Antiretroviral Therapy (ART): Understanding HIV and AIDS Medications

Written by Kendall K. Morgan
Medically Reviewed by Shruthi N, MD on March 11, 2025
9 min read

HIV medications can help lower your viral load, fight infections, and improve your quality of life. They can lower your chances of spreading HIV, but if you take them incorrectly, you can still give HIV to others. They're not a cure for HIV.

These medicines aim to:

  • Control the growth of the virus
  • Improve how well your immune system works
  • Slow or stop symptoms
  • Prevent transmission of HIV to others

The FDA has approved more than 30 antiretroviral drugs to treat HIV infection. They're often broken into nine classes because they work in different ways. Doctors suggest taking a combination or "cocktail" of at least two of them. This is called antiretroviral therapy (ART).

Your doctor will tell you specifically how to take your medications. You need to follow the directions exactly, and you shouldn't miss even one dose. If you miss doses, you could develop drug-resistant strains of HIV, and your medication may stop working.

Some other medicines and supplements don't mix well with HIV drugs, so make sure you tell your doctor about everything you're taking.

When HIV enters your bloodstream, it attaches to infection-fighting immune cells called CD4 cells. It penetrates the cells and uses their DNA to make copies of itself. Over time, the virus weakens the immune system, preventing your body's ability to fight off other infections or diseases. 

The classes of antiretroviral therapy drugs attack the HIV virus at various points in the duplication process to prevent it from making copies of itself. Taking an ART cocktail of drugs from different classes helps prevent drug resistance and is more effective at lowering the viral load, or how much virus is in your bloodstream. This is measured by a blood test. Though they do not cure HIV, the drugs can make the viral load almost undetectable, keeping you healthy longer and making it less likely to spread the virus to someone else. 

NRTIs force the HIV virus to use faulty versions of building blocks so infected cells can't make more HIV.

NRTIs include:

These are also called "non-nukes." NNRTIs bind to a specific protein, preventing the HIV virus from making copies of itself.

NNRTIs include:

  • Doravirine, or DOR (Pifeltro)
  • Efavirenz or EFV (Sustiva)
  • Etravirine or ETR (Intelence)
  • Nevirapine or NVP (Viramune)
  • Rilpivirine or RPV (Edurant)

These drugs block a protein that the infected cells need for putting together new HIV virus particles.

PIs include:

These drugs stop HIV from making copies of itself by blocking a key protein that allows the virus to put its DNA into the healthy cell's DNA. They're also called integrase strand transfer inhibitors (INSTIs).

INSTIs include:

  • Bictegravir or BIC (combined with other drugs as Biktarvy)
  • Cabotegravir and rilpivirine (Cabenuva)
  • Dolutegravir or DTG (Tivicay)
  • Elvitegravir or EVG (Vitekta)
  • Raltegravir or RAL (Isentress)

Unlike NRTIs, NNRTIs, PIs, and INSTIs, which work on infected cells, fusion inhibitors block HIV from getting inside healthy cells.

An example is enfuvirtide (ENF or T-20), sold under the brand name Fuzeon.

This class of drugs works by blocking the protein shell of the HIV-1 virus, known as the capsid. Lenacapavir (Sunlenca) is initially given as oral tablets and subcutaneous injections, followed by maintenance injections every six months. You'll take it in combination with other antiretroviral(s). You're most likely to use it if your HIV isn't controlled enough by another treatment plan.

This class of drug has just one medication — fostemsavir, or FTR (Rukobia). It targets the glycoprotein 120 on the surface of the virus. This stops the virus from being able to attach itself to the CD4 T cells of your body's immune system. It is for adults who have tried multiple HIV medications and whose HIV has been resistant to other therapies.
 

An example of this class of drugs is maraviroc, or MVC (Selzentry). It stops HIV before it gets inside a healthy cell but in a different way than fusion inhibitors. It blocks a specific kind of "hook" on the outside of certain cells so the virus can't plug in.

This class of antiviral medication works by blocking your body's HIV-infected cells from spreading the virus to those that are uninfected. Ibalizumab-uiyk (Trogarzo) is given by an IV infusion. It is used specifically for adults with HIV who have tried multiple HIV medications and whose HIV has been resistant to other therapies.

Ritonavir (RTV), taken in a low dose, raises blood levels of lopinavir (LPV) and the drug LPV/r (Kaletra).

Cobicistat (Tybost) does the same thing in combination with atazanavir, darunavir, and elvitegravir. 

Because these "drug boosters" can raise the levels of other drugs and cause potential harm, you should always tell your doctor about the medicines you are taking.

Some drug manufacturers put specific medicines together into a single pill so they're easier to take. They include:

Integrase strand transfer inhibitor (INSTI)-based:

  • Bictegravir + tenofovir alafenamide + emtricitabine, or BIC/TAF/FTC (Biktarvy)
  • Dolutegravir + abacavir + lamivudine, or DTG/ABC/3TC (Triumeq)
  • Dolutegravir + rilpivirine, or DTG/RPV (Juluca)
  • Dolutegravir + lamivudine, or DTG/3TC (Dovato)
  • Elvitegravir + cobicistat + tenofovir alafenamide + emtricitabine, or EVG/c/TAF/FTC (Genvoya)
  • Elvitegravir + cobicistat + tenofovir disoproxil fumarate + emtricitabine, or EVG/c/TDF/FTC (Stribild)

Protease inhibitor (PI)-based:

  • Atazanavir + cobicistat, or ATV/c (Evotaz)
  • Darunavir + cobicistat, or DRV/c (Prezcobix)
  • Darunavir + cobicistat + tenofovir alafenamide + emtricitabine, or DRV/c/TAF/FTC) (Symtuza)

Non-nucleoside reverse transcriptase inhibitor (NNRTI)-based:

  • Doravirine + tenofovir disoproxil fumarate + lamivudine, or DOR/TDF/3TC (Delstrigo)
  • Efavirenz + tenofovir disoproxil fumarate + emtricitabine, or EFV/TDF/FTC (Atripla)
  • Rilpivirine + tenofovir alafenamide + emtricitabine, or RPV/TAF/FTC (Odefsey)
  • Rilpivirine + tenofovir disoproxil fumarate + emtricitabine, or RPV/TDF/FTC (Complera)

Nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)-based:

Descovy and Truvada have also been approved as ways to prevent HIV infection for people who are at high risk. But if you take either of them, you have to practice safe sex, too.

PrEP stands for pre-exposure prophylaxis. That means you take these medications before ("pre-") HIV gets into your system (exposure) to help protect against infection (prophylaxis). These medications work quite well, but they aren't foolproof; if taken by mouth, you need to take them every day for the best effect, and even then, they don't work 100% of the time. A new form of PrEP can be taken by shot, every two months.

Because PrEP may not work perfectly (especially if you don't take it as directed), it's best to take other steps to protect yourself. For example, consider using a condom for extra protection if you have sex with people who might have HIV. Condoms will also help protect against other sexually transmitted infections (STIs).

PrEP medications for HIV include Truvada and Descovy (taken by mouth) and Apretude (taken by shot).

People who inject drugs are often more likely to get HIV, especially if they share needles or other tools. Gay and bisexual men are at increased risk through sexual activity, but heterosexual men and women can also get it from sexual activity. Anyone who has more chances of getting HIV should consider using PrEP.

PrEP can help protect both you and your baby if you plan to get pregnant from a partner with HIV. It helps block the virus from infecting you during pregnancy and while breastfeeding.

Adherence to your HIV treatment plan is essential for your health. To maintain an undetected or low viral load, you must take your medications at the same time every day or as prescribed. 

Before you even begin your treatment plan, you should discuss with your doctor any roadblocks you may have to sticking to taking your HIV medications as prescribed. These roadblocks may include inconsistent schedules or housing, financial concerns, or difficulty swallowing pills. Together, you can come up with a plan that will work for you. 

You can take steps to ensure that you stick to your ART drug schedule. These may include:

  • Taking your medicine at the same time every day
  • Setting an alarm on your phone
  • Scheduling taking your pill around activities you do everyday
  • Planning ahead for changes to your schedule
  • Keeping all doctor appointments

Be sure to discuss with your doctor what you should do if you miss a dose. 

The best way to keep HIV symptoms and complications at bay is to maintain the doctor-prescribed schedule of antiviral medications without missing any doses. If you do this, it'll help you:

  • Strengthen your immune system
  • Lessen the chances of infection of any type
  • Lessen your chances of getting "treatment-resistant" HIV
  • Lessen your chances of passing HIV on to other people

You're more likely to get certain infections if you have HIV (the risk goes down if you take your HIV medications). These infections include:

  • Viral infections such as herpes and shingles, which is treated with rest and antiviral meds
  • Bacterial infections such as tuberculosis or pneumonia, which is treated with antibiotics
  • Fungal infections such as thrush or pneumocystis pneumonia, which is treated with antifungal meds
  • Parasitic infections such as toxoplasmosis, which may need long-term treatment in people with HIV

If you don't feel well with your regular medications or you have trouble keeping up with doses, talk to your doctor. Together, you may be able to adjust your medication types and dosages to better address any symptoms or side effects.

If you have HIV, you'll have many treatment options to keep the virus under control. Following your treatment plan as prescribed by your doctor can keep you healthy and lower your chances of spreading HIV to others. If you're at risk of getting HIV, you may start treatment to protect yourself from the virus in advance. Ask your doctor about your treatment options and which ones they'd suggest for you and why.

What is the most common HIV medication?

Your treatment may vary, but for most people with HIV, experts now suggest a combination of an INSTI with two NRTIs.

What is the safest HIV drug?

World Health Organization suggests dolutegravir (DTG) as the standard treatment for all populations, including people who are pregnant or planning to be. But there are more than 30 FDA-approved ART drugs to treat HIV. Your doctor can help decide which HIV drug or combination of drugs is safest for you. 

Which medicine is best for HIV positives?

The best HIV treatment is based on your individual needs. Your doctor can help you decide which ART drug is best suited for you.

What drug is used to treat HIV?

Many different drugs and drug classes can help treat HIV. Sometimes, they are used in combination. Ask your doctor about your treatment options and which one they'd suggest for you.

What are four types of HIV drugs?

There are now nine types of HIV drugs. They're grouped based on how they work to block HIV from making more copies of itself.

What is the difference between NRTIs and NNRTIs?

Both medicines target an enzyme called reverse transcriptase. NRTIs block this enzyme, while NNRTIs work by binding to the enzyme and changing it.

What is the mechanism of action of NRTIs?

NRTI stands for nucleoside/nucleotide reverse transcriptase inhibitor. They block an enzyme that HIV needs to make more copies of itself.

Can you get HIV from someone who is undetectable? 

No. If HIV is undetectable in a person, they cannot spread HIV to someone else.