The treatment of HIV has transformed dramatically over the past few decades, with advancements in medications leading to effective, manageable treatment plans. Modern HIV medications, collectively known as antiretroviral therapies (ART), work to suppress the virus, allowing individuals with HIV to lead longer and healthier lives. This article offers an overview of the primary classes of HIV medications, how they work, and their impact on the body.

The Goal of ART

The main goal of ART is to reduce the viral load in the blood to an undetectable level, which prevents HIV from attacking the immune system and greatly reduces the risk of transmission. By consistently adhering to ART, people with HIV can maintain healthy immune systems and experience fewer complications related to the virus.

Classes of HIV Medications

There are six primary classes of HIV medications. Each class targets HIV at different stages of its life cycle, making combination therapy highly effective.

1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
   • oNRTIs, sometimes called “nukes,” interfere with an enzyme HIV uses to replicate. By blocking reverse transcriptase, NRTIs prevent the virus from creating copies of its genetic material.
   • oCommon NRTIs include tenofovir, emtricitabine, and abacavir.
2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
   • oKnown as “non-nukes,” NNRTIs also block the reverse transcriptase enzyme but bind to a different part of the enzyme than NRTIs. This alternative binding disrupts HIV replication.
   • oExamples of NNRTIs include efavirenz, rilpivirine, and doravirine.
3. Protease Inhibitors (PIs)
   • oProtease inhibitors block another enzyme called protease, which HIV needs to process its proteins and form new virus particles. By inhibiting protease, these medications prevent the virus from maturing and becoming infectious.
   • oCommon protease inhibitors include atazanavirand darunavir.
4. Integrase Strand Transfer Inhibitors (INSTIs)
   • oINSTIs prevent HIV from integrating its genetic material into the DNA of human cells, which is a crucial step in its life cycle. By blocking this integration, INSTIs reduce the virus’s ability to replicate.
   • oCommon INSTIs include dolutegravir, bictegravir, and cabotegravir.
5. Entry Inhibitors
   • oThese drugs prevent HIV from entering human cells. There are two main types: fusion inhibitors, which block the virus from fusing with the cell membrane, and CCR5 antagonists, which block a specific receptor on the cell surface.
   • oEnfuvirtide(a fusion inhibitor) and maraviroc (a CCR5 antagonist) are examples.
6. Post-Attachment Inhibitors
   • oA newer class, post-attachment inhibitors, prevents HIV from attaching to cells after it has bound to the receptor, blocking the virus from completing the entry process.
   • oIbalizumabis the primary drug in this class.

Combination Therapy: A Standard in HIV Treatment

ART usually involves a combination of drugs from two or more classes, which effectively lowers viral load and reduces the risk of drug resistance. Fixed-dose combination pills, which include multiple drugs in one dose, are common, making adherence easier for patients.

The Impact of ART on HIV Management

With the availability of combination ART, people living with HIV can achieve undetectable viral loads, meaning the virus is no longer transmittable. ART is a lifelong commitment, but with once-daily pills and options for long-acting injections, managing HIV is more accessible and convenient than ever.