HIV & AIDS Update: New Treatments, Easier Options
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on April 14, 2022.
HIV Options Are Numerous and Far Easier
The diagnosis of HIV can be a shock to anyone.
However, current treatments coupled with early diagnosis have significantly improved the outcomes of patients living with HIV. In fact, many people who are treated appropriately and monitored closely can live close to a normal life-span today.
That doesn't mean HIV's impact isn't still significant.
- In 2019, the estimated number of HIV infections in the US was 34,800 and the rate was 12.6 (per 100,000 people), based on government data. Approximately 34,800 new HIV infections occurred in the United States in 2019, per CDC research.
- Even more concerning: more than 1.2 million people in the U.S. are living with HIV today, but about 1 in 8 of them (13%) don’t know it.
- While there is still no cure for HIV AIDs, research and treatments have greatly expanded since the 1980's.
Combinations of drugs -- many recently approved -- have become more effective, easier to take, and with fewer side effects.
HIV Advances: One Convienent Pill
HIV treatments involve several antiretroviral therapy (ART) medications, often combined into one convenient pill. Combination treatments:
- make it easier to stay on course
- fight drug resistance
- help prevent treatment failures
- are often given once-a-day.
No more taking handfuls of pills every few hours.
Experts recommend starting HIV treatment as soon as diagnosed, regardless of the T-cell count (which is an indicator of how healthy the immune system is).
Plus, many of the latest combinations are recommended to be used in "treatment-naive" patients -- that is, patients who have never received any HIV medication. HIV drug-resistance testing is recommended in all patients.
TAF: The Latest Tenofovir
Tenofovir disoproxil fumarate (TDF) is a Nucleotide Reverse Transcriptase Inhibitor (NRTI) used in combination with other HIV medicines for treatment and for prevention with a PrEP regimen.
The latest approved form of tenofovir is called tenofovir alafenamide (TAF). TAF may have some safety advantages over TDF. TAF was first approved in November 2015 and is found in several HIV pills, such as:
- Genvoya (elvitegravir + cobicistat + emtricitabine + tenofovir alafenamide)
- Odefsey (emtricitabine + rilpivirine + tenofovir alafenamide)
- Descovy (emtricitabine + tenofovir alafenamide)
- Biktarvy (bictegravir + emtricitabine + tenofovir alafenamide).
TDF is similar to TAF, the single ingredient found in Viread and other HIV combination treatments:
- Stribild (cobicistat + elvitegravir + emtricitabine + tenofovir)
- Atripla (efavirenz + emtricitabine + tenofovir disoproxil)
- Complera (emtricitabine + rilpivirine + tenofovir disoproxil)
- Truvada (emtricitabine + tenofovir disoproxil)
- Symfi, Symfi-Lo (efavirenz + lamivudine + tenofovir disoproxil)
- Temixys and Cimduo (lamivudine + tenofovir disoproxil)
But what are the advantages for TAF compared to TDF?
How Does Tenofovir Alafenamide (TAF) Work?
TAF is known as a "prodrug" of tenofovir and is inactive when it is first taken. After it enters the body, it is changed to its active form in the cell (not in the blood like tenofovir disoproxil fumarate [TDF]).
TAF enters the HIV-infected cell much more efficiently than TDF, which results in much lower levels of drug in the blood, but higher levels within the cells where HIV-1 replicates. Therefore, TAF can be given at roughly 1/10th the dose of TDF (Viread).
Due to smaller doses and lower levels of drug in the blood, researchers state kidney toxicity and decreased bone mineral density may be less of a concern as with TAF (based on observed laboratory measures).
However, TDF is associated with lower lipid levels (such as cholesterol). When deciding which tenofovir agent to select, the clinician and patient should consider safety, cost, and ease of access between these drugs.
Descovy (emtricitabine + tenofovir alafenamide)
In April, 2016 FDA approved another TAF agent Gilead's Descovy (emtricitabine + tenofovir alafenamide [TAF]), an HIV nucleoside/tide reverse transcriptase inhibitor (NRTI) for the treatment of HIV-1 infection.
Descovy is used with other antiretroviral agents to treat HIV-1 in adults and children 12 years and older who weight at least 35 kg (77 lb).
In studies, Descovy is as effective as regimens with tenofovir disoproxil fumarate (TDF) in reducing the HIV virus, but with less kidney toxicity and bone loss based on lab values, a potential side effect for TDF.
Descovy: Similar to Truvada, Also Now for PrEP
Descovy is intended to be a safer replacement for Truvada (emtricitabine + tenofovir disoproxil fumarate [TDF]), another common HIV-1 infection treatment. In studies, it had less negative effects on bone turnover and kidney function.
Truvada was the first FDA-approved PrEP regimen. PrEP medicines like Truvada and Descovy work by blocking important pathways used by HIV to set up an infection. Both medications are from Gilead, and Truvada is now available generically. Generic Truvada may be the more preferred regimen by many health care insurers at this time, due to greater affordability.
Gilead offers a copay card to help with PrEP costs for patients with commericial insurance (but not government plans like Medicare or Medicaid). Low income patients without insurance may also receive assistance for PrEP.
Learn More: HIV Prevention: PrEP and Other Options
Descovy: Facts to Know
The recommended dosage for Descovy is one tablet taken once daily with or without food. To adequately treat HIV, Descovy must be taken together with other HIV-1 medicines.
The most common side effect, occurring in greater than 10% of patients (10 of every 100 patients) is an upset stomach (nausea).
Other side effects include:
- fat redistribution
- bone softening
- immune system changes
- kidney problems.
Be sure to talk with your doctor about all possible side effects with Descovy.
Apretude Injection for HIV PrEP
In Dec. 2021, the FDA approved ViiV Healthcare’s Apretude (cabotegravir extended-release injection), the first long-acting injection for HIV pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection. Apretude is classified as an integrase strand transfer inhibitor (INSTI) and works by preventing viral DNA from integrating into the genetic material of human immune cells (T-cells).
- Apretude is approved for use in adults and adolescents weighing at least 35 kg (77 lb) who are at risk of sexually acquiring HIV and who have a negative HIV-1 test prior to initiation. A negative HIV test is required prior to each injection.
- Apretude was proven superior to daily oral FTC/TDF (Truvada) in reducing HIV acquisition in two studies with over 7000 patients. Those receiving Apretude had a 69% and a 90% lower incidence of HIV compared to FTC/TDF tablets.
- Apretude is given as an intramuscular injection once a month for the first 2 months, then once every 2 months and is given only by a healthcare provider. A negative HIV test is required prior to each injection. Before the first Apretude injection, patients may take oral cabotegravir (Vocabria) for at least 28 days to determine cabotegravir tolerability (this is not required).
- Common side effects are injection site reactions like pain/tenderness, diarrhea, headache, fever, fatigue, sleep disorders, nausea, dizziness, flatulence, and stomach pain.
Genvoya (cobicistat, elvitegravir, emtricitabine, tenofovir alafenamide)
Tenofovir alafenamide (TAF) is also found in Gilead's four drug antiretroviral combo Genvoya, FDA-approved in November 2015.
Genvoya is an updated TAF version of Stribild, and can be used as a complete HIV regimen for patients 12 years and older and weighing at least 25 kilograms (55 lbs) who are treatment-naïve (no antiretroviral treatment history) or virally suppressed (along with other criteria).
Genvoya is a fixed-dose combination tablet that contains 3 ART classes:
Genvoya: A 4-Drug Single Tablet
The recommended dose of Genvoya (cobicistat, elvitegravir, emtricitabine, and tenofovir) is one tablet taken orally once daily with a meal; nausea may be a common side effect.
- Genvoya is used in patients with a body weight at least 25 kg and creatinine clearance (a measure of kidney function) greater than or equal to 30 mL per minute.
- A one tablet per day regimen is especially advantageous for patients who desire a once-a-day regimen or who may have difficulties taking mutiple doses or pills per day.
- Like other TAF agents, lower bone and kidney toxicity may be seen due to the lower blood concentrations of tenofovir achieved with TAF.
Genvoya may also be used in adults with creatinine clearance below 15 mL per minute who are receiving chronic hemodialysis. On days of hemodialysis, administer Genvoya after completion of hemodialysis treatment.
Genvoya carries a warning of a build-up of lactic acid in the blood and the possibility for severe liver problems, as do the other TAF agents Descovy and Odefsey that contain nuceloside analogs.
Genvoya: Facts to Know
Besides being a single, once-a-day pill, a major advantage of Genvoya is that it can be used in patients with moderately reduced kidney function (creatinine clearance [CrCl] of 30 or higher). In contrast, Stribild, which contains TDF, should generally only be used in patients 12 years and older, with CrCl of 70 or higher and weighing at least 35 kg (77 lb).
Drug interactions with most HIV treatments, including Genvoya, are common and should be screened for on a regular basis by your pharmacist or doctor.
Out of several regimens, both Stribild and Genvoya are both used as a complete regimen for treatment-naive adults and adolescents. These regimens are used regardless of viral load, have optimal effectiveness, good tolerability, and are easy to use. Selection should be based on safety, cost, and accessibility.
Odefsey from Gilead
In 2016, the FDA approved Odefsey (emtricitabine, rilpivirine and tenofovir alafenamide), a 3-drug, fixed-dose complete regimen for the treatment of HIV-1 infection. It is made by Gilead.
Odefsey is approved:
- In patients who weigh 35 kg (77lb) or more, who have not received HIV medicines in the past (treatment-naive), and who have no more than 100,000 copies/mL of HIV-1 RNA in their blood (HIV viral load).
- To replace current HIV-1 medicines in people who have been on the same drug regimen for at least 6 months, and who have an amount of HIV-1 in their blood that is less than 50 copies/mL, and have never failed past HIV-1 treatment.
It is not known if Odefsey is safe and effective in children under 12 years of age or who weigh less than 35 kg. Common side effects may include: skin rash, nausea, difficulty sleeping, headache and depression.
Biktarvy: The 4th TAF HIV Agent
In 2018, the FDA approved Biktarvy (bictegravir, emtricitabine and tenofovir alafenamide) from Gilead. It is a complete, once-daily, single tablet regimen for HIV treatment.
Biktarvy is an integrase strand transfer inhibitor and emtricitabine/tenofovir alafenamide (Descovy) combination for the treatment of HIV-1 infection. It is used in adults and pediatric patients weighing at least 14 kg (31 lbs):
- who have no antiretroviral treatment history, or
- to replace the current stable, HIV treatment regimen in those who are virologically-suppressed (HIV-1 RNA less than 50 copies per mL). Patients should have no history of treatment failure and no known resistance to Biktarvy components.
Biktary can be taken with or without food, and has no baseline viral load or CD4 count restrictions. In addition, Biktarvy does not require testing for HLA-B5701 gene variant because it does not contain abacavir. Patients with the HLA-B5701 gene variant cannot take abacavir as they have a higher risk of developing a possible life-threatening reaction to the medicine. Abacavir is found in products like Triumeq and Trizivir.
The most common side effects in clinical studies with Biktarvy include diarrhea (6%), nausea (5%), and headache (5%).
Prezcobix (darunavir + cobicistat)
Prezcobix (cobicistat and darunavir) was FDA-approved in 2015 for the treatment of HIV-1 infection in adults in combination with other antiretroviral therapy.
- Prezcobix contains Janssen's protease inhibitor darunavir (Prezista) and Gilead's pharmacokinetic enhancer cobicistat (Tybost).
- A booster is used to help raise the drug levels of protease inhibitors like darunavir or atazanavir (Reyataz).
Prezcobix is used with other HIV medicines in adult and pediatric patients weighing at least 40 kg (88 lb) with no darunavir resistance, and testing for this is recommended prior to starting treatment. Prezcobix can be used in patients who have or have not received HIV treatments in the past.
The dose of Prezcobix is one tablet daily with food. Use darunavir with caution in patients with a sulfonamide allergy.
Tybost (cobicistat) from Gilead
In 2014, FDA approved Tybost (cobicistat) from Gilead as a single entity "booster" drug used with other agents for HIV-1 treatment.
Tybost (cobicistat) is a potent cytochrome P450 3A enzyme inhibitor (not an antiretroviral) that acts as a "boosting" agent for HIV antiretroviral drugs. Cobicistat lowers the action of liver enzymes that break down certain antiviral medicines. This allows the HIV medication to be used more safely and effectively at lower doses.
Cobicistat is also found in combination tablets such as:
- Stribild (cobicistat, elvitegravir, emtricitabine, and tenofovir disoproxil fumarate)
- Prezcobix (darunavir and cobicistat)
- Symtuza (darunavir, cobicistat, emtricitabine, and tenofovir alafenamide)
- Genvoya (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide)
- Evotaz (atazanavir and cobicistat).
Triumeq: A 3-Drug Combo
- It is a fixed-dose combination tablet containing dolutegravir, an integrase strand transfer inhibitor, and the nucleoside reverse transcriptase inhibitors abacavir and lamivudine.
- The recommended dose of Triumeq in adults and pediatric patients weighing at least 40 kg (88 lb) is one tablet once daily with or without food.
- The most common side effects include trouble sleeping, headache, and tiredness. Use with caution in patients with heart disease.
- Tell your doctor if you are pregnant or plan to become pregnant. One of the medicines in Triumeq called dolutegravir may harm your unborn baby by causing a neural tube defect. Follow your doctor's directions.
- Have your pharmacist check for drug interactions each time you get a refill. If you take certain medicines, you may need a higher dose of dolutegravir while taking Triumeq.
Due to the abacavir component, Triumeq should not be used in patients who test positive for HLA-B * 5701 serotype, as abacavir is associated with potentially serious allergic skin reactions. Patients should be tested for this prior to starting any abacavir regimen, and if the results are positive, it should be listed as an abacavir allergy in the patient's chart.
A dolutegravir (DTG) and lamivudine (3TC) agent without abacavir -- Dovato -- was FDA-approved in April 2019. Dovato, also from ViiV Healthcare, is a 2-drug, once-daily, single-tablet regimen for the treatment of HIV-1 infection in adults.
- Dovato is for those who have never taken antiretroviral drugs and with no known resistance to either DTG or 3TC, or
- to replace their current HIV-1 medicines when their healthcare provider determines they are virologically suppressed (HIV-1 RNA less than 50 copies per mL), on a stable ART regimen with no history of treatment failure, and with no known resistance to either DTG or 3TC.
Atripla (efavirenz + emtricitabine + TDF)
Another one-pill option is Atripla (efavirenz, emtricitabine and tenofovir disoproxil fumarate), a combination NRTI/NNRTI from BMS/Gilead.
- Atripla is a NNRTI-based regimen for patients who have not received HIV treatment in the past. It is used as a complete regimen or in combination with other HIV drugs to treat patients weighing at least 40 kg (88 lb).
- The dose for Atripla is one pill taken once a day at bedtime on an empty stomach.
- Certain nervous system side effects are common at the beginning of therapy (drowsiness, dizziness, sleep disturbances) but typically improve in a few weeks, and that's why it's best to take it at bedtime.
Atripla should not be used in kidney disease (creatinine clearance below 50 mL/min).
Talk to your doctor or pharmacist about potential drug interactions with Atripla and other medicines.
Due to harm to an unborn baby, the manufacturer recommends that pregnancy should be avoided in women receiving Atripla and for 12 weeks after stopping treatment.
Juluca: A Complete Two-Drug Regimen
- Juluca is a combination integrase inhibitor (dolutegravir) and NNRTI (rilpivirine).
- It's used in eligible adults with suppressed HIV-1 virus (HIV-1 RNA less than 50 copies per mL) on a stable HIV medication regimen for at least 6 months, with no history of treatment failure and no known resistance to the individual components of Juluca.
Juluca was evaluated in two clinical trials of 1,024 participants whose virus was suppressed on their current anti-HIV drugs. Groups were randomly assigned to stay on their current regimen or switch to Juluca. The studies demonstrated that Juluca was effective in keeping the virus suppressed and comparable to those who continued their current anti-HIV drugs.
Common side effects in patients taking Juluca were diarrhea and headache. Serious side effects include skin rash, allergies, liver problems, depression or other mood changes. Juluca also has multiple drug interactions with common medicines and should not be given with other anti-HIV drugs.
Tell your doctor if you are pregnant or plan to become pregnant. Pregnancy testing is recommended before you start treatment. One of the medicines in Juluca called dolutegravir may harm your unborn baby by causing a neural tube defect. Follow your doctor's directions.
Trogarzo: First-In-Class for Drug-Resistant HIV
- Trogarzo, from TaiMed Biologics, is the first monoclonal antibody approved for the treatment of MDR HIV-1 infection.
- Trogarzo is given by a healthcare provider as a 15 to 30 minute IV infusion into the vein every 14 days. It is used in combination with other antiretroviral medications.
In clinical trials, 40 MDR HIV-1 patients with high HIV virus levels were studied who had already received multiple other HIV treatments (some patients with 10 or more other treatments). After 24 weeks of Trogarzo plus other antiretroviral drugs, 43% of the trial’s participants achieved HIV RNA suppression (HIV RNA < 50 copies/mL).
Diarrhea, dizziness, nausea and rash were commonly reported side effects with Trogarzo.
Symtuza Approved: A 4-Drug Single Tablet Regimen
In 2018, the FDA approved Janssen’s four-drug regimen Symtuza (darunavir, cobicistat, emtricitabine and tenofovir alafenamide - D/C/F/TAF) for HIV treatment. Individually, the drugs in Symtuza include a protease inhibitor, an antiviral booster, and 2 nucleoside reverse transcriptase inhibitors.
Symtuza is a darunavir-based, single-tablet regimen given once daily for the treatment of HIV-1 in treatment-naïve and certain virologically suppressed patients. Darunavir provides a high barrier to drug resistance.
Symtuza is approved to be used in adults and pediatric patients weighing at least 40 kg (88 lbs):
- who have no prior antiretroviral treatment history or
- who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable antiretroviral regimen for at least 6 months and have no known resistance associated with darunavir or tenofovir.
- The Symtuza dose is one tablet once daily with food in patients weighing at least 40 kg. For patients who are unable to swallow the whole tablet, Symtuza may be split with a tablet-cutter and taken immediately after splitting.
In two Phase 3 studies, Symtuza was compared to control regimens in those with no prior antiretroviral therapy history (AMBER study) and in virologically suppressed adults (EMERALD study). Symtuza was found effective and well-tolerated, with up to 95% of patients, achieving or maintaining virologic suppression (HIV-1 RNA < 50 copies/mL) in both studies.
Side effects (2% or more of subjects) included:
- stomach side effects, such as: diarrhea, intestinal gas, nausea, stomach pain
Merck’s HIV Drugs Pifeltro and Delstrigo
HIV treatment drugs Pifeltro (doravirine) and Delstrigo (doravirine, lamivudine, and tenofovir disoproxil fumarate) were both approved in 2018 for the treatment of HIV-1 infection in:
- adults with no prior antiretroviral treatment history, or
- adults with HIV-1 infection who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable antiretroviral regimen with no history of treatment failure. In addition, patients have no known substitutions associated with resistance to doravirine or the other individual components of Delstrigo.
Pifeltro (doravine) is a non-nucleoside reverse transcriptase inhibitor (NNRTI). Delstrigo also contains doravine plus lamivudine and tenofovir (nucleoside reverse transcriptase inhibitors or NRTs).
- Pifeltro (doravine) is used with other antiretroviral agents for HIV treatment.
- Pifeltro contains 100 mg of doravirine and the recommended dose is one 100 mg tablet taken orally once daily with or without food.
- Delstrigo is a complete regimen for HIV treatment.
- Delstrigo contains 100 mg of doravirine, 300 mg of lamivudine (3TC), and 300 mg of tenofovir disoproxil fumarate (TDF). The recommended dose is one tablet taken orally once daily with or without food.
Rukobia: A First-in-Class HIV Drug from ViiV
In July 2020, the FDA cleared the novel HIV treatment, Rukobia (fostemsavir) from ViiV Healthcare.
- Rukobia is used in combination with other antiretroviral (ARV) therapies in heavily treatment-experienced adults with multidrug-resistant HIV-1 infection.
- It is a 600 mg extended-release tablet taken twice daily with or without food.
- Eligible patients are failing their current ARV regimen due to resistance, intolerance or safety concerns.
- In studies, the most commonly reported side effect was nausea (>5%).
Approval was supported by the BRIGHTE Phase 3 study where 60% (n=163/272) of those who received Rukobia plus optimized background therapy achieved undetectable HIV viral load and clinically meaningful improvements to CD4+ T-cell count through Week 96.
Rukobia is a prodrug of temsavir and is classified as a gp120-directed attachment inhibitor. It blocks HIV from attaching to CD4+ T-cells.
Cabenuva: A Long-Acting Injectable for HIV-1 Treatment
In January 2021 the FDA approved ViiV Healthcare’s Cabenuva (cabotegravir and rilpivirine). This new option is a once-monthly, injectable complete regimen for the treatment of HIV-1 infection in adults and adolescents 12 years of age and older and weighing at least 35 kg.
Eligible patients should be on a stable ART regimen and virologically suppressed (HIV-1 RNA <50 copies/mL) with no history of treatment failure and no known or suspected resistance to either cabotegravir or rilpivirine.
Cabenuva is co-packaged as two extended-release intramuscular (IM) injectable suspensions: cabotegravir, an integrase strand transfer inhibitor (INSTI) and rilpivirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI).
- Prior to starting treatment, oral dosing of cabotegravir and rilpivirine may be administered for approximately one month to assess the tolerability of the medicines.
- Cabenuva is then injected by a healthcare provider once monthly or once every other month to replace the current antiretroviral regimen.
- Common side effects (>2%) include injection site reactions, fever, fatigue, headache, muscle pain, nausea, sleep disorders, dizziness, and rash.
Vocabria: An Oral Lead-In for Cabotegravir Injections to Assess Tolerance
In Jan. 2021 the FDA approved Vocabria (cabotegravir) 30 mg tablets, used in combination with Edurant (rilpivirine) 25 mg tablets for the short-term oral treatment of HIV-1 infection in adults to replace their current HIV-1 medicines. It is not known if Vocabria is safe and effective in children.
Vocabria + Edurant is indicated for patients who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen with no history of treatment failure and with no known or suspected resistance to either cabotegravir or rilpivirine.
- Patients may receive Vocabria + Edurant for one month (at least 28 days) before they receive Cabenuva (cabotegravir and rilpivirine) extended-release intramuscular suspension for the first time. Vocabia as a single agent (cabotegravir only) may also be used to assess tolerability one month before starting Apretude injections for PrEP. This will allow the healthcare provider to assess how well cabotegravir or rilpivirine is tolerated.
- Vocabria can also be used as oral therapy for people who will miss planned injections with Cabenuva.
- The most common side effects with Vocabria include: headache, nausea, abnormal dreams, anxiety and sleep disorders.
Recommended Regimens for Treatment-Naive HIV-1 Infected Patients
The Dept of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults / Adolescents (updated June 3, 2021) classifies the following regimens as recommended initial regimens for most people with HIV (recommendations in alphabetical order):
What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient
- Bictegravir, tenofovir alafenamide and emtricitabine [BIC + TAF + FTC] - (brand name: Biktarvy)
- Dolutegravir, abacavir and lamivudine [DTG + ABC + 3TC] (brand name: Triumeq) -- only for individuals who are HLA-B5701 negative and without chronic hepatitis B virus (HBV) coinfection
- Dolutegravir [DTG] (brand name: Tivicay, Tivicay PD) plus emtricitabine [FTC] (brand name: Emtriva); OR OR lamivudine [3TC] / dolutegravir [DTG] (brand name: Dovato); PLUS tenofovir alafenamide [TAF] (brand name: Descovy) OR tenofovir disoproxil fumarate (brand ndame: Truvada).
- Dolutegravir and lamivudine [DTG + 3TC] - (brand name: Dovato) - except for individuals with HIV RNA >500,000 copies/mL, HBV co-infection, or in whom ART is to be started before the results of HIV genotypic resistance testing for reverse transcriptase or HBV testing are available.
See full guideline for recommendations. Regimens may be updated as new approvals become available. Also see the full Guidelines to view Initial Regimens in Certain Clinical Situations (Table 6a). For individuals of childbearing potential, see Table 6b before prescribing one of these regimens.
Selection of a regimen for a particular patient should be guided by factors such as virologic efficacy, toxicity, pill burden, dosing frequency, drug-drug interaction potential, resistance test results, comorbid conditions, access, and cost.
Goals and Principles of Antiretroviral Therapy (ART)
To review, the overarching goal of ART is to reduce further disease and early death from HIV/AIDS, as well as to prevent transmission of HIV to others (Treatment as Prevention).
- ART should be offered to all HIV-1 infected patients, regardless of immune status.
- Highly effective ART regimens, such as those found in the DHHS HIV guidelines, should be considered for initial treatment.
- Drug therapy should always be patient-specific and determined based on kidney and liver function, HBV status, cardiovascular risk, child-bearing potential and pregnancy status, drug resistance testing, genotype/phenotype, and HLA-B*5701 status (if abacavir use).
- Therapy should be directed by clinicians with significant experience in HIV treatment.
- Patient education and importance of therapy adherence should be emphasized at the point of care.
- Caregiver education should be considered, if needed.
An Added Tool: Vaccinations
Vaccination is an important preventive tool for patients with HIV. Avoiding viral and bacterial illnesses is paramount, when possible, and vaccination offers an important option to help remain healthy. Here are the types of vaccines a patient with HIV will want to discuss with their healthcare provider. You may not need all of these and you may have already had some:
- Influenza vaccine each year to protect against seasonal flu.
- Tdap vaccine to protect against whooping cough and tetanus (Boostrix, Adacel)
- Pneumococcal vaccine (eg, Pneumovax 23) to protect against pneumonia and other pneumococcal diseases.
- Meningococcal conjugate vaccine series (Menactra, Menveo, or MenQuadfi) which protect against meningococcal disease.
- Hepatitis B vaccine series to protect against hepatitis B.
- HPV vaccine series to protect against human papillomavirus if you are a man or woman up to age 26 years
- MMR vaccine to protect against measles, mumps, and rubella if you were born in 1957 or after and have not gotten this vaccine or have immunity to these diseases.
- Varicella vaccine to protect against chickenpox if you were born in 1980 or after and have not gotten two doses of this vaccine or have immunity to this disease.
- COVID-19 vaccine to protect against SARS-CoV-2, the virus that causes COVID-19 disease. The three available COVID vaccines in the U.S are the Pfizer-BioNTech COVID-19 Vaccine or Comirnaty; the Moderna COVID-19 Vaccine, and the Janssen (J&J) COVID-19 vaccine. The COVID-19 vaccines do not contain live virus and are recommended for patients on ART by clinical experts.
As always, check with your doctor if you have any questions about vaccinations.
Join Forces to Fight HIV
Treatment of HIV is complex and requires an experienced and dedicated health care team AND a motivated and compliant patient. However, thanks to many years of research, there are multiple options today for patients living with HIV.
ART for treatment-naive patients may consist of two NRTIs in combination with a third active antiretroviral drug from one of three drug classes: an integrase strand transfer inhibitor (INSTI), a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor (PI) with a pharmacokinetic enhancer (cobicistat or ritonavir).
There is a 2 drug option today, as well, for certain patients -- Juluca (dolutegravir and rilpivirine) -- approved in November 2017. Juluca is an integrase strand transfer inhibitor (INSTI) and an HIV-1 non-nucleoside reverse transcriptase inhibitor (NNRTI) combination for the maintenance treatment of HIV-1 infection in adults who are virologically suppressed.
Keeping up with the news on the latest HIV treatments may seem like a full-time task. Consider joining the Drugs.com HIV Infection Support Group to help you stay on top of the latest news and research, voice your opinion, and ask questions of those who share your same concerns -- whether patients or caregivers.
Finished: HIV & AIDS Update: New Treatments, Easier Options
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- Apretude (cabotegravir). Drugs.com. Accessed 12/31/2021 at https://www.drugs.com/apretude.html
- FDA Approves Trogarzo (ibalizumab-uiyk) for Treatment-Experienced Patients with Multidrug Resistant HIV. Drugs.com. at https://www.drugs.com/newdrugs/fda-approves-trogarzo-ibalizumab-uiyk-experienced-patients-multidrug-resistant-hiv-4706.html
- Biktarvy Package Insert and Patient Information. Gilead Sciences. https://www.gilead.com/~/media/files/pdfs/medicines/hiv/biktarvy/biktarvy_pi.pdf
- Juluca Package Insert and Patient Information. ViiV Healthcare. https://www.gsksource.com/pharma/content/dam/GlaxoSmithKline/US/en/Prescribing_Information/Juluca/pdf/JULUCA-PI-PIL.PDF
- CDC. HIV Infection and Adult Vaccination. https://www.cdc.gov/vaccines/adults/rec-vac/health-conditions/hiv.html
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Department of Health and Human Services. Available at https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/what-start-initial-combination-regimens-antiretroviral-naive.
- Genyova Package Insert and Patient Information. Gilead Sciences. https://www.gilead.com/~/media/files/pdfs/medicines/hiv/genvoya/genvoya_pi.pdf
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.