HIV / AIDS

What types of HIV medications are there?

Although there is currently no cure for HIV, a range of medications can control the condition. People with HIV take combinations of medicines. These regimens help them lead longer and healthier lives.

This article provides a list of HIV medications that the United States Food and Drug Administration (FDA) have currently approved. We also give information about choosing an appropriate HIV regimen.

How HIV medications work

man emptying capsule into hand
There are a variety of medications that can control HIV.

HIV medications primarily work by stopping the virus from replicating.

The virus attacks the immune system by invading and killing the white blood cells that play an important role in this system.

After invading a white blood cell, the virus uses it to replicate itself. This allows HIV to spread. The immune system begins to weaken as this happens, leaving the person more susceptible to infection.

A class of drugs called antiretroviral medications, or antiretrovirals, can stop the virus from replicating. This helps protect the immune system, allowing people with HIV to lead long, productive lives.

Types of HIV medication

The HIV life cycle refers to the replication and spread of the virus throughout the body. There are seven classes of antiretrovirals, each of which target HIV at a different stage of its life cycle.

A central aim of this medication is to reduce a person’s viral load, or the amount of the virus in the blood, to an undetectable level.

An undetectable viral load indicates that a person’s HIV medications are working effectively to keep the virus under control.

The following antiretroviral medications currently have approval by the FDA.

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

NNRTIs stop HIV from replicating. They do this by binding to and altering an enzyme called reverse transcriptase, which HIV uses to replicate.

The list of NNRTIs includes:

Generic name Brand name
doravirine Pifeltro
efavirenz Sustiva
etravirine Intelence
nevirapine Viramune, Viramune XR
rilpivirine Edurant

Nucleoside reverse transcriptase inhibitors (NRTIs)

These drugs work in a similar way as the NNRTIs above: by preventing HIV from replicating. This reduces the viral load of HIV within a person’s body.

The list of NRTIs includes:

Generic name Brand name
abacavir Ziagen
emtricitabine Emtriva
lamivudine Epivir
tenofovir disoproxil
fumarate
Viread
zidovudine Retrovir

Protease inhibitors (PIs)

Developing HIV cells use an enzyme called protease to mature and replicate. Protease enables the virus to spread to other cells within the body.

PIs bind to and block this enzyme, thereby preventing HIV from replicating.

Examples of PIs include:

Generic name Brand name
atazanavir Reyataz
darunavir Prezista
fosamprenavir Lexiva
ritonavir Norvir
saquinavir Invirase
tipranavir Aptivus

Fusion inhibitors

To replicate successfully, HIV must enter a cell, in a process called fusion. Fusion inhibitors are drugs that prevent HIV from entering the cells.

Enfuvirtide is one fusion inhibitor, and it has the brand name Fuzeon.

CCR5 antagonists

To enter a cell, HIV must first bind to a special receptor on the cell’s surface. One of these receptors is the CCR5 coreceptor.

CCR5 antagonists are drugs that block the CCR5 coreceptor, preventing HIV from attaching to and entering the white blood cell. For this reason, doctors refer to CCR5 antagonists as entry inhibitors.

Maraviroc is an example of a CCR5 antagonist, and it is available under the brand name Selzentry.

Post-attachment inhibitors

Post-attachment inhibitors are another type of entry inhibitor. These drugs block two kinds of receptor on the surface of white blood cells: the CCR5 and CXCR4 coreceptors.

As with CCR5 antagonists, these drugs prevent HIV from entering the cells, thereby preventing the virus from replicating.

Ibalizumab is a post-attachment inhibitor available under the brand name Trogarzo.

Integrase strand transfer inhibitors (INSTIs)

After entering a white blood cell, HIV can replicate by inserting, or integrating, its DNA into that of the cell.

This process relies on an enzyme called integrase.

INSTIs disable the effects of integrase, thereby preventing HIV from inserting its DNA into the host cell. As a result, HIV is unable to make copies of itself.

Examples of INSTIs include:

Generic name Brand name
dolutegravir Tivicay
raltegravir Isentress, Isentress HD

Pharmacokinetic enhancers

Pharmacokinetic enhancers are not antiretrovirals, but they may complement antiretroviral therapy.

These drugs can boost the effects of some HIV medications.

Cobicistat is the generic name of a pharmacokinetic enhancer available under the brand name Tybost.

Combination HIV medicines

A person with a recent HIV diagnosis will usually start treatment by taking a combination of HIV medications.

This combination usually includes three HIV medicines from two or more classes of drug, all contained within a single pill.

There are many different single-pill drug combinations available. A person should discuss the best combination for their requirements with a healthcare provider.

Choosing an HIV regimen

doctor talking to male patient
A person’s healthcare provider will identify the most suitable medication.

The healthcare provider will work with a person to choose an HIV regimen that best meets their needs.

As part of this process, the healthcare provider may recommend drug-resistance testing. This procedure identifies medications that may not be effective in treating a person’s HIV.

A healthcare provider may also take the following into account when recommending an HIV regimen:

  • whether the person is pregnant or planning on becoming pregnant
  • whether the person has other medical conditions, such as heart disease
  • possible side effects of HIV medications
  • potential drug interactions with other medications and supplements
  • any issues that may make it difficult to take HIV medications consistently, such as a busy schedule, a lack of health insurance, or alcohol and drug use
  • the cost of the HIV medications

Takeaway

Antiretroviral medications cannot cure HIV, but they can help protect a person’s immune system.

When choosing an appropriate regimen, work closely with a healthcare provider to identify the most appropriate combination of HIV medications.

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