HIV medications stop the virus from making copies of itself. The Food and Drug Administration (FDA) has approved more than 50 HIV medications.
HIV is transmitted through contact with blood, semen, breast milk, or other bodily fluids that contain the virus. HIV targets the immune system and invades T cells, which are white blood cells that fight infection.
The virus then replicates (makes copies of itself), and the cells burst open. They release many viral cells that go on to invade other cells in the body.
This process destroys the immune system’s ability to fight infections and generally prevents the body from working well.
There is currently no known cure for HIV. However, medications can help people manage the condition and lead healthy lives. These drugs work by stopping HIV from replicating.
Here’s a list of drugs, known as antiretrovirals, that are currently approved by the Food and Drug Administration (FDA) to treat HIV.
Many different classes of antiretroviral drugs are used to treat HIV. A healthcare professional will assess a person with HIV and decide on the best medications for their individual case.
This decision will depend on:
- the person’s viral load
- their T-cell count
- their strain of HIV
- the severity of their case
- how far the HIV has spread
- any comorbidities (co-occurring health conditions) the person has
- any additional medications the person is taking (to avoid interactions between HIV drugs and other drugs)
HIV is treated with at least two different medications, although those medications can sometimes be combined into one pill. This is because attacking HIV from multiple directions lowers the viral load more quickly, which has been shown to most effectively control HIV.
Taking more than one antiretroviral drug also helps prevent resistance to the drugs being used. This means that a person’s medications may continue to work to treat HIV.
A person may be prescribed two to four individual antiretroviral drugs, or they may be prescribed a single combination drug in what’s sometimes known as a single-tablet regimen (STR). Combination HIV drugs pack multiple medications into the same pill, tablet, or other drug form.
Integrase inhibitors stop the action of integrase, a viral enzyme (a type of protein) that HIV uses to infect T cells by inserting HIV DNA into human DNA.
Integrase inhibitors are usually among the first HIV drugs used in people who have recently contracted HIV. This is because they work well and have minimal side effects.
The following drugs are integrase inhibitors:
- bictegravir (not available as a stand-alone drug but available in the combination drug Biktarvy)
- cabotegravir (Vocabria)
- dolutegravir (Tivicay, Tivicay PD)
- elvitegravir (not available as a stand-alone drug but available in the combination drugs Genvoya and Stribild)
- raltegravir (Isentress, Isentress HD)
These drugs belong to a well-established category of integrase inhibitors known as INSTIs. There is another, more experimental category of integrase inhibitors called integrase binding inhibitors (INBIs), but no INBIs are FDA approved to treat HIV.
NRTIs are sometimes referred to as “nukes.” They work by interrupting the life cycle of HIV as it tries to copy itself. These drugs also have other actions that prevent HIV from replicating in the body.
The following drugs are NRTIs:
- abacavir (Ziagen)
- emtricitabine (Emtriva)
- lamivudine (Epivir)
- tenofovir alafenamide fumarate (Vemlidy)
- tenofovir disoproxil fumarate (Viread)
- zidovudine (Retrovir)
As a stand-alone drug, tenofovir alafenamide fumarate has received full FDA approval to treat chronic hepatitis B but only tentative FDA approval to treat HIV. A person with HIV who takes tenofovir alafenamide fumarate will likely receive it as part of a combination HIV drug, not as a stand-alone drug.
Tenofovir disoproxil fumarate, emtricitabine, and lamivudine can treat hepatitis B as well.
Zidovudine was the
Combination NRTIs
The following combination drugs are made up of either two or three NRTIs:
- abacavir/lamivudine/zidovudine (Trizivir)
- abacavir/lamivudine (Epzicom)
- emtricitabine/tenofovir alafenamide fumarate (Descovy)
- emtricitabine/tenofovir disoproxil fumarate (Truvada)
- lamivudine/tenofovir disoproxil fumarate (Cimduo, Temixys)
- lamivudine/zidovudine (Combivir)
Descovy and Truvada may also be prescribed to some people without HIV as part of a preexposure prophylaxis (PrEP) regimen.
These drugs work in a similar way to NRTIs. They stop the virus from replicating itself in the body.
The following drugs are NNRTIs, or “non-nukes”:
- doravirine (Pifeltro)
- efavirenz (Sustiva)
- etravirine (Intelence)
- nevirapine (Viramune, Viramune XR)
- rilpivirine (Edurant)
Cytochrome P4503A, or CYP3A, is an enzyme in the liver that helps with several functions in the body, including metabolizing (breaking down) medications. CYP3A inhibitors increase the levels of certain HIV drugs (as well as other non-HIV drugs) in the body.
The following drugs are CYP3A inhibitors:
- cobicistat (Tybost)
- ritonavir (Norvir)
Cobicistat cannot promote anti-HIV activity when it’s used alone, so it’s always paired with another antiretroviral.
Ritonavir can promote anti-HIV activity when it’s used alone. However, to achieve this, it must be used in much higher doses than people can typically tolerate. It’s prescribed alongside other HIV drugs as a booster drug, which means it helps enhance the performance of the other drugs.
PIs work by binding to the enzyme protease. HIV needs protease to replicate in the body. When protease can’t do its job, the virus can’t complete the process that makes new copies. This lowers the number of viruses that can infect more cells.
Some PIs are FDA approved only to treat hepatitis C, but these are not the same as those used to treat HIV.
The following drugs are PIs used to treat HIV:
- atazanavir (Reyataz)
- darunavir (Prezista)
- fosamprenavir (Lexiva)
- lopinavir (not available as a stand-alone drug but available with ritonavir in the combination drug Kaletra)
- ritonavir (Norvir)
- tipranavir (Aptivus)
PIs are almost always used with either cobicistat or ritonavir, the CYP3A inhibitors.
Lopinavir is not available as a stand-alone drug. It’s available only in Kaletra, a combination HIV drug that also includes ritonavir.
Tipranavir is available as a stand-alone drug, but it must be given together with ritonavir.
Even if a PI is available as a stand-alone drug, it should always be combined with other antiretrovirals to create a complete regimen, or antiretroviral therapy.
Atazanavir and fosamprenavir are often given together with ritonavir, but in certain situations, they don’t have to be. They can be used without a CYP3A inhibitor.
Rarely used PIs
Nelfinavir (Viracept) is an HIV PI that’s rarely used because it has more side effects. Nelfinavir is always given without ritonavir or cobicistat.
Fusion inhibitors are another class of HIV medication.
HIV needs a host T cell to make copies of itself. By blocking the virus from entering a host T cell, fusion inhibitors prevent it from replicating.
Fusion inhibitors are rarely used in the United States because other available drugs are more effective and better tolerated.
There are currently two fusion inhibitors available: enfuvirtide (Fuzeon) and maraviroc (Selzentry).
Because HIV affects the immune system, researchers have been studying ways that biological drugs can prevent viral replication. Certain immune-based treatments have seen some success in clinical trials.
The first immune-based therapy that received FDA approval to treat HIV was ibalizumab-uiyk (Trogarzo) in 2018.
This drug belongs to a class of drugs known as post-attachment inhibitors. It prevents HIV from entering certain immune cells. This medication must be used with other antiretrovirals as part of an optimized background therapy, or optimized background regimen.
Attachment inhibitors are a newer class of HIV drugs. They work by attaching to a viral protein, which prevents that protein from attaching to and entering healthy T cells.
Only one attachment inhibitor, known as
The FDA approved this drug in July 2020, making it one of the newest HIV drugs on the market. Rukobia is used in combination with other HIV drugs and is intended for “treatment-experienced” people who have already tried several HIV drugs.
CCR5 antagonists block HIV from entering cells. These drug are rarely used in the United States because other available drugs are more effective, and this medication requires special testing before use.
Only one CCR5 antagonist, maraviroc (Selzentry), is currently available.
Fusion inhibitors, post-attachment inhibitors, attachment inhibitors, and CCR5 antagonists are all a part of a larger class of HIV drugs known as entry inhibitors.
All entry inhibitors work by blocking the virus from entering healthy T cells. These drugs are rarely used as first-line treatments for HIV.
The following drugs are entry inhibitors:
- enfuvirtide (Fuzeon)
- fostemsavir (Rukobia)
- ibalizumab-uiyk (Trogarzo)
- maraviroc (Selzentry)
Combination drugs combine multiple medications into one drug form. This type of regimen is typically used in people who have never taken HIV medications before.
The following combination drugs include only NRTIs:
- abacavir/lamivudine/zidovudine (Trizivir)
- abacavir/lamivudine (Epzicom)
- emtricitabine/tenofovir alafenamide fumarate (Descovy)
- emtricitabine/tenofovir disoproxil fumarate (Truvada)
- lamivudine/tenofovir disoproxil fumarate (Cimduo, Temixys)
- lamivudine/zidovudine (Combivir)
It’s much more common for combination drugs to be made up of medications from different drug classes than from the same drug class. These are known as multiclass combination drugs or single-tablet regimens (STRs).
Multiclass combination drugs (STRs)
The following combination drugs include only a PI and a CYPA3A inhibitor:
- atazanavir/cobicistat (Evotaz)
- darunavir/cobicistat (Prezcobix)
- lopinavir/ritonavir (Kaletra)
The CYPA3A inhibitor functions as a booster drug.
The following combination drugs include both NRTIs and NNRTIs:
- doravirine/lamivudine/tenofovir disoproxil fumarate (Delstrigo)
- efavirenz/lamivudine/tenofovir disoproxil fumarate (Symfi)
- efavirenz/lamivudine/tenofovir disoproxil fumarate (Symfi Lo)
- efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla)
- emtricitabine/rilpivirine/tenofovir alafenamide fumarate (Odefsey)
- emtricitabine/rilpivirine/tenofovir disoproxil fumarate (Complera)
Symfi and Symfi Lo are made up of the same generic medications, but Symfi Lo contains a smaller dose of efavirenz.
The following combination drugs include NRTIs, an INSTI, and the CYP3A inhibitor cobicistat:
The following combination drugs include at least one NRTI and an INSTI:
The manufacturer of Biktarvy refers to it as being “built on Descovy,” or as bictegravir plus Descovy.
The following combination drugs include an NNRTI and an INSTI:
- cabotegravir/rilpivirine (Cabenuva)
- dolutegravir/rilpivirine (Juluca)
The following combination drug includes NRTIs, a PI, and the CYP3A inhibitor cobicistat:
- darunavir/cobicistat/emtricitabine/tenofovir alafenamide fumarate (Symtuza)
Many HIV drugs can cause temporary side effects when first used. In general, these effects can include:
These drugs may cause side effects for the first several weeks. If the side effects get worse or last longer than a few weeks, consider talking with a healthcare professional. They may suggest ways to ease the side effects, or they may prescribe a different drug altogether.
Less often, HIV drugs can cause serious or long-term side effects. These effects depend on the type of HIV drugs used. A healthcare professional can offer more information.
There’s not yet a cure for HIV, but prescription medications can help slow the progression of the virus. Drugs can also improve HIV symptoms and make living with the condition more comfortable.
This medication list provides a brief overview of the types of drugs available to treat HIV. You can talk with a healthcare professional about all of these options, and they can determine the best treatment plan for you.
