Types of Treatment
With HIV treatment, many people can lead a long and healthy life. Over 20 anti-HIV drugs are now available worldwide. Each drug belongs to a 'class' of drugs that work against HIV in a particular way.
The classes of anti-HIV drugs are:
- Nucleoside reverse transcriptase inhibitors (NRTIs or 'nukes').
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs or 'non-nukes').
- Protease inhibitors (PIs).
- Fusion and entry inhibitors.
- Integrase inhibitors.
Guidelines recommend that you should start treatment with three anti-HIV drugs. This is often called 'combination therapy'. Often two or more of these drugs are combined in one tablet to reduce the number of pills you need to take.
Two of the three drugs used in combinations come from the NRTI class. The preferred NRTIs are FTC and tenofovir (combined in a pill called Truvada, and also available combined with efavirenz in a pill called Atripla), or 3TC and abacavir (combined in a pill called Kivexa).
In addition, you will need to take a third drug. Most people take an NNRTI, usually efavirenz (called Sustiva, which is also available combined in a single pill with tenofovir and FTC called Atripla).
Sometimes the third drug is a protease inhibitor. The anti-HIV effect of this drug will be 'boosted' by taking it with a small amount of a second protease inhibitor called ritonavir (Norvir).
Both types of combination are very effective against HIV. NNRTIs are often preferred to protease inhibitors because they generally cause fewer side-effects and are easier to take; but the disadvantage of NNRTIs is that resistance can develop more quickly.
You should have an opportunity to discuss with your doctor the drugs that are likely to be most suitable for you. If you have taken HIV treatment before, your doctor will need to look at your treatment history and the results of a resistance test to decide about the most suitable combination of drugs for you.
In recent years, drugs have been developed that work against strains of HIV that have become resistant to other drugs. These include powerful protease inhibitors, especially darunavir (Prezista), an NNRTI called etravirine (Intelence), the integrase inhibitor raltegravir (Isentress) and the entry inhibitor maraviroc (Celsentri).