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HIV: Antiretroviral Therapy (ART)

Topic Overview

Antiretroviral therapy (ART) is the combination of several antiretroviral medicines used to slow the rate at which HIV makes copies of itself (multiplies) in the body. A combination of three or more antiretroviral medicines is more effective than using just one medicine (monotherapy) to treat HIV.

The use of three or more antiretroviral medicines—sometimes referred to as an anti-HIV "cocktail"—is currently the standard treatment for HIV infection. So far, this treatment offers the best chance of preventing HIV from multiplying, which allows your immune system to stay healthy. The goal of antiretroviral therapy is to reduce the amount of virus in your body (viral load) to a level that can no longer be detected with current blood tests.

Antiretroviral medicines that are often used to treat HIV include:

  • Nucleoside/nucleotide reverse transcriptase inhibitors, also called nucleoside analogs, such as abacavir, emtricitabine, and tenofovir. These medicines are often combined for best results.
  • Nonnucleoside reverse transcriptase inhibitors (NNRTIs), such as efavirenz, etravirine, and nevirapine.
  • Protease inhibitors (PIs), such as atazanavir, darunavir, and ritonavir.
  • Entry inhibitors, such as enfuvirtide and maraviroc.
  • Integrase inhibitors, such as dolutegravir and raltegravir.

Some medicines are available combined together in one pill. This reduces the number of pills to be taken each day.

The U.S. National Institutes of Health recommends using one of the following programs for people who begin treatment for HIV:1

  • Efavirenz + tenofovir + emtricitabine
  • Ritonavir-boosted atazanavir + tenofovir + emtricitabine
  • Ritonavir-boosted darunavir + tenofovir + emtricitabine
  • Raltegravir + tenofovir + emtricitabine

Other drug combinations are approved and may be used in some cases.

Also, studies have shown that if you are not infected with HIV, taking antiretroviral medicines can protect you against HIV.2, 3 But to keep your risk low, you still need to use safer sex practices.

References

Citations

  1. U.S. Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents (2013). Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. Available online: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf.
  2. Grant RM, et al. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27): 2588–2599.
  3. Baeten JM, et al. (2012). Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. New England Journal of Medicine, 367(5): 399–410.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Peter Shalit, MD, PhD - Internal Medicine
Current as of June 4, 2014

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