What to know about antiretroviral therapy for HIV

Antiretroviral therapy refers to any HIV treatment that uses a combination of two or more drugs. A healthcare provider may choose to prescribe a combination of three or more drugs to improve the treatment's chance of success.

In this article, we take look at the effects of antiretroviral therapy, the official guidelines of its use, and a list of antiretroviral therapy drugs.

What is antiretroviral therapy?

Specialists introduced antiretroviral therapy in 1996 in response to the poor success rate among those taking only one HIV medication at a time.

The beginnings of three-drug antiretroviral treatment marked a turning point in the history of HIV treatment. The new treatment design transformed what used to be a diagnosis with a very poor outlook into a manageable condition.

Antiretroviral therapy has a twofold effect on the body. It increases the number of immune cells while also decreasing the number of virus cells present in the body.

Antiretroviral therapy has the following positive effects on HIV:

• stops it from multiplying in the blood
• reduces viral load, which is the number of HIV copies in the blood
• increases the number of CD4 cells, which are immune cells that HIV targets, to improve immune system function
• slows down and prevents the development of stage 3 HIV, or AIDS
• prevents transmission
• reduces the severity of complications and increases survival rates
• keeps virus counts low in the blood

When prescribing antiretroviral therapy, healthcare providers typically use a regimen of three or more drugs for the best chances of lowering the amount of HIV in the body.

A person can, however, talk to their healthcare provider about a single pill that contains several medications.

According to the Centers for Disease Control and Prevention (CDC), antiretroviral therapy can reduce viral load to such an extent that it is undetectable. This means that a person can no longer transmit the virus to another person, even via condomless sex.

This concept is called undetectable = untransmittable, or U=U.

The CDC advise that people with HIV take antiretroviral medication regardless of their health status or how long they have had HIV.

When a person with HIV uses antiretroviral therapy as their healthcare provider instructs, it can help them live a full, healthy life.

Antiretroviral therapy drugs and regimens

There are seven classes of HIV drug, including around 30 different medications:

• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• nucleoside reverse transcriptase inhibitors (NRTIs)
• post-attachment inhibitors
• protease inhibitors (PIs)
• CCR5 antagonists
• integrase strand transfer inhibitors (INSTIs)
• fusion inhibitors

Initial treatment regimens usually include two NTRIs combined with a third active antiretroviral drug, which may be in the INSTI, NNRTI, or PI class. They may sometimes include a booster, which may be cobicistat (Tybost) or ritonavir (Norvir).

The antiretroviral therapy starting regimen for adults and adolescents with HIV is usually one of the following:

• bictegravir/tenofovir alafenamide/emtricitabine (Biktarvy)
• dolutegravir (Tivicay) plus tenofovir/emtricitabine (Truvada)
• raltegravir (Isentress) plus tenofovir/emtricitabine (Truvada)
• abacavir/dolutegravir/lamivudine (Triumeq), but not for those with a genetic sensitivity to abacavir

Once the healthcare provider finds an effective regimen, it takes around 3–6 months before the viral load reaches an undetectable level. This is not a cure, as the virus will remain in certain body tissues. However, the levels will be substantially lower.

For antiretroviral therapy to be effective, a person must take the medication exactly as a healthcare provider prescribes. Avoid missing doses or stopping medication for any period of time. Adhering to the regimen will prevent HIV from multiplying in the blood and affecting the immune system.

When discussing the most suitable treatment regimen, talk to the healthcare provider about any possible difficulties with taking the medication, such as a busy lifestyle or a lack of health insurance. They can help address and solve these issues.

Healthcare providers will take the following into consideration when choosing a person's antiretroviral therapy regimen:

• other health conditions
• whether the person is pregnant
• possible side effects of the HIV medications
• possible interactions between HIV medications and other medications a person is taking
• the cost of HIV medications
• a person's ability to adhere to their medication regimen

Summary

Antiretroviral therapy refers to HIV treatment that uses a combination of two or more antiretroviral drugs. Antiretroviral therapy revolutionized HIV treatment upon its introduction in 1996.

Antiretroviral therapy is an effective treatment for HIV. It does not cure the condition, but it can reduce the viral load to undetectable levels. This means that the virus is not transmittable through sexual activity and a person's immune system can recover.

It usually takes around 3–6 months for the viral load to reach undetectable levels.

Strict adherence to the antiretroviral therapy regimen is important, as this will prevent HIV from multiplying in the blood and tissues and damaging the immune system.


Medically reviewed by Daniel Murrell, M.D.

Written by Jenna Fletcher

SOURCE: MEDICAL NEWS TODAY