Types of treatment

Over 20 anti-HIV drugs are now available. Each drug belongs to a ‘class’ of drugs that work against HIV in a particular way.

You don’t need to know about all the types of drugs, or the details about the drugs you’re on, for you to be able to take your treatment properly. Your HIV healthcare team will have the specialist knowledge to talk to you about what might work best for you. Making sure you take your treatment as recommended is what’s most important.

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 developed by the British HIV Association (BHIVA, the organisation for specialist HIV doctors in the UK) set out the medical treatment people with HIV in the UK should receive.

These 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.

For people who have not been on HIV treatment, it’s recommended you start on a combination containing two NRTIs and either a ritonavir-boosted protease inhibitor, or an NNRTI, or an integrase inhibitor.

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. The guidelines recommend that this is one of the following: atazanavir (Reyataz); darunavir (Prezista); efavirenz (Sustiva); or raltegravir (Isentress). Atazanavir and darunavir are boosted with another protease inhibitor, ritonavir (Norvir) to increase their levels in the body.

The guidelines suggest some alternative third drugs for certain situations; for example, if someone has another health problem. These are: Kaletra (lopinavir/ritonavir); fosamprenavir (Telzir); nevirapine (Viread, Viread prolonged-release); and rilpivirine (Edurant)

All these combinations are very effective against HIV. NNRTIs are often preferred 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 to take.

There are now a number of anti-HIV drugs that work against virus that is resistant to other drugs. These include powerful protease inhibitors, especially darunavir (Prezista), the NNRTI etravirine (Intelence), the integrase inhibitor raltegravir (Isentress), and the entry inhibitor maraviroc (Celsentri).

Thanks to these drugs, an undetectable viral load is now achievable for nearly all people.