There's no cure for HIV/AIDS, but a variety of drugs can be used in combination to control the virus. Each class of anti-HIV drugs blocks the virus in different ways. It's best to combine at least three drugs from two classes to avoid creating strains of HIV that are immune to single drugs.
The classes of anti-HIV drugs include:
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs). These disable a protein needed by HIV to make copies of itself. Examples include efavirenz (Sustiva), etravirine (Intelence) and nevirapine (Viramune).
- Nucleoside reverse transcriptase inhibitors (NRTIs). NRTIs are faulty versions of building blocks that HIV needs to make copies of itself. Examples include Abacavir (Ziagen), and the combination drugs emtricitabine and tenofovir (Truvada), and lamivudine and zidovudine (Combivir).
- Protease Inhibitors (PIs). PIs disable protease, another protein that HIV needs to make copies of itself. Examples include atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva) and ritonavir (Norvir).
- Entry or fusion inhibitors, These drugs block HIV's entry into CD4 cells. Examples include enfuvirtide (Fuzeon) and maraviroc (Selzentry).
- Integrase inhibitors Raltegravir (Isentress) works by disabling integrase, a protein that HIV uses to insert its genetic material into CD4 cells.
When to start treatment
Guidelines from the Department of Health and Human Services recommend that everyone with HIV infection, regardless of CD4 count, be offered antiviral medication. However, some experts question the guidelines because of concerns about long-term toxicity of these drugs, drug resistance, cost and difficulty adhering to the drug regime.
You should definitely begin treatment, however, if:
- You have severe symptoms
- You have an opportunistic infection
- Your CD4 count is under 350
- You're pregnant
- You have HIV-related kidney disease
- You're being treated for hepatitis B
Treatment can be difficult
HIV treatment regimens may involve taking multiple pills at specific times every day for the rest of your life. Side effects can include:
- Nausea, vomiting or diarrhea
- Heart disease
- Weakened bones
- Shortness of breath
- Skin rash
- Bone death, particularly in the hip joints
Codiseases and cotreatments
Some health issues that are a natural part of aging may be more difficult to manage if you have HIV. Some medications that are common for age-related cardiovascular, metabolic and bone conditions, for example, may not interact well with anti-HIV medications. Talk to your doctor about other conditions for which you're taking medication.
Your doctor will monitor your viral load and CD4 counts to determine your response to treatment. Viral load should be tested at the start of treatment and then every three to four months during therapy. CD4 counts should be checked every three to six months.
HIV treatment should reduce your viral load to the point that it's undetectable. That doesn't mean your HIV is gone. It just means that the test isn't sensitive enough to detect it. You can still transmit HIV to others when your viral load is undetectable.