There are a variety of treatments for people living with HIV. This option may help prevent missed doses.
The treatment for HIV has improved. HIV was considered fatal in the 1980s. HIV has become a chronic condition thanks to advances in treatment.
One of the biggest recent advances in HIV treatment is the development of a single-dose medication — one pill that contains a combination of several different HIV drugs.
A combination pill is a big step forward from the cumbersome, multi-pill drug regimens that used to be the only treatment option for people with HIV.
The combination pills need to be taken with other drugs. emtricitabine and tenofovir disoproxil fumarate are examples.
The other pills form a complete regimen of their own. There are pills that combine three different drugs. Dolutegravir and rilpivirine are two newer two-drug combinations that form a complete HIV regimen.
Juluca includes two drugs from different drug classes, which is important in comparison to two-drug combinations. The drugs in Truvada are in the same class.
A single-tablet regimen is a combination pill that can be used as a complete HIV regimen.
In 1987, the Food and Drug Administration (FDA) approved the very first drug to treat HIV. It was called azidothymidine, or AZT (now referred to as zidovudine).
The drug AZT helps prevent the virus from copying itself. The immune system is strong because of the amount of HIV in the body.
AZT is part of a class of antiretroviral drugs called nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs).
The introduction of AZT was a major advancement in HIV treatment, but it isn’t a perfect drug. At the time it was introduced, AZT was the most expensive medication in history, costing users $8,000 to $10,000 per year (roughly $20,000 to $25,000 per year in 2022 dollars).
This drug can lead to significant and potentially serious side effects in some people. Moreover, when AZT is used by itself, HIV quickly becomes resistant. This drug resistance allows disease recurrence.
“AZT is still on the market, but it isn’t used in adults. Babies born to HIV-positive people may be given post-exposure prophylactics.”
Other HIV drugs followed AZT, including protease inhibitors. These drugs work by stopping HIV from making more viruses inside cells that are already affected by HIV.
When people with HIV were only given one drug at a time, the drug became resistant to it, making it useless.
By the end of the 1990s, single-drug therapy gave way to combination treatment.
At least two different HIV drugs are included in combination treatment. The drugs have at least two different ways of stopping the virus from replicating.
This therapy was historically called highly active antiretroviral therapy. It’s now called antiretroviral therapy or combination antiretroviral therapy. It previously required what was referred to as “a cocktail of drugs” in the form of handfuls of pills, often taken multiple times per day. Now, a person living with HIV may be prescribed a single combination pill.
The amount of HIV in a person is reduced by effective combination therapy. The combination regimen is designed to maximize the level of HIV suppression while avoiding the possibility of the virus becoming resistant to any drug.
If an HIV-positive person is able to achieve viral suppression through HIV treatment, the
Different classes of drugs are used to treat HIV. The drugs in these classes interfere with how HIV copies itself.
- Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs, or “nukes”). NRTIs prevent the virus from copying its genetic material. NRTIs block an enzyme called reverse transcriptase, which HIV uses to convert its genetic material (RNA) to DNA.
- Integrase strand transfer inhibitors (INSTIs). INSTIs are a category of integrase inhibitors specifically used to treat HIV. Integrase inhibitors block an enzyme, integrase, that viruses need to insert copies of its genes into a human cell’s genetic material.
- Protease inhibitors (PIs). PIs block an enzyme called protease, which the virus needs to process proteins that are essential to its ability to make more of itself. These drugs severely limit HIV’s ability to replicate.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs, or “non-nukes”). NNRTIs also block the virus from converting RNA, its genetic material, to DNA with reverse transcriptase. However, they work differently from NRTIs.
- Entry inhibitors. Entry inhibitors stop HIV from getting into cells of the immune system in the first place. This broad category of drugs includes drugs from the following classes: chemokine coreceptor antagonists (CCR5 antagonists), fusion inhibitors, and attachment inhibitors. Although these antiretrovirals stop HIV from one of the first steps in making copies of itself, these medications are often saved for when a person is limited in options due to many drug-resistant mutations of HIV.
ritonavir and cobicistat are drugs that are part of a class of drugs called the cytochrome P4503A inhibitors. They are mostly booster drugs. ritonavir and cobicistat enhance the effects of other HIV drugs. The PI drug class has a drug named rionavir.
People on antiretroviral medications used to take multiple pills each day. The complicated regimen led to mistakes and missed doses.
Fixed-dose combinations of HIV drugs became available in 1997. These drugs combine two or more drugs from the same or different classes into one pill. The single pill is easier to take.
Combivir was the first of these brand-name combination drugs. Currently, 23 combination tablets are approved to treat HIV. Keep in mind that some of them may need to be taken with other antiretroviral drugs to form a complete HIV regimen.
The FDA approved the combination tablets.
- Atripla, which contains efavirenz (NNRTI), emtricitabine (NRTI), and tenofovir disoproxil fumarate (NRTI)
- Biktarvy, which contains bictegravir (INSTI), emtricitabine (NRTI), and tenofovir alafenamide fumarate (NRTI)
- Cimduo, which contains lamivudine (NRTI) and tenofovir disoproxil fumarate (NRTI)
- Combivir, which contains lamivudine (NRTI) and zidovudine (NRTI)
- Complera, which contains emtricitabine (NRTI), rilpivirine (NNRTI), and tenofovir disoproxil fumarate (NRTI)
- Delstrigo, which contains doravirine (NNRTI), lamivudine (NRTI), and tenofovir disoproxil fumarate (NRTI)
- Descovy, which contains emtricitabine (NRTI) and tenofovir alafenamide fumarate (NRTI)
- Dovato, which contains dolutegravir (INSTI) and lamivudine (NRTI)
- Epzicom, which contains abacavir (NRTI) and lamivudine (NRTI)
- Evotaz, which contains atazanavir (PI) and cobicistat (CYP3A inhibitor)
- Genvoya, which contains elvitegravir (INSTI), cobicistat (CYP3A inhibitor), emtricitabine (NRTI), and tenofovir alafenamide fumarate (NRTI)
- Juluca, which contains dolutegravir (INSTI) and rilpivirine (NNRTI)
- Kaletra, which contains lopinavir (PI) and ritonavir (PI/CYP3A inhibitor)
- Odefsey, which contains emtricitabine (NRTI), rilpivirine (NNRTI), and tenofovir alafenamide fumarate (NRTI)
- Prezcobix, which contains darunavir (PI) and cobicistat (CYP3A inhibitor)
- Stribild, which contains elvitegravir (INSTI), cobicistat (CYP3A inhibitor), emtricitabine (NRTI), and tenofovir disoproxil fumarate (NRTI)
- Symfi, which contains efavirenz (NNRTI), lamivudine (NRTI), and tenofovir disoproxil fumarate (NRTI)
- Symfi Lo, which contains efavirenz (NNRTI), lamivudine (NRTI), and tenofovir disoproxil fumarate (NRTI)
- Symtuza, which contains darunavir (PI), cobicistat (CYP3A inhibitor), emtricitabine (NRTI), and tenofovir alafenamide fumarate (NRTI)
- Temixys, which contains lamivudine (NRTI) and tenofovir disoproxil fumarate (NRTI)
- Triumeq, which contains abacavir (NRTI), dolutegravir (INSTI), and lamivudine (NRTI)
- Trizivir, which contains abacavir (NRTI), lamivudine (NRTI), and zidovudine (NRTI)
- Truvada, which contains emtricitabine (NRTI) and tenofovir disoproxil fumarate (NRTI)
It is easier to treat people with HIV with just one daily pill. The drugs are improved by it.
A 2018 study involving over 1,000 people with HIV also compared people on single-tablet regimens to people on multi-tablet regimens. The researchers concluded that people on single-tablet regimens were more likely to stick to their regimens and to experience viral suppression.
Adding more drugs to a pill can cause more side effects. Each drug has its own set of risks. It can be hard to tell which of the drugs in a combination pill caused a person to have a side effect.
It is important to choose an HIV treatment. The healthcare team can help people living with HIV make a decision.
Before deciding on a treatment, it is a good idea to discuss the benefits and risks of single tablets versus a combination pill. People with HIV can get help choosing the best option for their lifestyle and health needs from a healthcare professional.