How does ART work?

Drugs
Antiretroviral therapy treats HIV by suppressing the virus’ activity in the body. For most people who take them, these medications are very effective at keeping HIV under control.

Treatment helps to improve quality of life, and it can ensure that a person with HIV has a similar life expectancy to a person without the virus.

Suppressing viral activity results in a low viral load and a reduced risk of developing other illnesses.

According to the United States Department of Health and Human Services (HHS), the main goal of antiretroviral therapy is to reduce a person’s viral load to undetectable levels.

When the viral load is so low that it is undetectable, there is no risk of transmitting the virus to others.

Here, we describe different antiretroviral drugs and their side effects and provide information about beginning treatment.

How do antiretroviral drugs work?

Man holding pill bottle of antiretroviral drugs for HIV
Antiretroviral medication can help treat HIV by preventing it from targeting healthy cells.

HIV attacks the body’s immune system.

A weak immune system means that the body struggles to fight off illnesses, from infections to cancer.

Antiretroviral medications prevent HIV from multiplying, thus protecting the cells that the virus would otherwise target.

The less HIV present in a person’s body, the easier it will be for the immune system to recover.


Types of antiretroviral drugs

Treating HIV involves a combination of medications. The following are the different categories of antiretroviral drugs:

Nucleoside reverse transcriptase inhibitors (NRTIs)

NRTIs block the action of an enzyme called viral reverse transcriptase, which is necessary for HIV to replicate.

Examples of NRTIs include:

  • abacavir (Ziagen)
  • emtricitabine (Emtriva)
  • lamivudine (Lamivudine RBX, Zefix, Zetlam)
  • stavudine (Zerit, Stavudin)
  • tenofovir (Viread)
  • zidovudine (Retrovir)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

NNRTIs work similarly to NRTIs. The only difference is that they act on different sites of the enzyme.

Examples of these antiretroviral medications include:

  • delavirdine (Rescriptor)
  • doravirine (Pifeltro)
  • efavirenz (Sustiva)
  • etravirine (Intelence)
  • nevirapine (Viramune)
  • rilpivirine (Edurant)

Protease inhibitors (PIs)

PIs impede another viral enzyme, HIV protease. HIV requires protease to replicate.

Types of PIs include:

  • atazanavir (Reyataz)
  • darunavir (Prezista)
  • fosamprenavir (Lexiva, Telzir)
  • indinavir (Crixivan)
  • lopinavir (Kaletra)
  • ritonavir (Norvir)
  • saquinavir (Invirase)
  • tipranavir (Aptivus)

Entry inhibitors

As the name suggests, these drugs prevent the virus from entering the targeted cells.

To penetrate immune cells, HIV must fuse to the cells’ receptors, and these drugs work to stop this from happening.

People often take entry inhibitors when other treatments have been unsuccessful.

Examples currently in use include:

  • enfuvirtide (Fuzeon)
  • maraviroc (Selzentry)

Integrase inhibitors

HIV uses a protein called integrase to send its genetic material into the cells that it targets. Integrase inhibitors block this action.

Research into these drugs is ongoing, but types currently approved for use include:

  • dolutegravir (Tivicay)
  • elvitegravir (Vitekta)
  • raltegravir (Isentress)


Side effects

Side effects of antiretroviral drugs can include difficulty sleeping and headaches.
Side effects of antiretroviral drugs can include difficulty sleeping and headaches.

Antiretroviral drugs can have adverse effects. Most are simple to manage, and newer drugs tend to cause fewer of these reactions.

The benefits of taking HIV medications typically outweigh the side effects — these treatments can help people live long, healthy lives with reduced risks of complications and transmission.

Potential side effects vary, depending on the type of medications a person uses.

Potential short-term side effects of antiretroviral therapy can include:

Long-term side effects may include:

Side effects that indicate a more serious complication and may require urgent care include:

  • extreme fatigue
  • nausea
  • fever
  • persistent vomiting
  • a rash

People who experience swelling of the face, throat, or tongue require emergency treatment. If this occurs, call an ambulance or go to the nearest emergency department.


Managing side effects

A healthcare provider can give advice and other forms of support for people experiencing side effects of HIV treatment. If symptoms are severe or ongoing, healthcare professionals may recommend alternative medications.

It helps for people to discuss their lifestyle, needs, preferences, and current health status with their healthcare provider, who can take these into account when prescribing a treatment plan.

Interactions with other substances

Antiretroviral drugs can interact with other medications, supplements, and herbal products.

It is important to discuss all current medicines and supplements with a healthcare provider, as these can influence how HIV medication works. In some cases, they can cause adverse reactions.


When to start antiretroviral therapy

A person should seek treatment as soon as they receive an HIV diagnosis.
A person should seek treatment as soon as they receive an HIV diagnosis.

Guidelines from the HHS recommend that all individuals with HIV begin antiretroviral therapy as soon as possible. This gives people the best chance of reducing their viral load and risk of complications.

For some groups of people with HIV, it is especially important to seek immediate treatment.

These include:

  • people in the early stages of HIV
  • women who are pregnant or breastfeeding
  • people with AIDS (the late stage of HIV)
  • people with HIV-related infections or cancers
  • people who have sex with people who do not have HIV

Research suggests that prompt treatment reduces the risk of transmission, disease progression, and complications.

It also significantly increases life expectancy for many people. For example, according to a 2017 study in The Lancet HIV, a 20-year-old with HIV who lives in the U.S. or Canada and is receiving treatment has a life expectancy similar to that of the general population.

If a person with HIV does not receive treatment, the virus typically develops into AIDS within 10 years. AIDS causes irreversible immune system damage and a higher risk of infections and related cancers.

Takeaway

Antiretroviral drugs are effective treatments for HIV. Organizations around the world recommend that everyone with HIV begins this type of therapy as soon as possible.

These drugs can also reduce the risk of HIV-related complications, stop the virus from progressing, and limit or prevent transmission.

In addition, antiretroviral medicines increase a person’s quality of life and life expectancy.

Some people experience side effects, and these may go away after a few weeks of treatment. There are several classes of antiretroviral drugs, so even if one causes side effects, others may not.

A healthcare provider can offer information and guidance about treatment options for people with HIV.

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