HIV Treatment Regimens
Although there is no cure for HIV at this time, there are medications used to treat and suppress the virus. Eventually, a person’s viral load can become “undetectable” meaning that the amount of HIV in the blood is so low, that the virus is not detected when tested. Controlling viral load is essential for those with HIV to lead a longer life with fewer HIV-related complications.
Recent research has suggested that those who achieve and maintain an undetectable viral load have virtually no risk of transmitting the virus to an HIV-negative partner. This idea has been referred to as “undetectable = untransmittable” or “U=U”. Therefore, the risk of HIV transmission to an HIV-negative partner can be reduced when an HIV-positive partner is on ART and taking their medications as prescribed.1-3
HIV treatment regimens
Treatment with multiple HIV medications from a variety of different drug classes has been shown to be the most effective in helping an individual achieve viral suppression. Using multiple medications or classes of medications to treat HIV is referred to as antiretroviral therapy (ART) or combination antiretroviral therapy (cART).
In the past, HIV treatment options were available only as monotherapies, or medications that contained one active ingredient. Today, combination therapies are available that combine multiple medications, usually from different drug classes, in one tablet. This helps make taking and adhering to HIV treatment simpler, which is especially important in preventing HIV from mutating and developing resistance against a medication.1,4,5
HIV drug classes
HIV medications can be separated into different categories, called drug classes. Each drug class targets a different point in the HIV life cycle. The main HIV drug classes in order of the life cycle steps they impact include:
Targets of different HIV drug classes
The first two steps of the life cycle are called binding and fusion and focus on HIV getting into a human CD4 cell, or T cell. Once inside, the virus needs to disassemble itself and begin the replication process. The drug classes that interfere with the binding and fusion process include CCR5 antagonists, post-attachment inhibitors, and fusion inhibitors.
The next three steps represent the replication process of the virus’s genetic material. These processes are called reverse transcription, integration, and replication. The drug classes that act here include NRTIs, NNRTIs, and integrase inhibitors.
The last two steps of the process involve HIV re-assembling itself into new, mature virions that can be released from the CD4 cell and enter the bloodstream where they can go on to infect new cells. Protease inhibitors act at this step and prevent the assembly process.
Fully formed HIV carries around with it its viral RNA (its genetic material) and several enzymes, including the reverse transcriptase enzyme, the integrase enzyme (both involved in replication), and the protease enzyme. An HIV virion is not considered complete and able to infect more CD4 cells without all of these components.
A pharmacokinetic enhancer does not treat HIV directly, but rather, enhances the effect of certain HIV-fighting medications, such as protease inhibitors or integrase inhibitors, that are used alongside it.6
Some examples of common combination therapies that combine multiple medications are below. Several of these are designed to be standalone therapies, and are not to be taken with other HIV medications. Others need to be taken with additional HIV therapies. Other medications that might be added to these combination regimens include any additional medications from the classes listed, as well as fusion inhibitors, CCR5 antagonists, and post-attachment inhibitors. Your healthcare provider will let you know which medications you should be taking and when.
- Epzicom (abacavir and lamivudine)
- Triumeq (abacavir, dolutegravir, and lamivudine)
- Trizivir (abacavir, lamivudine, and zidovudine)
- Evotaz (atazanavir and cobicistat)
- Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide)
- Prezcobix (darunavir and cobicistat)
- Symtuza (darunavir, cobicistat, emtricitabine, and tenofovir alafenamide)
- Dovato (dolutegravir and lamivudine)
- Juluca (dolutegravir and rilpivirine)
- Delstrigo (doravirine, lamivudine, and tenofovir disoproxil fumarate)
- Atripla (efavirenz, emtricitabine, and tenofovir disoproxil fumarate)
- Symfi/Symfi Lo (efavirenz, lamivudine, and tenofovir disoproxil fumarate)
- Genvoya (elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide)
- Stribild (elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate)
- Odefsey (emtricitabine, rilpivirine, and tenofovir alafenamide)
- Complera (emtricitabine, rilpivirine, and tenofovir disoproxil fumarate)
- Descovy (emtricitabine and tenofovir alafenamide)
- Truvada (emtricitabine and tenofovir disoproxil fumarate)
- Cimduo (lamivudine and tenofovir disoproxil fumarate)
- Combivir (lamivudine and zidovudine)
- Kaletra (lopinavir and ritonavir)