drug cocktail" emerged: taking three medications together to slow down HIV at different points in its life cycle. This made treatment success much more likely.
    • 2006: The first pill was released that combined an entire regimen of HIV medications into a single tablet. Called Atripla, it had three drugs inside it that each fought HIV in a different way.
    • 2007-today: We’ve seen steady improvements in HIV treatment options, with over a dozen new single-tablet regimens and a handful of unique new drugs giving people more choice than ever, while keeping HIV at bay better and causing fewer side effects.

    Currently in the U.S., there are more than 30 individual medications that can be used to treat HIV. Scientists have also developed more than 20 single-tablet regimens that each contain a combination of two or more HIV medications—this means that most of the time, you only need to take one pill, once a day to treat HIV.

    What Is HIV Drug Resistance, and What Can I Do About It?

    With the development of newer categories of medications and simpler regimens to take, resistance to HIV drugs has become less frequent among people living with HIV. But it does still happen, particularly with long-term HIV thrivers who have been on multiple different HIV medication regimens.

    Why Do People Develop HIV Medication Resistance?

    There are three reasons why people may develop resistance to one or more HIV medications:

    • The virus can get clever and become resistant to medications if you have not been taking them consistently. This is why many medical providers stress the concept of “adherence,” or taking your medications as directed every day.
    • You may have been exposed to HIV through someone who already had a resistant virus.
    • The virus may get tricky on its own and figure out a way to maneuver around the medications, even if you take them faithfully.

    Low adherence is a common cause of drug resistance. When a person misses too many doses, levels of the medications in their blood may drop lower, and the virus is able to outsmart the medications so that they don’t work anymore.

    Usually, the first sign you’ll see that drug resistance is happening is that your viral load will stop being undetectable and start to go higher (over 2,000 copies per milliliter). If this happens, you will want to talk with your health care provider about doing resistance testing to confirm what drugs you’ve become resistant to and figure out a new regimen that will work.

    What Do I Do If I Have HIV Drug Resistance?

    Whether you have become resistant to certain classes of HIV medications in the past, or whether you just found out for the first time that you are resistant to some medications—all is not lost! Newer HIV medications are not only strong at combating HIV, easy to take, and cause few side effects; they can also often work well against resistant virus, and are much more forgiving if you miss a dose here and there.

    Additionally, scientists and medical providers are tirelessly working to explore new combinations of powerful medications that weren’t used together before in an effort to treat people who are living with resistant strains of HIV.

    What this means is that you can work with your health care provider to get the bloodwork that will show which medications will work best for you. Together, you can find an ART regimen that will combine the medications that work best, and avoid the ones that may not work as well for you anymore.

    In this video from Greater Than AIDS, David Malebranche, M.D., explains what happens next if you learn you have HIV drug resistance.

    How Does the Future of HIV Medication Treatment Look?

    The future of HIV medication treatment looks very promising. Here’s why:

    • HIV treatment regimens keep getting stronger, safer, and easier to take. New pills get approved every year, and more are on the way.
    • Pills aren’t the only form of treatment in the works: Scientists are also working to develop HIV meds that can be taken by injection just once every couple of months, instead of by mouth every day.
    • In addition, new forms of treatment are being researched that work in a totally different way from ART—and may help the body fight off HIV on its own.

    One of the most exciting of these new forms of treatment is what’s called a monoclonal antibody, which can block HIV from attaching to T cells. The concept is similar to a vaccine you might get to protect you from diseases like chicken pox or measles, where the drug helps your body to produce the tools it needs to stop infection.

    With monocolonal antibodies, however, these tools are manufactured in a lab. Then, instead of waiting for the human body to produce more antibodies to fight HIV off naturally, we can give someone these antibodies in an injection or infusion that will enter the blood and block HIV from entering T cells.

    If all of that sounds kind of like an HIV prevention vaccine or a cure, then you’re getting a sense of why this form of treatment is so exciting! Our main goal is still to eventually develop a cure for HIV, and in fact the science behind these monoclonal antibodies may hold the key to that.

    Until that cure comes, make sure you are taking your HIV medications consistently and following up with your medical team regularly. This way your mind, body, and spirit will be in the best possible state to welcome that cure when it is developed and available.

    HIV Meds Are Just Part of the Bigger Treatment Picture

    While we have specifically been talking about HIV medications in this article, successful HIV treatment is about much more than simply taking your meds. It involves your mental health, non-medicinal approaches to taking care of your body, some herbal and natural supplements, and engaging with your medical team.

    Don’t be afraid to ask questions or make suggestions if you are curious about your medication regimen or are interested in changing—it’s YOUR body, and YOU are the one in charge!

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    HIV Medications Approved for Use in the U.S.

    Since the first HIV medication was approved for use by the U.S. Food and Drug Administration in 1987, nearly three dozen more antiretrovirals have been approved to fight HIV. On top of that, we also have more than 20 combination pills—tablets or capsules that contain two or more HIV medications within them.

    To learn more about each of these medications, use the list below, which is sorted by the brand name used in the U.S. (In parentheses, you'll also see the generic name for each drug, along with other commonly used alternate names. For the combination pills, the names of the medications within them are separated by slashes.)

    David Malebranche, M.D., M.P.H.

    David Malebranche, M.D., M.P.H.

    David Malebranche, M.D., M.P.H., is a black same-gender-loving educator, author, activist, and internal medicine physician. He co-hosts the YouTube series 'Revolutionary Health' as part of The Counter Narrative Project and also appears on the #AskTheHIVDoc video series.