Due to advances in medications, HIV is a treatable condition. Most people can slow or halt the progression using medication regimens called antiretroviral therapy (ART).
ART reduces the amount of HIV (viral load) in the blood until the virus is no longer detectable. When the virus is undetectable, it can no longer transmit to others — known as undetectable = untransmissible, or U=U.
Most people using ART will have an undetectable viral load within 6 months of treatment.
ART drug regimens combine two or three HIV medications, each with a different purpose. The most common drug classes used in ART are:
- nucleoside reverse transcriptase inhibitors (NRTIs)
- non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- protease inhibitors (PIs)
- integrase strand transfer inhibitors (INSTIs)
- pharmacokinetic enhancers
ART: HIV drug regimens
HIV drug regimens consist of two or three drugs, and most follow a 3-drug regimen. This article looks at HIV medications and drug combinations commonly used in ART.
What are the most common ART drug regimens?
Many combination HIV medications are used in ART, but Biktarvy has been the most commonly prescribed in recent years. Descovy and Tivicay are other frequently prescribed options.
Biktarvy is made up of three HIV medications:
- emtricitabine, an NRTI
- tenofovir alafenamide, an NRTI
- bictegravir, an INSTI
Descovy is always prescribed along with another HIV treatment and is often combined with Tivicay. Descovy is made up of two HIV medications, both of which are NRTIs:
- emtricitabine
- tenofovir alafenamide
Tivicay contains an HIV medication called dolutegravir, which is an INSTI. Healthcare professionals will always prescribe Tivicay in combination with other HIV medications.
Other ART drug regimens
Other common combination drugs used in ART include:
- Genvoya
- Odefsey
- Triumeq
- Symtuza
- Prezcobix
- Truvada, especially in combination with Tivicay or Isentress during pregnancy
In some situations, but less often, the following drugs are used:
Dovato is a two-drug regimen often used, especially when there is concern about weight gain associated with the HIV drug regimen.
Cabenuva is an injectable treatment regimen that has recently gained approval from the Food and Drug Administration (FDA).
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Nucleoside reverse transcriptase inhibitors (NRTIs)
There are many HIV drug classes, but healthcare professionals most commonly prescribe NRTIs. These drugs stop HIV cells from multiplying. They do this by blocking reverse transcriptase, an enzyme HIV needs to make copies of itself.
Within the NRTI category, the most commonly used drugs are:
- emtricitabine (Emtriva)
- lamivudine (Epivir)
- tenofovir alafenamide fumarate
Less common NRTIs include:
- tenofovir disoproxil fumarate (Viread)
- abacavir (Ziagen) is also used, but not as often due to the risk of heart attacks
- zidovudine (Retrovir) is rarely used anymore
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
NNRTIs also prevent HIV cells from multiplying. They work by binding to and altering the enzyme reverse transcriptase, which HIV cells require to make copies of themselves.
Within NNRTIs, the most commonly used medications are:
Protease inhibitors (PIs)
PIs prevent HIV from multiplying by blocking the action of HIV protease, an enzyme HIV needs in order to replicate.
The most commonly used PI is darunavir (Prezista).
Less often, atazanavir (Reyataz) and ritonavir (Norvir) are also used. Healthcare professionals most often prescribe these two drugs to people who have previous experience with HIV treatment.
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Get free cardIntegrase strand transfer inhibitors (INSTIs)
INSTIs block the action of HIV integrase, an enzyme that HIV cells need in order to multiply.
The most commonly used INSTI is bictegravir.
Other INSTIs regularly used in HIV treatment include:
The FDA approved cabotegravir in combination with raltegravir as the first injectable HIV medication. Healthcare professionals commonly prescribe raltegravir during pregnancy.
Pharmacokinetic enhancers
Pharmacokinetic enhancers are added to HIV treatment regimens to boost the effectiveness of HIV medication.
Healthcare professionals currently prescribe only one pharmacokinetic enhancer: cobicistat (Tybost). They will always prescribe cobicistat in combination with other HIV medications.
Other HIV medications
The most common HIV medications are discussed above. Healthcare professionals may prescribe other drugs in certain circumstances, especially if someone has a resistance to certain HIV drugs.
Other HIV medications include:
- Fusion inhibitors block HIV cells from entering white blood cells called CD4 T-lymphocytes. Example: enfuvirtide (Fuzeon).
- CCR5 antagonists stop HIV cells from entering immune system cells by blocking CCR5 receptors. Example: maraviroc (Selzentry).
- Attachment inhibitors stop HIV cells from entering CD4 cells by binding to the surface of HIV cells. Example: fostemsavir (Rukobia).
- Post-attachment inhibitors prevent HIV cells from entering CD4 cells. Example: ibalizumab-uiyk (Trogarzo).
Summary
Treatment for HIV consists of a drug regimen called antiretroviral therapy (ART). A healthcare professional will prescribe several different HIV medications for you to take in combination.
Many types of HIV medications are used in ART. Biktarvy is one of the most commonly prescribed drug regimens. A combination of Descovy and Tivicay is another common treatment. Other drug treatments include Triumeq, Genvoya, and Odefsey.
Taking HIV medication as prescribed aims to lower the amount of HIV in your blood until the virus is no longer detectable.
Many HIV medications come with side effects. If you’re concerned about your medication or side effects, consider taking with a healthcare professional. They can help you adjust your dosage or change medication to find one that’s right for you.
If you need help covering the cost of medications, Optum Perks free Discount Card could help you save up to 80% on prescription drugs. Follow the links on drug names for savings on that medication or search for a specific drug here.