There is no cure for HIV. However, antiretroviral therapy (ART) is a very effective treatment to prevent the progression of HIV and to prevent the transmission of HIV to others. It enables HIV-positive individuals to live relatively normal, healthy lives (1).
What is ART?
ART is a life-long daily treatment that must be strictly followed. It is a combination of different HIV medicines (HIV regimen) that work by suppressing the replication of the virus. This reduces the amount of HIV in the body, known as viral load. HIV viral suppression is defined as less than 200 copies of HIV per milliliter of blood (2).
When this viral load is at undetectable levels (viral suppression), it doesn’t mean the virus is gone completely, but it does prevent the disease from progressing and means there is effectively no risk of passing HIV to others through sex (2). It also reduces the risk of transmission through shared needles and syringes, from a mother to her baby during pregnancy and at birth, and during breastfeeding. However, current recommendations in the United States state that HIV-positive mothers should not breastfeed their babies even if they have an undetectable viral load (2).
At the end of 2019, an estimated 59% of individuals on ART had achieved suppression of the HIV virus with no risk of transmitting the virus to others through sex (1).
It is important to remember that ART does not prevent the transmission of other STDs. So just because you or your partner are on ART, other safe sex practices are still important.
What are the HIV medicines in an HIV regimen?
There are seven classes of HIV medicines, which are classified based on how they fight HIV (3):
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
- Nucleoside reverse transcriptase inhibitors (NRTIs)
- Protease inhibitors (PIs)
- Fusion inhibitors
- CCR5 antagonists
- Integrase strand transfer inhibitors (INSTIs)
- Post-attachment inhibitors
HIV regimens can differ between individuals and are selected based on various factors, including possible side effects, potential drug interactions, and disease progression.
When to start ART?
ART should be started as soon as possible following an HIV diagnosis. It doesn’t matter how healthy you are or how long you have had HIV.
ART is life-long and must be taken as prescribed on a daily basis. If ART is not taken consistently, drug-resistant HIV strains can develop, meaning the medications will no longer be effective (2).
Routine viral load and CD4+ T cell monitoring are important to ensure that treatment is effective and maintaining viral load at undetectable levels in the blood (3).
If the treatment is discontinued, HIV will continue to replicate increasing the risk of HIV transmission and the disease can progress to AIDS (3).
What are the potential side effects of ART?
HIV medicines available nowadays generally cause fewer side effects than some HIV medicines used in the past (4). However, some people do still experience a range of side effects, which can include:
- Nausea and vomiting
- Diarrhea
- Difficulty sleeping
- Dry mouth
- Headache
- Rash
- Dizziness
- Fatigue
- Pain
What other treatment options are there?
Methods are also available to reduce the risk of contracting HIV. Pre-exposure prophylaxis (PrEP) is a daily medication that individuals at high risk of HIV (e.g. partner of an HIV-positive person) can take to minimize their risk of HIV infection. There are currently two FDA-approved PrEP medications that reduce the risk of contracting HIV via sex by up to 99% (5).
Post-exposure prophylaxis (PEP) is an emergency medication that must be started within 72 hours of exposure. PEP is a short course of medication that reduces the risk of infection but should not be used to replace other HIV and STD prevention methods (6).
References:
1. HIV/AIDS. World Health Organization.
2. HIV Treatment. CDC. Reviewed May 2021.
3. HIV Treatment: The Basics. NIH.gov (Reviewed March 2020)
4. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Clinical Info. HIV.gov (Updated June 20201)
5. FDA approves second drug to prevent HIV infection as part of ongoing efforts to end the HIV epidemic. FDA News Release. (October 2019).
6. PEP (Post-Exposure Prophylaxis). CDC. (Reviewed May 2021)
