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HIV and AIDS Medications and Drug Classes

Medically reviewed by L. Anderson, PharmD Last updated on May 3, 2019.

Overview | Treatment as Prevention | Drug Tables | PrEP | More Information

HIV Treatment Options: An Overview

If you are diagnosed with HIV (human immunodeficiency virus) infection, you will have many questions about treatment options, advantages, and side effects. Today, it is well-known that early diagnosis, combined with advanced current treatments, and regular medical follow-up, can significantly improve the health outcomes of a patient living with HIV. In fact, many people with HIV who are treated appropriately, take their medications as directed, and are monitored closely can live close to a normal life-span.

Diagnosis and early treatment is still important even though HIV has become more of a chronic disease for many people. In 2017, the latest year that data is available, the number of new HIV diagnoses in the United States was over 38,000.

There is no cure or vaccine for HIV/AIDS yet, but research has greatly expanded since the 1980’s. It's important to know your status: HIV screening is recommended by the US Centers for Disease Control and Prevention (CDC) for patients between 13 and 64 years of age at least once in their lifetime.

Treatment with HIV medicines -- called antiretroviral therapy (ART) -- is recommended for everyone with an HIV diagnosis. Starting treatment early can delay the progression of HIV to AIDS and infectious complications, improve the quality of life, and prolong life expectancy to near normal. You should start ART as soon as possible after your diagnosis, and continue your medications lifelong.

Antiretroviral drugs slow the growth and replication of HIV. ART works to lower the viral load, which is the amount of HIV in your blood.

  • Lowering the amount of HIV in the blood may in turn lead to an increase of the CD4 (T cell) count, which will help you fight infections.
  • This also helps improve the immune system, increasing its ability to defend the body against HIV infection and lower the risk of progressing to AIDS and AIDS-related complications.
  • These medicines are not a cure for HIV or AIDS, and you should take the medication each day as prescribed to help prevent HIV resistance.

HIV: Treatment as Prevention

Early HIV testing, treatment and taking your medication as prescribed each day can help protect your partner, too. Achieving an undetectable viral load can drastically lower the risk transmitting HIV to an HIV-negative partner. This supports the undetectable equals untransmittable initiative (U=U) and most people can reach an undetectable viral load within 6 months after starting ART. 

Data from The Lancet in 2019 from Rodger and colleagues details the results of The PARTNER 1 and 2 studies and other research on the transmission of HIV in serodifferent couples, where one partner is HIV-positive and the other HIV-negative. Overall, this observational study found that the risk of transmission of HIV through condomless sex is effectively zero while the HIV+ partner is on ART and the virus remains undetectable. This association was found for both gay men and heterosexual couples. 

Research published in the Journal of the American Medical Association (JAMA) in 2019 from Eisinger and colleagues notes that viral load testing for HIV-positive patients receiving ART should occur every 3 to 4 months after the plasma HIV-1 RNA level becomes undetectable, per HHS guidelines. If the patient's viral load and clinical status remains stable for 2 years, viral load testing can then be extended to every 6 months. Adherence to ART therapy is important to maintain the undetectable status. Viral rebound can occur within 2 or 3 weeks of stopping ART; therefore, continued daily treatment is necessary.

Treatment during pregnancy also helps to greatly lower the risk of HIV transmission to an unborn baby.

Most treatments for HIV and AIDS are given as a three medication regimen in combination (often in one pill).

There are several types of antiretroviral medications. Some of the most common include these classes:

  • nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)
  • protease inhibitors (PI)
  • integrase inhibitors (INSTI)
  • non-nucleoside reverse transcriptase inhibitors (NNRTI)
  • CCR5 antagonists
  • fusion inhibitors

ART regimens typically consist of two nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) plus a third agent, such as a protease inhibitor (PI), an integrase strand transfer inhibitor (INSTI), or a non-nucleoside reverse transcriptase inhibitor (NNRTI). Plus, a boosting agent like ritonavir may be given to increase the blood levels of certain drugs. However, newer medications, such as the single tablet, two-drug regimen Dovato (dolutegravir and lamivudine) are now available to even further help lower your pill burden.

HIV Treatment Options: HIV Medications and Drug Classes

The following tables list the main classes and groups of FDA-approved medications used to treat HIV in the U.S., with a brief description of the drug class. New options are frequently approved.

Drugs and combinations are identified by generic and brand names, as well as common abbreviations.

Follow the links to access up-to-date drug information such as dosing, side effects, drug interactions and pill pictures for each agent and drug class.

Antiviral Boosters

Generic Name Brand Name Abbreviation
ritonavir Norvir RTV
cobicistat Tybost COBI
  • Antiviral boosters are medicines often used in conjunction with other specific antiviral drugs to enhance or increase their effect.
  • They might be used in conjunction with the protease inhibitors like darunavir or atazanavir.
  • Antiviral boosters ensure the correct levels of drug are in the blood.

Antiviral Combinations

Generic Name Brand Name Abbreviation
abacavir / dolutegravir / lamivudine Triumeq ABC + DTG + 3TC
abacavir / lamivudine Epzicom ABC + 3TC
abacavir / lamivudine / zidovudine Trizivir ABC + 3TC + ZDV
atazanavir / cobicistat Evotaz ATV + COBI
bictegravir / emtricitabine / tenofovir alafenamide fumarate Biktarvy BIC + FTC + TAF
cobicistat / darunavir Prezcobix COBI + DRV
cobicistat / darunavir / emtricitabine / tenofovir alafenamide fumarate Symtuza COBI + DRV + FTC + TAF
cobicistat / elvitegravir / emtricitabine / tenofovir alafenamide fumarate Genvoya COBI + EVG + FTC + TAF
cobicistat / elvitegravir / emtricitabine / tenofovir disoproxil fumarate Stribild COBI + EVG + FTC + TDF
dolutegravir / rilpivirine Juluca DTG + RPV
dolutegravir / lamivudine Dovato DTG + 3TC
doravirine / lamivudine / tenofovir disoproxil fumarate Delstrigo DOR + 3TC + TDF
efavirenz / emtricitabine / tenofovir disoproxil fumarate Atripla EFV + FTC + TDF
efavirenz / lamivudine / tenofovir disoproxil fumarate Symfi, Symfi Lo EFV + 3TC + TDF
emtricitabine / lopinavir / ritonavir / tenofovir disoproxil fumarate AccessPak for HIV PEP Expanded with Kaletra FTC + LPV + RTV + TDF
emtricitabine / nelfinavir / tenofovir disoproxil fumarate AccessPak for HIV PEP Expanded with Viracept FTC + NFV + TDF
emtricitabine / rilpivirine / tenofovir alafenamide fumarate Odefsey FTC + RPV + TAF
emtricitabine / rilpivirine / tenofovir disoproxil fumarate Complera FTC + RPV + TDF
emtricitabine / tenofovir alafenamide fumarate Descovy FTC + TAF
emtricitabine / tenofovir disoproxil fumarate Truvada, AccessPak for HIV PEP Basic FTC + TDF
lamivudine / tenofovir disoproxil fumarate Cimduo, Temixys 3TC + TDF
lamivudine / zidovudine Combivir 3TC + ZDV
  • No more taking handful of pills multiple times each day. Combinations of HIV treatments -- many recently approved -- have become more effective, easier to take, and with fewer side effects.
  • A person's initial HIV regimen generally includes two or three HIV medicines from at least two different drug classes. This generally includes two nucleoside reverse transcriptase inhibitors (NRTIs) plus a third agent (PI, INSTI, or NNRTI), and possibly a boosting agent. However, two-drug complete regimens are also now available for patients who have never taken HIV drugs before.
  • Combination agents can make treatments easier and help patients to take their medication each day as prescribed and adhere to their regimen long term.

CD4-Directed Post-Attachment HIV-1 Inhibitor (a biologic)

Generic Name Brand Name
ibalizumab-uiyk Trogarzo
  • Trogarzo (ibalizumab-uiyk) is an HIV-1 antiretroviral biologic drug given by intravenous injection. It is a CD4 domain 2-directed humanized monoclonal antibody of immunoglobulin G (IgG) isotype 4. Trogarzo binds to CD4+ receptors on host T-cells and blocks the HIV virus from entering the cell.
  • Trogarzo, from TaiMed Biologics, was approved in March 2018. It is a first-in-class agent for multidrug-resistant HIV (MDR HIV-1) used in patients who have failed other  therapies.
  • Trogarzo is active against HIV-1 strains resistant to all approved antiretrovirals.
  • In studies, 40 MDR patients with high HIV virus levels who had previously received several other HIV treatments were evaluated. After 24 weeks of Trogarzo plus other antiretroviral drugs, 43% of the trial’s participants achieved HIV RNA suppression.
  • After appropriate dilution, this agent is given as a single intravenous (IV) loading dose of 2,000 mg followed by a maintenance dose of 800 mg every 2 weeks.
  • Common side effects reported in studies included diarrhea, dizziness, nausea and rash.

CCR5 Antagonists

Generic Name Brand Name Abbreviation
maraviroc Selzentry MVC
  • Chemokine receptor antagonists (CCR5 Antagonists) block the entry of HIV into the host cell, thereby slowing the replication of the virus. They are not usually first-line treatments.
  • Selzentry is approved only for the treatment of CCR5-tropic HIV-1 infection in patients 2 years and older and weighing ≥10 kg, in combination with other antiretroviral agents.
  • Selzentry, available as a tablet or an oral solution, is taken twice a day with or without food. Selzentry is given in combination with other antiretroviral medications.

Fusion Inhibitors

Generic Name Brand Name Abbreviation
enfuvirtide Fuzeon T-20
  • Fusion inhibitors like enfuvirtide (Fuzeon) block HIV’s ability to infect healthy CD4 cells.
  • When used with other anti-HIV medicines, these drugs can reduce the amount of HIV in the blood, increase the number of CD4 cells, and keep help the immune system healthy so it can fight infection.
  • They are not typically used as an initial tratment.

Integrase Strand Transfer Inhibitors (INSTI)

Generic Name Brand Name Abbreviation
bictegravir (part of fixed-dose combination) Biktarvy BIC
dolutegravir Tivicay DTG
raltegravir IsentressIsentress HD RAL
  • Integrase is an enzyme used by HIV to make copies of itself. Integrase strand transfer inhibitors, also just known as integrase inhibitors, block the action of integrase.
  • Integrase strand transfer inhibitors prevent HIV from multiplying in the host.
  • Elvitegravir (Vitekta) was discontinued from the U.S. market in 2016.
  • Bictegravir, part of the fixed dose combination drug Biktarvy, is not expected to become available in the U.S. as a stand alone drug

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Generic Name Brand Name Abbreviation
delavirdine Rescriptor DLV
doravirine Pifeltro DOR
efavirenz Sustiva EFV
etravirine Intelence ETR
nevirapine Viramune, Viramune XR NVP
rilpivirine Edurant RPV
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs), or non-nucleoside analogs, bind directly to reverse transcriptase to prevent conversion of RNA to DNA to keep HIV out of the healthy human cell, and blocks replication.
  • NNRTIs are often combined into pills as part of a multi-drug regimen that can be taken once a day.

Nucleoside, Nucleotide Reverse Transcriptase Inhibitors (NRTIs)

Generic Name Brand Name Abbreviation
abacavir Ziagen ABC
didanosine Videx, Videx EC DDI
emtricitabine Emtriva FTC
lamivudine Epivir 3TC
stavudine Zerit d4T
tenofovir disoproxil fumarate Viread TDF
zidovudine Retrovir AZT or ZDF
  • Nucleoside reverse transcriptase inhibitors (NRTIs), sometimes referred to as nucleoside analogs, were the first antiretroviral drugs to be developed, starting with zidovudine (Retrovir or AZT) in March 1987.
  • Viread (tenofovir disoproxil fumarate) was the first nucleotide analog reverse transcriptase inhibitor (NRTI) approved for HIV treatment. Both classes work by blocking the reverse transcriptase enzyme needed for HIV to replicate itself.
  • Nucleotide analogs are different from the nucleoside analogs, although they act in much the same way. In order for nucleoside analogs to work, they must undergo chemical changes (phosphorylation) to become active in the body. Nucleotide analogs, like tenofovir, bypass this step because they are already chemically activated.
  • Commonly prescribed NRTIs include: abacavir / lamivudine (Epzicom), emtricitabine / tenofovir alafenamide (Descovy), and emtricitabine / tenofovir alafenamide (Truvada).

Protease inhibitors (PIs)

Generic Name Brand Name Abbreviation
atazanavir Reyataz ATV
darunavir Prezista DRV
fosamprenavir Lexiva FPV
indinavir Crixivan IDV
lopinavir and ritonavir Kaletra LPV + RTV
nelfinavir Viracept NFV
ritonavir Norvir RTV
saquinavir Invirase SQV
tipranavir Aptivus TPV
  • Protease Inhibitors (PIs) work by interfering with the enzyme HIV protease, which in turn interrupts HIV replication at a later stage in its life cycle. This causes HIV particles in the body to become structurally disorganized and noninfectious.
  • PIs can cause a significant number of side effects due to drug interactions with some other medications metabolized by a particular enzyme system in the liver.
  • Darunavir (Prezista) and atazanavir (Reyataz) are commonly used; this class is given with booster medications (ritonavir or cobicistat) to help keep blood levels of the drug correct.

Pre-Exposure Prophylaxis (PrEP)

Generic Name Brand Name Abbreviation
emtricitabine and tenofovir disoproxil fumarate Truvada, AccessPak for HIV PEP Basic FTC + TDF
  • Pre-exposure prophylaxis (PrEP) with antiretroviral medications is a standard treatment that can be used to help prevent new infections among those at high risk for contracting HIV.
  • HIV treatment guidelines recommend that PrEP be used for people who are HIV-negative and at substantial risk for HIV infection, including high risk men who have sex with men; high risk transgender women, high risk heterosexual men and women; and high risk injection drug users.
  • PrEP, if used correctly, can reduce the risk of HIV transmission by over 90 percent. However, PrEP should be used with counseling on other risk reduction practices, such as correct condom use and safe needle practices.
  • In May 2018, PrEP with Truvada was approved to reduce the risk of sexually acquired HIV-1 in at-risk, HIV-negative adolescents weighing at least 35 kg, along with safer sex practices. The most common side effects in adolescents were similar to those seen in the Truvada adult trials: headache, abdominal pain and weight loss.

Truvada is still the only FDA-approved pre-exposure prophylaxis (PrEP) regimen. In April 2016, the FDA approved Gilead's Descovy (emtricitabine + tenofovir alafenamide fumarate), an HIV nucleoside reverse transcriptase inhibitor (NRTI) for the treatment of HIV-1 infection. But unlike Truvada, Descovy is not yet approved for PrEP.

Descovy contains tenofovir alafenamide fumarate (TAF) instead of tenofovir disoproxil fumarate (TDF). The use of a tenofovir alafenamide fumarate (TAF) based regimen is as effective as a tenofovir disoproxil fumarate (TDF) based regimen in reducing viral loads, but TAF is associated with less kidney toxicity and bone loss.

Although Descovy is intended to be a safer replacement for Truvada (emtricitabine/tenofovir disoproxil fumarate (TDF), Descovy is not yet approved for pre-exposure prophylaxis (PrEP). Phase 3 clinical trials comparing the effectiveness of Truvada to Descovy for PrEP are currently ongoing and sponsored by Gilead Sciences. Study completion is expected in 2021.

More Information

Slideshow: HIV & AIDS Update: New Treatments, Easier Options

For more information on AIDS/HIV treatment guidelines or clinical trials go to AIDSInfo sponsored by the National Institutes of Health (NIH). You may also contact them at 1-800-HIV-0440 (1-800-448-0440).

See Also

Sources

  1. Rodger A, Cambiano V, Bruun T, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet 2019; 2428-38. Accessed July 1, 2019 at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext
  2. RW Eisinger, CW Dieffenbach, AS Fauci. HIV viral load and transmissibility of HIV infection: undetectable equals untransmittable. Journal of the American Medical Association (JAMA). 2019 Feb 5;321(5):451-452. Accessed July 1, 2019 at doi: 10.1001/jama.2018.21167
  3. US Centers for Disease Control and Prevention (CDC). Statistics Overview. April 12, 2019. Accessed April 29, 2019 at https://www.cdc.gov/hiv/statistics/overview/index.html
  4. Safety and Efficacy of Emtricitabine and Tenofovir Alafenamide (F/TAF) Fixed-Dose Combination Once Daily for Pre-Exposure Prophylaxis in Men and Transgender Women Who Have Sex With Men and Are At Risk of HIV-1 Infection. ClinicalTrials.gov. Accessed April 29, 2019 at https://clinicaltrials.gov/ct2/show/study/NCT02842086
  5. Bictegravir. AIDSInfo. Accessed May 3, 2019 at https://aidsinfo.nih.gov/drugs/570/bictegravir/0/professional
  6. Bartlett JG, et l. Patient education: Initial treatment of HIV (Beyond the Basics). Up to Date. Accessed May 3, 2019 at https://www.uptodate.com/contents/initial-treatment-of-hiv-beyond-the-basics
  7. HIV: Antiretroviral Therapy (ART). Kaiser Permanente. Topic Overview. https://m.kp.org/georgia/health-wellness/health-encyclopedia/he.hiv-antiretroviral-therapy-art.tm6421
  8. Barrett J. Specialty Pharmacy Times. Antiretroviral Therapy Adherence Crucial for Undetectable Equals Untransmittable Method in HIV. Jan. 22, 2019. Accessed July 1, 2019 at https://www.specialtypharmacytimes.com/news/antiretroviral-therapy-adherence-crucial-for-undetectable-equals-untransmittable-method-in-hiv

Further information

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