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How Antiretroviral Therapy Drugs Treat HIV

Learn how antiretroviral therapy (ART) drugs help control progression and prevent the transmission of HIV.

Antiretroviral drugs for treating HIV against a blue background.

Medically reviewed in July 2022

The prognosis for people infected with HIV is much better than it was in previous decades, thanks to a better understanding of the virus, better screening methods, earlier treatment, and more effective medications.

Commonly referred to as HIV, human immunodeficiency virus is a chronic viral infection that targets the body’s immune system.

Untreated, HIV can progress to acquired immune deficiency syndrome (AIDS). If a person develops AIDS, the body will have little immunological defense against serious infections and certain types of cancer.

While there is no cure for HIV, the disease can be managed with treatment—and if you’ve been diagnosed with HIV, it is important to start treatment immediately. Delaying treatment can increase the chances of HIV progressing to AIDS and other serious complications.

Antiretroviral therapy
The treatment for HIV infection is called antiretroviral therapy, often abbreviated as ART. These medicines work by disrupting the lifecycle of HIV, preventing the virus from reproducing and enabling the immune system to remain strong.

Regimens
There are over two dozen different ART drugs available. These ART drugs are categorized into six different medication classes. People receiving treatment for HIV are given a combination of several medications from different classes. A combination of ART drugs is called a regimen.

The backbone of most regimens are drugs called NRTIs (nucleoside or nucleotide reverse transcriptase inhibitors). These drugs are sometimes called “nukes.” They work by blocking an enzyme called reverse transcriptase, which HIV needs in order to make copies of itself. This disrupts the lifecycle of the virus.

A standard regimen typically includes two NRTIs, plus another ART drug from a different medication class. The other medication classes of ARTs are:

  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  • Integrase inhibitors (IIs)
  • Protease inhibitors (PIs)
  • Fusion inhibitors (FIs)
  • Chemokine receptor antagonists (CRAs)

These drugs work by blocking or disrupting different enzymes or processes that the virus uses to replicate itself.

Many ART regimens are taken as oral medications, which are taken every day. Other forms of ART drugs are under development. In 2021, the FDA approved a long-acting ART medication that is given as a monthly injection.

Choosing an ART regimen
There is no regimen that is best, only a regimen that is best for a particular person. Deciding on what therapies to use is a decision that must be made under the guidance of an HIV specialist.

Whatever ART regimen you are taking, consistency is the key to success. ART will need to be taken for the duration of a person’s life. Stopping treatment—or even taking drugs at inconsistent times—can lead to drug resistance. Drug resistance means there will be fewer medications that can treat the HIV infection.

If you or a loved one is diagnosed with HIV, it is important to partner with a healthcare provider and begin treatment as soon as possible.

Article sources open article sources

UpToDate. "Patient education: Initial treatment of HIV (Beyond the Basics)."
Mary D. Nettleman. "HIV Treatment, Medications, Prognosis, and Prevention." MedicineNet. December 18, 2019.
HIV.gov. "What is HIV?"
Cleveland Clinic. "HIV & AIDS."
MedlinePlus. "HIV/AIDS."
Centers for Disease Control and Prevention. "What his HIV treatment?"
Office of AIDS Research. "HIV Treatment."
Caitlin Mahon. "Life expectancy for people with HIV is now near-normal – but only for those accessing treatment." Avert. May 15, 2017.
Office of AIDS Research. "HIV/AIDS Glossary."
U.S. Department of Veteran Affairs. "Nucleoside Reverse Transcriptase Inhibitors (nucleoside analogues, NRTIs or nukes)."
Office of AIDS Research. "FDA-Approved HIV Medicines."
Eric F. Egelund and Jessica Huston. "Long-Acting Antiretroviral Therapies for HIV Treatment and Prevention." Contagion, 2021. Vol. 6, No. 3.
Kevin Kunzmann. "Adding Long-Acting Injectable Options for HIV Management." ContagionLive. October 3, 2021.
HIV.gov. "Why Should You Take Your HIV Medication Every Day?"

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