Antiretroviral Therapy (ART): Understanding HIV and AIDS Medications

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

HIV medications can help lower your viral count, fight HIV infection, and improve your quality of life. Antiretroviral therapy can lower your chances of spreading HIV when taken correctly to lower your viral count to "undetectable." Although there's not a cure for HIV, ART can help slow the progress of the virus and in some cases prevent AIDS.

When HIV enters your bloodstream, it attaches to immune cells called CD4 T cells. HIV enters your T cells, inserts it's own genetic code into your DNA to make copies of itself. Then, it puts together new viruses and busts out of the cell to enter new T cells.

Over time, the virus weakens your immune system by killing off your T cells (depleting them). This can prevent your body from fighting off other infections or diseases. If your immune system becomes damaged, your condition can progress to AIDS. That means your T cell number has fallen too low.

Taking retroviral medications can help prevent AIDS. HIV medicines aim to:

  • Control how fast HIV makes copies which can damage your immune system
  • Improve how well your immune system works
  • Slow or stop symptoms of HIV
  • Prevent transmission of HIV to others

If you don't have HIV, you can take pre-exposure prophylaxis (PrEP to protect yourself from HIV if you're at risk. And if your partner takes ART and has an undetectable viral count, they basically have no risk of passing along HIV. Find out more about HIV medications and how you can lower your risk for HIV.

The FDA has approved more than 30 antiretroviral medications to treat HIV infection. The medicines are often broken down by how they work to stop HIV from infecting your cells. Here are the basic steps of how HIV works:

Attach to healthy T cells

CCR5 is a specific kind of "hook" on the surface of your immune T cells that HIV can bind. The virus hooks to your T cell using glycoprotein 120 (gp 120), a protein that HIV can "plug in" to enter your cell.

Fuse and enter healthy cells

After HIV plugs in, the virus fuses it's shell to your cell and enters. This fusion method helps the virus empty its genetic code into your T cell.

Make viral genes

After the HIV enters a healthy T cell, it uses special proteins (reverse transcriptases) to make copies of HIV genes.

Intergrate for safe keeping

The virus must put the viral genetic code inside your cell's DNA to make more copies and keep it safe. To do this, HIV uses another protein called integrase.

Assembly

Once all the HIV gene copies are made, the virus puts the protective shell (capsid) together. The capsid shell protects the viral genes once HIV breaks out of the infected cell to attach and infect more healhty T cells.

What is antiretroviral therapy (ART)?

Doctors suggest taking a combination or "cocktail" of at least two antiretroviral therapy medicines --- that's ART. ART attacks to HIV at different stages to stop the virus from making copies of itself. Taking an ART cocktail from different classes helps:

  • Prevent medication resistance
  • Work better to lower your viral load --- how much virus is in your bloodstream

Your doctor can order a blood test to measure your viral load. Although HIV has no cure, ART can lower your viral load to almost undetectable to keep you healthy longer, and lower your chance of spreading the virus to someone else. 

Also called nucleotide reverse transcriptase inhibitors, NRTIs block an enzyme protein that forces the virus to use faulty versions of building blocks. That means HIV can't change RNA to DNA nor make copies of itself.

NRTIs include:

These are also called "non-nukes." NNRTIs bind to a specific enzyme protein to stop the virus from changing its RNA genetic code to DNA. If HIV can't change RNA to DNA, the virus can't make copies of itself.

NNRTIs include:

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

These medicines block a protein that the virus uses to put together new HIV virus particles.

PIs include:

  • Atazanavir (Reyataz), or ATV 
  • Darunavir  (Prezista), or DRV
  • Fosamprenavir (Lexiva), or FPV
  • Ritonavir or RTV (Norvir)
  • Tipranavir (Aptivus), or TPV

Also called integrase strand transfer inhibitors (INSTIs), the medicines turn off a key protein that the virus uses to put its viral DNA into your own DNA. This prevents the virus from making more copies of HIV.

INSTIs include:

  • Cabotegravir (Apretude or Vocabria), or CAB
  • Dolutegravir (Tivicay), or DTG 
  • Raltegravir (Isentress), or RAL

Elvitegravir (Vitekta), or EVG, is also an INSTI, but isn't used alone. You'll fine EVG combined with other HIV medications.

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.

A capsid inhibitor blocks the virus from making its protective shell (capsid) that contains the virus genetic code. Without a shell, the virus can't make more HIV particles. There are two forms of capsid inhibitors:

  • Lenacapavir (Sunlenca), oral tablets
  • Lenacapavir (Yeztugo),  subcutaneous injection

You'll start by taking the pills to get the medicine dose up in your body. Then, you'll only need to take a shot once every six months. But your doctor may also combine other antiretroviral treatments, too.

Glycoprotein 120 (gp120) is a type of "plug" on the surface of the virus that attaches to the "hook" on your  CD4 T cell. But gp120 attachment inhibitors can block the "plug" to stop the virus from getting inside.

If other HIV medications aren't working, or your HIV has become resistant to your current ART, your doctor may sugget fostemsavir (Rukobia), or FTR.
 

CCR5 is a specific kind of "hook" on the outside of certain cells that allows HIV to get inside. But CCR5 antagonists block the "hook" so that HIV can't plug in.

This type of medicine stops HIV before it gets inside a healthy cell, such as:

  • Maraviroc (Selzentry), or MVC

This medication works can block cells infected with HIV from spreading the virus to uninfected, healthy cells. But ibalizumab-uiyk (Trogarzo) is usually combined with other HIV medications.

A pharmacokinetic enhancer is a "drug booster" that helps raise the level of another medicine in your bloodstream. This can aid other medications and help them work better.

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

Cobicistat (Tybost) also raises blood levels of other medicines, in combination with atazanavir, darunavir, and elvitegravir. 

Keep in mind that at higher amounts, some medications can also cause potential side effects and harm. So tell your doctor about any medicines you are taking to check for interactions.

Some medication companies combine the medicines together into a single dose, so it's easier to take. Here are some combination ART medicines.

Integrase strand transfer inhibitor (INSTI)-based:

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

Protease inhibitor (PI)-based:

  • Atazanavir + cobicistat (Evotaz), or ATV/c 
  • Cabotegravir and rilpivirine (Cabenuva), or CAB/RPV
  • Darunavir + cobicistat (Prezcobix), or DRV/c  
  • Darunavir + cobicistat + emtricitabine + tenofovir alafenamide (Symtuza), or DRV/c/TAF/FTC
  • Lopinavir + ritonavir (Kaletra), or LPV/r  

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

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

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

  • Abacavir + lamivudine (Epzicom), or ABC/3TC 
  • Tenofovir alafenamide + emtricitabine (Descovy), or TAF/FTC 
  • Tenofovir disoproxil fumarate + emtricitabine (Truvada), or TDF/FTC 
  • Tenofovir disoproxil fumarate + lamivudine (Cimduo), or TDF/3TC 

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 because you take the medication before ("pre-") HIV gets into your system (exposure) to help protect against infection (prophylaxis). PrEP works quite well as long as you take your medicine as prescribed. There are two types of PrEP:

  • Daily pills that you take by mouth --- about 99% effective when taken every day.

  • Bimonthly or biyearly shots are available, if you can't remember a daily pill.

Because PrEP may not work perfectly, if you miss a dose, it's best to protect yourself in other ways. Luckily there are simple ways you can protect youself, such as:

  • Use a condom if you have sex with people who might have HIV --- it also helps protect against other sexually transmitted infections (STIs).

  • Skip out on sharing any needles or syringes with people who may have HIV.

PrEP medications for HIV include Truvada and Descovy (taken by mouth) or Apretude and Yeztugo (taken by shot). Anyone who at a higher risk for HIV can consider using PrEP. 

Talk to your doctor openly about your risk to see if PrEP is right for you. PrEP may be an option if you don't have HIV and you:

  • Have sex with multple partners

  • Have a history of STDs

  • Inject drugs, especially if you share needles or other tools

  • Have anal sex

  • Have vaginal, anal, or oral sex with someone who has HIV

PrEP can also 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. Discuss PrEP and other options before getting pregnant with your doctor. They can help you come up with the best plan for you health.

Sticking to your HIV treatment plan is key for your health. To get to an undetected or low viral load, take your medications at the same time every day or as prescribed. 

Before you even begin your treatment plan, discuss any roadblocks you may have about sticking to taking your HIV medications with your doctor. These roadblocks may include:

  • Shifting schedules
  • Housing
  • Cost concerns
  • Harder time swallowing pills
  • Difficulty remembering a daily pill

Together, you can come up with a plan that will best work for you and your busy schedule. You can take steps to ensure that you stick to your medication schedule which 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 talk with your health care team about what you should do if you miss a dose. They can help you quickly get back on track.

Medication interactions

Some other medicines and supplements don't mix well with HIV medicines. If you're taking other medications, tell your health care team about it. They can review them and let you know about any interactions.

Preventing drug resistance

Your doctor will tell you specifically how to take your medications. If you follow the directions exactly, and you don't miss even one dose, you can prevent drug-resistant strains of HIV. That means your medication will keep working and you won't need to switch treatments.

 

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
  • Lower your infection risk of any type
  • Lower your chances to get "treatment-resistant" HIV
  • Lower your risk to pass on HIV to other people

You're more likely to get certain infections if you have HIV because the virus can damplen your immune system. But ART can prevent this and lower your infection risk. Some infections that you may get include:

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

If your regular medicines are causing side effects and you don't feel well, or have trouble keeping up with doses, talk to your doctor. They might 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 some of the most common HIV medications are combination cocktails called antiretroviral therapy (ART). Some common ART meds include:

  • Bictegravir +  emtricitabine + tenofovir alafenamide (Biktarvy)
  • Dolutegravir + lamivudine (Dovato)
  • Dolutegravir + abacavir + lamivudine (Triumeq, Triumeq PD)

What is the safest HIV medication?

World Health Organization suggests dolutegravir (DTG) as a starting treatment for anyone with HIV, even if you're pregnant or planning to be. But there are more than 30 FDA-approved ART medications to choose from, so you and your doctor can decide which is safest for you. 

Which medicine is best if you're HIV positive?

The best HIV treatment is based on your individual needs and your doctor will ask you about your:

  • Other medical conditions
  • Potential side effects, if you're already on HIV medicines
  • Other medications, if you're taking any
  • Preference about keeping up with daily pills or shots

They'll also test you for drug resistance. This can help narrow down which HIV medication will work best to keep your particular HIV strain in control. You and your healht care team can decide together what's best suited for you.

What medication treats HIV?

Many medications can treat HIV and stop the virus from entering, making copies, and infecting other healthy cells. Sometimes, the antiretroviral therapies are combined, too. 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 medications 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 that helps HIV change RNA into DNA. NRTIs block this enzyme, but NNRTIs bind the enzyme to change it.

What is the mechanism of action (how it works) of NRTIs?

NRTI stands for nucleoside/nucleotide reverse transcriptase inhibitor and blocks an enzyme that HIV needs to change RNA into DNA. If HIV can't make DNA, it can't make more copies of itself.

Can you get HIV from someone who is undetectable? 

Not likely. If HIV is undetectable in a person, it means the doctor tested their blood for HIV genes and could not find any virus. So they basically can't spread HIV to someone else.