HIV medications stop the virus from making copies of itself. The Food and Drug Administration (FDA) has approved over 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.
After the virus invades the T cells, it replicates (makes copies of itself). Then 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 keeps the body from working well.
There’s currently no known cure for HIV. However, medications can help people living with HIV 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.
There are many different classes of antiretroviral drugs used to treat HIV. A healthcare professional will assess a person living 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
- other chronic health conditions, also known as comorbidities
- other medications that they’re taking, as to avoid interactions between their HIV drugs and their 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 control HIV the best.
Taking more than one antiretroviral drug also helps prevent resistance to the drugs being used. This means a person’s medications may work better 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 drug form.
Integrase inhibitors stop the action of integrase. Integrase is a viral enzyme that HIV uses to infect T cells by putting HIV DNA into the 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. Other, more experimental categories of integrase inhibitors include integrase binding inhibitors (INBIs), but there are no FDA-approved INBIs 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 first FDA-approved HIV drug. It’s also known as azidothymidine or AZT. Zidovudine is rarely used in adults now. It’s mainly given to babies with HIV-positive birthing parents as a form of postexposure prophylaxis.
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 several functions in the body, including breaking down or metabolizing 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 doesn’t have the ability to 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: It helps to 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 only FDA approved to treat hepatitis C, but these aren’t 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.
Ritonavir is both a CYP3A inhibitor and a PI. It’s often used to boost other HIV medications.
Lopinavir isn’t available as a stand-alone drug. It’s only available 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 HIV medications (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.
Atazanavir and darunavir can be used alongside cobicistat.
Rarely used PIs
The following HIV PI is rarely used because it has more side effects:
- nelfinavir (Viracept)
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. Fusion inhibitors block the virus from entering a host T cell, which prevents the virus from replicating.
Fusion inhibitors are rarely used in the United States because other available drugs are more effective and better tolerated.
Only one fusion inhibitor is currently available:
- enfuvirtide (Fuzeon)
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.
In 2018, the first immune-based therapy received FDA approval to treat HIV:
- ibalizumab-uiyk (Trogarzo)
It 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 drug. They work by attaching to a viral protein, which prevents the viral protein from attaching to and entering healthy T cells.
Only one attachment inhibitor is currently available:
- fostemsavir (Rukobia)
The FDA approved fostemsavir (Rukobia) 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.
Chemokine coreceptor antagonists, or CCR5 antagonists, block HIV from entering cells. CCR5 antagonists are rarely used in the United States because other available drugs are more effective, and this medication requires special testing prior to its use.
Only one CCR5 antagonist is currently available:
- maraviroc (Selzentry)
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 classified as 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 to treat people who’ve never taken HIV medications before.
The following combination drugs only include 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 or single-tablet regimens (STRs)
The following combination drugs only include 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. However, 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 also 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 no cure for HIV yet, 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 is a brief overview of the types of drugs that are available to treat HIV. Talk with a healthcare professional about all of these options. They can help determine the best treatment plan.