HIV Treatment & Drug Classes

If you have ever been prescribed treatment for HIV, you are probably familiar with many of the antiretroviral (ARV) medications available. You also may know that treatment options can be complicated, especially if you have a strain of HIV that is resistant to one of more of the drugs.

young woman

Making sure you are familiar with the different classes of medications that treat HIV, will help you to have an informed conversation with your doctor about finding a treatment regimen that works, and will keep working, for you.

Explore the links below for an overview of ARV medications and drug classes.

HIV Treatment Goals

Drug Classes

Combination Therapy

Suggested Reading

HIV Treatment Goals

HIV treatment, or antiretroviral (ARV) medications, which are used to treat HIV, cannot cure the disease, but they can keep the virus from making copies of itself (replicating).

Treatment needs to be well-tolerated, convenient and selected with both the likelihood of success against the current viral strain(s) as well as allow for future therpeutic options. HIV medication has several major goals:

Stop viral replication
Restore or maintain immune function
Prevent mother-to-child transmission
Improve patient quality of life

Drug Classes

Several classes of HIV medications fight against HIV. To visualize their function and mechanism of action, please visit the

HIV animations.

Class	Function
Nucleoside reverse transcriptase inhibitors (NRTIs), also known as "nukes", nucleoside analogs, or backbone Abacavir (ABC) Didanosine (ddl) Emtricitabine (FTC) Lamivudine (3TC) Stavudine (d4T) Zidovudine (ZDV) Combinations of NRTIs are also available. For more information, please click here.	The oldest class of antiretroviral (ARV) medications, NRTIs block HIV's ability to copy a cell's DNA, which the virus needs to make copies of itself.
Class	Function
Nucleotide reverse transciptase inhibitors (NtRTIs) Tenofovir DF (TDF) Combinations that include an N(t)RTI are also available. For more information, please click here .	Like NRTIs, NtRTIs block HIV's ability to copy a cell's DNA, preventing the virus from replicating. NtRTIs (unlike NRTIs) are chemically pre-activated.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Efavirenz (EFV) Etravirine (ETR) Nevirapine (NVP) Combinations that include an NNRTIs are also available. For more information, please click here .	NNRTIs block the same protein as the NRTI, but are chemically different. Resistance to this class of medications develops quickly if not used in combination with an NRTI.
Protease inhibitors (PIs) Atazanavir (ATZ) Darunavir (DRV) Fosamprenavir (FPV) Indinavir (IDV) Lopinavir + Ritonavir (LPV) Nelfinavir (NFV) Ritonavir (RTV) Saquinavir (SQV) Tipranavir (TPV)	PIs block protease, an enzyme that the HIV virus needs to make copies of itself.
Fusion inhibitor (FI) Enfuvirtide (T-20)	FIs inhibit viral infection before it enters the cell at the point of fusion. Specifics can be seen in the animations. This medication must be administered by injection.
Class	Function
CCR5 Inhibitor Maraviroc	CCR5 inhibits viral infection before it enters the cell at the point of attachment. Specifics can be seen in the animations.
Class	Function
Integrase Inhibitor Raltegravir	Integrase inhibitors block the process of integration (when HIV's DNA is incorporated into the CD4 cell's DNA), hence blocking replication.

Combination Therapy

The purpose of combination is to prevent viral replication in more than one mechanism to minimize the potential for viral mutations to escape inhibition. The choice of the combination should be one that provides a complementary viral inhibition, is convenient and is well tolerated.

Therapy for HIV usually includes 3 or more medications from the classes outlined. The combination of these HIV medications is designed to keep the virus from making copies of itself, while minimizing potential side effects and pill burden. These combinations are referred to as HAART, highly active antiretroviral therapy. Guidelines on the optimal use of HAART are regularly updated and are available on a number of websites:

International recommendations (WHO): www.who.int/hiv/pub/guidelines
Recommendations for patients living in the USA: www.aidsinfo.nih.gov/guidelines/

Recommendations for patients living in Europe, see: www.europeanaidsclinicalsociety.org/guidelines.asp

For additional guidelines, see: The Clinical Guidelines portal

Many factors contribute to viral failure. Factors such as adherence, drug resistance, and side effects may be involved. If this happens, your doctor will discuss options with you for changing your medication regimen. The Doctor's decision will depend partly on your treatment history, lifestyle and whether resistance to any antiretroviral (ARV) medication has developed. Additional tests can help guide the next regimen for optimal success.