Treatment Overview

Treatment for HIV  

Since the approval of a drug called AZT in 1987, about 30 HIV drugs have been approved for the treatment of people living with HIV, and more are being developed. You may have heard these drugs called many different names, including "The Cocktail," antiretrovirals and highly active antiretroviral therapy (HAART or ART). The use of HIV medication, often called antiretroviral (ARV) drugs, to treat HIV infection is called antiretroviral therapy (ART). ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission. People on ART take a combination of HIV medicines (called an HIV regime) every day.  

Standard ART consists of the combination of at least three ARV drugs to effectively suppress the HIV virus and stop the progression of HIV disease. There are currently five different "classes" of HIV drugs. Each class of drug attacks the virus at different points in its life cycle, so if you are taking HIV medication, you will generally take 3 different antiretroviral drugs from 2 different classes.

This regimen is standard for HIV care and is important because no drug can cure HIV, and taking a single drug, by itself, won’t stop HIV from harming you. Taking 3 different HIV medications does the best job of controlling the amount of virus in your body and protecting your immune system. Some HIV medicines are available in combination: two or more different HIV medications combined in one pill. 

Taking more than one drug also protects you against HIV drug resistance. When HIV reproduces, it can make copies of itself that are imperfect. These mutations may not respond to the drugs you take to control your HIV. If you follow the 3-drug regimen, the HIV in your body will be less likely to make new copies that don’t respond to your HIV medication. 

Classes of HIV drugs  

Each HIV medication is pretty powerful by itself and the key to treating your HIV disease successfully is to pick the right combination of drugs from the different classes of HIV medications.

Antiretrovirals are separated into different classes based on the way an individual drug stops HIV from replicating in your body. The classes include:

  • Entry/Fusion Inhibitors: These medications work to block the virus from ever entering your cells in the first place. HIV needs a way to attach and bond to your CD4 cells, and it does that through special structures on cells called receptor sites. Receptor sites are found on both HIV and CD4 cells (they are found on other types of cells too). Fusion inhibitors can target those sites on either HIV or CD4 cells and prevent HIV from attaching to your healthy cells.
  • Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs): Sometimes called "nukes." These drugs work to block a very important step in HIV’s reproduction process. Nukes act as faulty building blocks in production of viral DNA. This blocks HIV’s ability to use a special type of enzyme (reverse transcriptase) to correctly build new copies of its DNA. Without being able to build new DNA, HIV can't reproduce. 
  • Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs): These are called "non-nukes." They work in a very similar way to "nukes." Non-nukes also block the enzyme, reverse transcriptase, and prevent HIV from making copies of its own DNA. But unlike the nukes (which work on the genetic material), non-nukes act directly on the enzyme itself to prevent it from functioning correctly.
  • Integrase Inhibitors: HIV uses your cells’ genetic material to make its own DNA (a process called reverse transcription). Once that happens, the virus has to integrate its genetic material into the genetic material of your cells. This is accomplished by an enzyme called integrase. Integrase inhibitors block this enzyme and prevent the virus from adding its DNA into the DNA in your CD4 cells. Preventing this process prevents the virus from replicating and making new viruses.
  • Protease Inhibitors (PIs): When HIV replicates inside your cells, it creates long strands of its own genetic material. These long strands have to be cut into shorter strands in order for HIV to create more copies of itself. The enzyme that acts to cut up these long strands is called protease. Protease inhibitors (stoppers) block this enzyme and prevent those long strands of genetic material from being cut up into functional pieces.
  • Fixed-dose combinations: These are not a separate class of HIV medications but combinations of the above classes and a great advancement in HIV medicine. They include antiretrovirals which are combinations of 2 or more medications from one or more different classes. These antiretrovirals are combined into one single pill with specific fixed doses of these medicines.

Antiretroviral Agents for HIV – Pill Chart 2015 – Boehringer Ingelheim

What treatments are currently available?  

Below is a visual list description of all the current HIV antiretroviral (ARV) treatments available in Australia:  

Non-Nucleoside Reverse Transcriptase (NNRTI)

Non-Nucleoside Reverse Transcriptase (NNRTI) – Pill Chart 2015 – Boehringer Ingelheim

Nucleoside / Nucleotide Reverse Transcriptase Inhibitors

Nucleoside / Nucleotide Reverse Transcriptase Inhibitors – Pill Chart 2015 – Boehringer Ingelheim

PI: Protease Inhibitors

PI: Protease Inhibitors – Pill Chart 2015 – Boehringer Ingelheim

Entry Inhibitors

Entry Inhibitors – Pill Chart 2015 – Boehringer Ingelheim

Integrase Inhibitors

Integrase Inhibitors – Pill Chart 2015 – Boehringer Ingelheim

Combined Agents (3 drugs combined in 1 tablet)

Combined Agents – Pill Chart 2015 – Boehringer Ingelheim

Which medications are right for you?  

Your s100 prescriber will take many things into account when considering which HIV medications to prescribe for you. These will include your preferences (number of pills, once a day versus twice, etc.), the general state of your health (including your CD4 count), possible side effects, your medical and psychiatric history, etc. You should talk with your health provider about the choice of medications, including possible side effects and how you should take them. Whether you are starting treatment for the first time, experiencing challenges with treatment or thinking about switching treatment, Positive Women Victoria can provide information and referrals to assist you in the decision making process, but it is important to include your doctor in these discussions. 

Other medications  

Sometimes your HIV medications may be only a part of the whole package of medications you may take. If you are at risk for opportunistic infections, your healthcare provider may also put you on daily or weekly medications to prevent your getting sick with a specific kind of infection. This type of treatment is known as prophylaxis.

In addition, you may take other medications to prevent side-effects such as diarrhea, nausea, or pain. If you have other health problems (like high blood pressure or diabetes), you may also need to take medications to treat those conditions. All of these medications work together to keep you as healthy as possible while complementing your treatment for HIV.

It is important to discuss ALL of your medications when you see your health care provider, because each one is important to the success of your whole treatment plan.

Much of the above information is sourced from Aids.gov. The images are published by Boehringer Ingelheim.