HIV Treatment

HIV Treatment: The Basics

(Last updated 9/29/2013; last reviewed 9/29/2013)

Key Points

  • Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. ART involves taking a combination of HIV medicines (called an HIV regimen) every day.
  • ART is recommended for all people infected with HIV. ART can’t cure HIV, but it can help people infected with HIV live longer, healthier lives. ART also reduces the risk of sexual transmission of HIV.
  • Potential risks of ART include side effects from HIV medicines and drug interactions between HIV medicines or between HIV medicines and other medicines a person is taking. Poor adherence—not taking HIV medicines every day and exactly as prescribed—can lead to drug resistance, which is another risk of ART.
  • When to start ART and what HIV medicines to take depend on a person’s individual needs. People with HIV work closely with their health care providers to make decisions regarding the use of HIV medicines.

What is antiretroviral therapy?

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. ART involves taking a combination of HIV medicines (called an HIV regimen) every day. ART is recommended for everyone with HIV. ART can’t cure HIV, but it helps people with HIV live longer, healthier lives.

How do HIV medicines work?

HIV attacks and destroys the infection-fighting CD4 cells of the immune system. Loss of CD4 cells makes it hard for the body to fight off infections.

HIV medicines prevent HIV from multiplying (making copies of itself), which reduces the amount of HIV in the body. Having less HIV in the body gives the immune system a chance to recover. Even though there is still some HIV in the body, the immune system is strong enough to fight off infections and cancers.

By reducing the amount of HIV in the body, HIV medicines also reduce the risk of HIV transmission to sexual partners.

What are risks of taking HIV medicines?

Potential risks of ART include side effects from HIV medicines and drug interactions between HIV medicines or between HIV medicines and other medicines a person is taking. Poor adherence—not taking HIV medicines every day and exactly as prescribed—can lead to drug resistance, which is another risk of ART.

Side effects
Side effects from HIV medicines can vary depending on the medicine and the person taking the medicine. People taking the same HIV medicine can have very different side effects. Some side effects, for example, headache or occasional dizziness, may not be serious. Other side effects, such as swelling of the mouth and tongue or liver damage, can be life-threatening.

Drug interactions
HIV medicines can interact with other HIV medicines in an HIV regimen. They can also interact with other medicines that a person with HIV is taking. A drug interaction can cause a medicine to be less effective or stronger than desired. Drug interactions can also cause side effects.

Drug resistance
When HIV multiplies, the virus sometimes mutates (changes form) and makes variations of itself. Variations of HIV that develop while a person is taking HIV medicines can lead to drug-resistant strains of HIV. HIV medicines that previously worked against a person’s HIV can’t suppress the new, drug-resistant HIV. In other words, the person’s HIV continues to multiply. Drug resistance can cause HIV treatment to fail. Poor adherence to an HIV regimen increases the risk of drug resistance.

When is it time to start treatment with HIV medicines?

When to start ART depends on a person’s individual needs. Factors that influence the decision to start ART include:

  • The overall health of the person with HIV, including any other medical conditions or HIV-related illnesses the person may have
  • The person’s test results, especially CD4 count results
  • The person’s readiness for lifelong treatment with HIV medicines

What HIV medicines should be included in an HIV regimen?

There are more than 20 HIV medicines available to make up an HIV regimen. The HIV medicines are grouped into six drug classes according to how they fight HIV. A person’s initial HIV regimen usually includes three or more HIV medicines from at least two different HIV drug classes.

Selection of an HIV regimen depends on several factors, including possible side effects of HIV medicines and potential drug interactions between medicines. Because the needs of people with HIV vary, there are several HIV regimens to choose from.

How can I learn more about ART?

To learn more about ART, read the fact sheets in the AIDSinfo HIV Treatment series. Topics covered in the series include starting ART, recommended HIV regimens, side effects of HIV medicines, HIV drug resistance, and medication adherence.

This fact sheet is based on information from the following sources:

HIV Treatment

Just Diagnosed: Next Steps After Testing Positive for HIV

(Last updated 9/30/2013; last reviewed 9/30/2013)

Key Points

  • For people with HIV, the first step after testing HIV positive is to see a health care provider.
  • People with HIV work closely with their health care providers to make important decisions, such as when to start treatment and what HIV medicines to take. Making these decisions begins with a baseline evaluation.
  • A baseline evaluation includes a review of the person’s health and medical history, a physical exam, and lab tests. 
  • Results from a baseline evaluation are used to determine the stage of the person’s HIV infection, assess the person’s readiness to start HIV medicines, and guide selection of the person’s first HIV regimen

What is the next step after testing positive for HIV?

Testing positive for HIV often leaves a person overwhelmed with questions and concerns. So the first step after testing positive is to see a health care provider.

People with HIV work closely with their health care providers to make important decisions, such as when to start treatment and what HIV medicines to take. Making these decisions begins with a baseline evaluation.

What is an HIV baseline evaluation?

A baseline evaluation includes all the information collected during a person’s initial visits with a health care provider. An HIV baseline evaluation involves a review of the person’s health and medical history, a physical exam, and lab tests.

The purpose of a baseline evaluation is to:

  • Determine the stage of the person’s HIV infection
  • Evaluate the person’s readiness to start treatment
  • Collect information to guide selection of the person’s first HIV regimen

As part of the baseline evaluation process, the health care provider also explains the benefits and risks of HIV treatment and discusses ways to reduce the risk of passing HIV to others. The health care provider also takes time to answer any questions.

What are some questions people with HIV typically ask during their first visits with an HIV health care provider?

People often ask their health care providers the following questions:

  • Because I have HIV, will I eventually get AIDS?
  • What can I do to stay healthy and avoid getting other infections?
  • How will HIV treatment affect my lifestyle?
  • How should I tell my partner that I have HIV?
  • Is there any reason to tell my employer and those I work with that I have HIV?
  • Are there support groups for people with HIV?
Many people find it helpful to write down questions before a medical appointment. Some people bring a family member or friend to their HIV appointments to remind them of questions to ask and to jot down the answers.

What lab tests are included in a baseline evaluation?

The following tests are conducted as part of a baseline evaluation.

CD4 count
A CD4 count measures the number of CD4 cells in a sample of blood. CD4 cells are infection-fighting cells of the immune system. HIV destroys CD4 cells, which damages the immune system. A damaged immune system makes it hard for the body to fight off infections. Treatment with HIV medicines (antiretroviral therapy [ART]) prevents HIV from destroying CD4 cells.

Because a falling CD4 count indicates that HIV is advancing and damaging the immune system, the test is an important factor in the decision to start ART. The test is also used to monitor the effectiveness of HIV medicines once treatment is started.

Viral load
A viral load test measures how much virus is in the blood (viral load). A goal of HIV treatment is to keep a person’s viral load so low that the virus can’t be detected by a viral load test. A high viral load increases the urgency to start ART.

Drug-resistance testing
Drug-resistance testing identifies which, if any, HIV medicines will not be effective against a person’s strain of HIV. Drug resistance test results are used to guide selection of an HIV regimen.

Testing for sexually transmitted infections (STIs)
Coinfection with another STI can cause HIV infection to advance faster and increase the risk of HIV transmission to a sexual partner. STI testing makes it possible to detect and treat any STIs promptly.

A baseline evaluation also includes other tests, such as a blood cell count, kidney and liver function tests, and tests for hepatitis.

How does a baseline evaluation help determine if a person is ready to start HIV treatment?

Before starting treatment, people with HIV must be prepared to take HIV medicines every day for the rest of their lives. A baseline evaluation can help to identify any issues that can make medication adherence difficult, such as lack of health insurance or alcohol or drug abuse. (Medication adherence means taking HIV medicines every day and exactly as prescribed.) Health care providers can recommend additional support to help people deal with these issues before treatment starts.

This fact sheet is based on information from these sources:

HIV Treatment

When to Start Antiretroviral Therapy

(Last updated 9/29/2013; last reviewed 9/29/2013)

Key Points

  • Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. ART is recommended for everyone infected with HIV. When to start ART, however, depends on a person’s unique needs and circumstances.
  • A person’s CD4 count is an important factor in the decision to start ART. A falling CD4 count indicates that HIV is advancing and damaging the immune system. A rapidly decreasing CD4 count increases the urgency to start ART.
  • The U.S. Department of Health and Human Services (HHS) provides guidelines on the use of HIV medicines to treat HIV infection. The HHS guidelines recommend ART for everyone infected with HIV, but the recommendation is strongest for those with CD4 counts less than 350 cells/mm3.
  • Regardless of CD4 count, there is greater urgency to start ART when a person has a high viral load or any of the following conditions: pregnancy, AIDS, and certain HIV-related illnesses and coinfections.  
  • ART is a life-long treatment that helps people with HIV live longer, healthier lives. But effective ART depends on adherence— taking HIV medicines every day and exactly as prescribed. Before starting ART, it’s important to address issues that can make adherence difficult.

When is it time to start treatment with HIV medicines?

Treatment with HIV medicines (called antiretroviral therapy or ART for short) is recommended for everyone infected with HIV. When to start ART, however, depends on a person’s unique needs and circumstances.

What factors influence the decision to start ART?

The following factors influence the decision to start ART:

  • A person’s CD4 count and other test results
  • Pregnancy
  • HIV-related illness or AIDS (AIDS is the most advanced stage of HIV infection.)
  • A person’s ability and willingness to commit to lifelong treatment with HIV medicines

Why is a person’s CD4 count an important factor in deciding when to start ART?

A CD4 count measures the number of CD4 cells in a sample of blood. CD4 cells are infection-fighting cells of the immune system. HIV attacks and destroys CD4 cells, making it hard for the body to fight off infection. A falling CD4 count indicates that HIV is advancing and damaging the immune system. If a person’s CD4 count is rapidly decreasing, there is greater urgency to start ART.

The U.S. Department of Health and Human Services (HHS) provides guidelines on the use of HIV medicines to treat HIV infection. The HHS guidelines recommend ART for everyone with HIV, but the recommendation is strongest for those with CD4 counts less than 350 cells/mm3. (The CD4 count of a healthy person ranges from 500 to 1,200 cells/mm3.) 

Once a person starts taking HIV medicines, an increasing CD4 count is a sign that the immune system is recovering.

What other factors increase the urgency to start ART?

Other factors that increase the urgency to start ART include high viral loads and conditions such as pregnancy, AIDS, and certain HIV-related illnesses and co-infections.

  • High viral loads
    An HIV viral load test measures the amount of HIV in a person’s blood. The urgency for ART increases when a person’s viral load is greater than 100, 000 copies/mL.
  • Pregnancy
    Pregnant women with HIV should take HIV medicines to prevent mother-to-child transmission of HIV and to protect their own health. Women who have a high viral load or symptoms of HIV infection should start taking HIV medicines as soon as possible in pregnancy. Women without symptoms of HIV infection and a high viral load may consider waiting until after the first trimester of pregnancy (12 weeks of pregnancy) to begin taking HIV medicines.
  • AIDS
    People whose HIV has advanced to AIDS need to take HIV medicines. A diagnosis of AIDS is based on the following:
    • A CD4 count less than 200 cells/mm3
  • OR

    • The presence of an AIDS-defining condition. AIDS-defining conditions are infections and cancers that are life-threatening when they develop in people with HIV. Certain forms of cervical cancer and tuberculosis are examples of AIDS-defining conditions.
  • HIV-related illnesses and co-infections  Some illnesses that develop in people infected with HIV increase the urgency for ART. These illnesses include HIV-related kidney disease and certain opportunistic infections (OIs). OIs are infections that develop more often or are more severe in people with weakened immune systems, such as people with HIV. 

    Coinfection is when a person has two or more infections at the same time. The urgency for ART is increased in individuals who are infected with HIV and hepatitis B or hepatitis C virus.

How does a person’s readiness to take HIV medicines every day affect the decision to start treatment?

ART is a life-long treatment that helps people with HIV live longer, healthier lives. But effective treatment depends on adherence—taking HIV medicines every day and exactly as prescribed. Before starting ART, it’s important to address issues that can make adherence difficult.

How can I learn more about factors that affect the decision to start ART?

This fact sheet is based on information from the following sources:

HIV Treatment

What to Start: Selecting a First HIV Regimen

(Last updated 11/7/2013; last reviewed 11/7/2013)

Key Points

  • The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines (called an HIV regimen) every day.
  • HIV medicines are grouped into six drug classes according to how they fight HIV. The six drug classes include over 20 HIV medicines.
  • The U.S. Department of Health and Human Services (HHS) provides guidelines on the use of HIV medicines to treat HIV infection. The HHS guidelines recommend starting treatment with a regimen of three or more HIV medicines from at least two different drug classes.
  • The choice of HIV medicines to include in an HIV regimen varies depending on a person's individual needs. Factors to consider when choosing an HIV regimen include possible side effects of HIV medicines, the potential for drug interactions, and the health of the person with HIV.

What is the next step after deciding to start HIV treatment?

The next step is choosing the HIV medicines to take. The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines (called an HIV regimen) every day.

There are over 20 HIV medicines approved for use in an HIV regimen. Some HIV medicines are available in combination (in other words, two or more different HIV medicines combined in one pill).

The U.S. Department of Health and Human Services (HHS) guidelines on the use of HIV medicines recommend starting treatment with a regimen of three or more HIV medicines from at least two different drug classes. 

What are the HIV drug classes?

HIV medicines are grouped into six drug classes according to how they fight HIV. The six drug classes are:

In general, a person’s first HIV regimen includes two NRTIs in combination with an NNRTI, a PI, an INSTI, or a CCR5.

Click here to see the AIDSinfo fact sheet that lists the FDA-approved HIV medicines by drug class.

What factors are considered when choosing an HIV regimen?

The choice of HIV medicines to include in an HIV regimen depends on a person’s individual needs. When deciding on an HIV regimen, people with HIV and their health care providers consider the following factors:

  • Other diseases or conditions that the person with HIV may have  
  • Possible side effects of HIV medicines
  • Potential interactions between HIV medicines or between HIV medicines and other medicines the person with HIV is taking
  • Results of drug-resistance testing and other tests
  • Convenience of the regimen. For example, a regimen that includes two or more HIV medicines combined in a single pill is convenient to follow.
  • Any personal issues that can make it difficult to follow an HIV regimen, for example, a busy schedule that changes from day to day

Careful consideration of these factors helps guide selection of an HIV regimen from the list of recommended regimens.

What are the preferred regimens for people taking HIV medicines for the first time?

The HHS guidelines recommend the following preferred regimens for people taking HIV medicines for the first time:  

NNRTI-based regimen 

PI-based regimens

  • atazanavir (brand name: Reyataz) boosted with ritonavir (brand name: Norvir) plus Truvada 
  • Ritonavir is an HIV medicine given with other HIV medicines to increase (boost) their effectiveness. Truvada is a combination of two HIV medicines—emtricitabine and tenofovir disoproxil fumarate—in one pill.
  • darunavir (brand name: Prezista) boosted with ritonavir plus Truvada 

INSTI-based regimens 

  • dolutegravir (brand name: Tivicay) plus Truvada 
  • dolutegravir plus Epzicom for those who are HLA B*5701 negative. 
  • Epzicom is a combination of two HIV medicines—abacavir (brand name: Ziagen) and lamivudine (brand name: Epivir)—in one pill. 
  • raltegravir (brand name: Isentress) plus Truvada 
  • Stribild for those with estimated creatinine clearance (CrCl) ≥70 mL/min 
  • Stribild includes the following four medicines combined in one pill: elvitegravir, an HIV medicine only approved for use in Stribild; cobicistat, a medicine used to increase the effectiveness of elvitegravir; emtricitabine; and tenofovir disoproxil fumarate. 

Because the needs of people with HIV vary, the preferred regimens may not be right for everyone. The HHS guidelines list alternative HIV regimens to use if none of the preferred regimens meet a person’s individual needs.

How long does it take for treatment to work?

Viral load is the measure of HIV in a person’s blood. A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. An undetectable viral load is the best sign that HIV treatment is effective.

Once a person starts treatment, it’s possible to have an undetectable viral load within 3 to 6 months. Having an undetectable viral load doesn’t mean a person’s HIV is cured. There is still some HIV in the person’s body, but the undetectable viral load signals that HIV treatment is working effectively. Effective ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.

HIV Treatment

FDA-Approved HIV Medicines

(Last updated 9/30/2013; last reviewed 9/30/2013)

Antiretroviral therapy (ART) is the use of HIV medicines to treat HIV infection. ART involves taking a combination of HIV medicines (called an HIV regimen) every day. A person's initial HIV regimen generally includes three or more HIV medicines from at least two different drug classes

ART is recommended for all people infected with HIV. ART can’t cure HIV, but it can help people with HIV live longer, healthier lives. HIV medicines can also reduce the risk of HIV transmission.

The following table lists HIV medicines approved by the U.S. Food and Drug Administration (FDA) for the treatment of HIV infection in the United States. The HIV medicines are listed according to drug class and identified by generic and brand names.


FDA-Approved HIV Medicines
Drug Class Generic Name
(Other names and acronyms)
Brand Name Current Manufacturer FDA Approval Date
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
NRTIs block reverse transcriptase, an enzyme HIV needs to make copies of itself. abacavir 
(abacavir sulfate, ABC)
Ziagen GlaxoSmithKline
888-825-5249
December 17, 1998
didanosine 
(ddI, ddI EC)
Videx Bristol-Myers Squibb 
800-332-2056 
October 9, 1991 
Videx EC 
(enteric-coated)
October 31, 2000
emtricitabine
(FTC)
Emtriva Gilead Sciences
800-445-3235
July 2, 2003
lamivudine 
(3TC)
Epivir GlaxoSmithKline
888-825-5249
November 17, 1995
stavudine 
(d4T)
Zerit Bristol-Myers 
Squibb
800-332-2056
June 24, 1994
tenofovir disoproxil 
fumarate

(tenofovir DF, TDF)
Viread Gilead Sciences
800-445-3235
October 26, 2001
zidovudine
(azidothymidine, AZT, ZDV)
Retrovir GlaxoSmithKline
888-825-5249
March 19, 1987
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs bind to and later alter reverse transcriptase, an enzyme HIV needs to make copies of itself.
delavirdine
(delavirdine mesylate, DLV)
Rescriptor
Pfizer
212-733-2323
April 4, 1997
efavirenz 
(EFV)
Sustiva Bristol-Myers Squibb
800-332-2056
September 17, 1998
etravirine 
(ETR)
Intelence
Janssen Pharmaceuticals, Inc.
800-526-7736
January 18, 2008
nevirapine 
(NVP)
Viramune
Boehringer Ingelheim 
800-243-0127
June 21, 1996
Viramune XR (extended release)
March 25, 2011
rilpivirine
(rilpivirine hydrochloride, RPV)
Edurant Janssen Pharmaceuticals, Inc. 
800-526-7736
May 20, 2011
Protease Inhibitors (PIs)
PIs block HIV protease, an enzyme HIV needs to make copies of itself
atazanavir
(atazanavir sulfate, ATV)
Reyataz Bristol-Myers Squibb 
800-332-2056
June 20, 2003
darunavir
(darunavir ethanolate, DRV)
Prezista  Janssen Pharmaceuticals, Inc. 
800-526-7736
June 23, 2006
fosamprenavir (fosamprenavir calcium, FPV)
Lexia GlaxoSmithKline 888-825-5249
October 20, 2003
indinavir
(indinavir sulfate, IDV)
Crixivan
Merck 
908-423-1000
800-727-5400 
March 13, 1996
nelfinavir
(nelfinavir mesylate, NFV)
Viracept
Agouron Pharmaceuticals
619-622-3000
March 14, 1997
ritonavir
(RTV)
Norvir
Abbott Laboratories 
847-937-6100
March 1, 1996
saquinavir
(saquinavir mesylate, SQV)
Invirase
Hoffmann-La Roche 
888-835-2555
December 6, 1995
tipranavir
(TPV)
Aptivus
Boehringer Ingelheim 
800-243-0127
June 22, 2005
Fusion Inhibitors
Fusion inhibitors block HIV from entering the CD4 cells of the immune system.
enfuvirtide
(T-20)
Fuzeon
Hoffmann-La Roche
888-835-2555
March 13, 2003
Entry Inhibitors
Entry inhibitors block proteins on the CD4 cells that HIV needs to enter the cells.
maraviroc
(MVC)
Selzentry
Pfizer 
212-733-2323
August 6, 2007
Integrase Inhibitors
Integrase inhibitors block HIV integrase, an enzyme HIV needs to make copies of itself.
dolutegravir
(DTG) 
Tivicay 
Viiv Healthcare
888-825-5249 
August 13, 2013 
raltegravir
(RAL)
Isentress
Merck 
908-423-1000
800-727-5400
October 12, 2007
Combination HIV Medicines
Combination HIV medicines contain two or more HIV medicines from one or more drug classes.
abacavir and lamivudine
Epzicom
GlaxoSmithKline 888-825-5249
August 2, 2004
abacavir, lamivudine, and zidovudine
Trizivir
GlaxoSmithKline 888-825-5249
Nov. 14, 2000
efavirenz, emtricitabine, and tenofovir DF Atripla

Bristol-Myers Squibb
800-332-2056

Gilead Sciences
800-445-3235

July 12, 2006
elvitegravir*, cobicistat†, emtricitabine, and tenofovir DF Stribild Gilead Sciences
800-445-3235
August 27, 2012
emtricitabine, rilpivirine, and tenofovir DF Complera Gilead Sciences
800-445-3235
August 10, 2011
emtricitabine and tenofovir DF Truvada Gilead Sciences
800-445-3235
August 2, 2004
lamivudine and
zidovudine
Combivir GlaxoSmithKline
888-825-5249
September 27, 1997
lopinavir and ritonavir (LPV/RTV) Kaletra Abbott Laboratories
847-937-6100
September 15, 2000
* Elvitegravir is an integrase inhibitor that is approved only for use as a component of Stribild.
Cobicistat is a type of medicine called a pharmacokinetic enhancer. It is used to increase the effectiveness of elvitegravir.

This fact sheet is based on information from the following sources:

HIV Treatment

Drug Resistance

(Last updated 9/29/2013; last reviewed 9/29/2013)

Key Points

  • Drug resistance is when HIV creates variations of itself that can’t be controlled by HIV medicines that were previously effective. In other words, the HIV medicines no longer prevent a person’s HIV from multiplying. Drug resistance can cause HIV treatment to fail.
  • A person can initially be infected with drug-resistant HIV or develop drug-resistant HIV after starting HIV medicines.
  • Drug-resistance testing identifies which, if any, HIV medicines won’t be effective against a person’s HIV. Drug-resistance testing results help determine which HIV medicines to include in an HIV treatment regimen.
  • Adherence to an effective HIV treatment regimen reduces the risk of drug resistance. Adherence means taking HIV medicines every day and exactly as prescribed.

What is drug resistance?

Once a person becomes infected with HIV, the virus begins to multiply (make copies of itself) in the body. As HIV multiplies, it sometimes mutates (changes form) and produces variations of itself. Variations of HIV that develop while a person is taking HIV medicines can lead to drug-resistant strains of HIV. HIV medicines that previously controlled the person’s HIV are no longer effective against the new, drug-resistant HIV. In other words, the person’s HIV continues to multiply. Drug resistance can cause HIV treatment to fail.

Because drug-resistant HIV can spread from person to person, some people are initially infected with a drug-resistant strain of HIV.

How does poor medication adherence increase the risk of drug resistance?

Medication adherence means taking HIV medicines every day and exactly as prescribed. Skipping HIV medicines allows HIV to multiply, which increases the risk that the virus will mutate and produce drug-resistant HIV.

As a result of drug resistance, one or more HIV medicines in a person’s HIV regimen may no longer be effective.

What is cross resistance?

Cross resistance is when resistance to one HIV medicine causes resistance to other medicines in the same HIV drug class. (HIV medicines are grouped into drug classes according to how they fight HIV.) As a result of cross resistance, a person’s HIV may be resistant even to HIV medicines that the person has never taken. Cross resistance limits the number of HIV medicines available to include in an HIV regimen.

What is drug-resistance testing?

Drug-resistance testing is done to identify which, if any, HIV medicines won’t be effective against a person’s strain of HIV. Drug-resistance testing is done using a sample of blood.

Drug-resistance testing is done when a person first begins receiving care for HIV infection. Resistance testing should be done whether the person decides to start taking HIV medicines immediately or to delay treatment. If treatment is delayed, resistance testing should be repeated when treatment begins.

Drug-resistance testing done before a person starts taking HIV medicines for the first time can show whether the person was initially infected with a drug-resistant strain of HIV. The results can also guide the choice of HIV medicines to include in a person’s first HIV regimen.

After treatment is started, drug-resistance testing is also done if viral load testing indicates that a person’s HIV regimen isn’t controlling the virus. If drug-resistance testing shows that the HIV regimen isn’t effective because of drug resistance, the test results can be used to select a new HIV regimen.

How can a person taking HIV medicines reduce the risk of drug resistance?

Adherence to an effective HIV treatment regimen reduces the risk of drug resistance.

Here are some tips on adherence for people living with HIV:

  • Once you decide to start treatment, work closely with your health care provider to choose an HIV regimen that suits your needs. A regimen that meets your needs will make adherence easier. Tell your health care provider about any personal issues that can make adherence difficult, for example, a busy schedule or an illness such as depression.
  • When you start treatment, closely follow your HIV regimen. Take your HIV medicines every day and exactly as prescribed.
  • Keep your medical appointments so that your health care provider can monitor your treatment. Appointments are a good time to ask questions and ask for help to manage problems that make it hard to follow an HIV regimen.

How can I learn more about drug resistance?

This fact sheet is based on information from the following sources:

HIV Treatment

HIV Medication Adherence

(Last updated 9/29/2013; last reviewed 9/29/2013)

Key Points

  • Medication adherence means sticking firmly to an HIV regimen—taking HIV medicines every day and exactly as prescribed.   
  • Adherence to an HIV regimen gives HIV medicines the chance to do their job. HIV medicines prevent HIV from multiplying, which protects the immune system and reduces the risk of drug resistance.
  • Adherence can be difficult for many reasons. For example, side effects from HIV medicines can make it hard to stick to an HIV regimen.
  • To get tips on medication adherence, read this AIDSinfo fact sheet: Following an HIV Regimen: Steps to Take Before and After Starting HIV Medicines.

What is medication adherence?

Adherence means “to stick firmly.” So for people with HIV, medication adherence means sticking firmly to an HIV regimen—taking HIV medicines every day and exactly as prescribed.

Why is adherence to an HIV regimen important?

Adherence to an HIV regimen gives HIV medicines the chance to do their job: to prevent HIV from multiplying and destroying the immune system.

Poor adherence to an HIV regimen allows HIV to destroy the immune system. A damaged immune system makes it hard for the body to fight off infections and certain cancers. Poor adherence also increases the risk of drug resistance.

What is drug resistance?

Drug resistance is when HIV is no longer suppressed by HIV medicines that previously prevented the virus from multiplying.

Drug resistance can develop as HIV multiplies in the body. When HIV multiplies, the virus sometimes mutates (changes form) and makes variations of itself. Variations of HIV that develop while a person is taking HIV medicines can lead to new, drug-resistant strains of HIV. The drug-resistant HIV no longer responds to the HIV medicines that used to suppress the person’s HIV. In other words, the person’s HIV continues to multiply.

Once drug-resistant HIV develops, it remains in the body. Drug resistance limits the number of HIV medicines available to include in a current or future HIV regimen.

What is the connection between medication adherence and drug resistance?

Taking HIV medicines every day prevents HIV from multiplying, which reduces the risk that HIV will mutate and produce drug-resistant HIV. Skipping HIV medicines allows HIV to multiply, which increases the risk of drug-resistant HIV developing.

Research shows that a person’s first HIV regimen offers the best chance for long-term treatment success. So adherence is important from the start—when a person first begins taking HIV medicines.

Why is medication adherence sometimes difficult?

Adherence to an HIV regimen can be difficult for several reasons. For example, side effects from HIV medicines, such as nausea or diarrhea, can make it hard to follow an HIV regimen. A complicated regimen that involves taking several pills at different times every day can also be hard to follow.

The following is a list of other factors that can make medication adherence difficult:

  • Interactions between HIV medicines and other medicines a person may take
  • Trouble swallowing pills or other difficulty taking medicines
  • A busy schedule, shift work, or travel away from home that makes it hard to take pills on time
  • Illness or depression
  • Alcohol or drug use that interferes with the activities of daily life
  • Fear of disclosing one’s HIV-positive status to others  
  • Lack of health insurance to pay for HIV medicines

Planning ahead can help. For example, it helps to have a plan in place to manage any issues that can make adherence difficult.

To get tips on adherence, read the AIDSinfo fact sheet: Following an HIV Regimen: Steps to Take Before and After Starting Treatment.

This fact sheet is based on information from the following sources.

HIV Treatment

Following an HIV Regimen: Steps to Take Before and After Starting HIV Medicines

(Last updated 9/29/2013; last reviewed 9/29/2013)

Key Points

  • For people with HIV, medication adherence means sticking firmly to an HIV regimen—taking HIV medicines every day and exactly as prescribed.
  • Adherence to an HIV regimen gives HIV medicines a chance to do their job. HIV medicines prevent HIV from multiplying, which protects the immune system and reduces the risk of drug resistance.
  • This fact sheet offers people living with HIV tips on adherence to try before and after starting an HIV regimen.

Before starting an HIV regimen, talk to your health care provider about medication adherence.

Talking with your health care provider will help you understand why you’re starting HIV treatment and why medication adherence is important. Information that you share with your health care provider will make it easier to select an HIV regimen that suits your needs. The information will also help you and your health care provider plan ahead for any issues that may make adherence difficult.

Tell your health care provider about other medicines you take, including vitamins, herbal supplements, and other medicines you buy without a prescription. Other medicines you take may interact with the HIV medicines in your HIV regimen. A drug interaction can cause a medicine to be less effective or stronger than desired. Drug interactions can also cause side effects.

Tell your health care provider about any personal issues that can make adherence difficult, such as depression or alcohol or drug use that interferes with the activities of daily life. If needed, your health care provider can recommend resources to help you address these issues before you start treatment.

Describe your schedule at home and at work to your health care provider. Working together, you can arrange your HIV medication schedule to match your day-to-day routine.

Ask your health care provider for written instructions on how to follow your HIV regimen. The instructions should include the following details:

  • Each HIV medicine included in your regimen
  • How many pills of each medicine to take
  • When to take each medicine
  • How to take each medicine (for example, with or without food)
  • Possible side effects from each medicine, including serious side effects
  • How to store each medicine

Try practicing the instructions by using small candies instead of actual HIV medicines. The practice will help you identify and address problems with adherence before you start your HIV regimen.

After you start an HIV regimen, use a variety of strategies to maintain adherence.

To maintain adherence over the long term, try some of the following strategies:

  • Use a 7-day pill box. Once a week, fill the pill box with your HIV medicines for the entire week.
  • Take your HIV medicines at the same time every day.
  • Set the alarm on your cell phone to remind you to take your medicines. (An alarm clock or timer works too.)
  • Ask your family members, friends, or coworkers to remind you to take your medicines.
  • Keep your medicines nearby. Keep a back-up supply of medicines at work or in your purse or briefcase.
  • Plan ahead for changes in your daily routine, including weekends and holidays. If you’re going away, pack enough medicine to last the entire trip.
  • Use a medicine diary to stay on track. There are many apps available for smartphones that you can use to record when you take your medicines. (Or if you prefer, use a paper bound diary.) Enter the name of each medicine; include the dose, number of pills to take, and when to take them. Record each medicine as you take it. Reviewing your diary will help you identify the times that you’re most likely to forget to take your medicines.
  • Keep all your medical appointments. Use a calendar to keep track of your appointments. If you run low on medicines before your next appointment, call your health care provider to renew your prescriptions.
  • Get additional tips on adherence by joining a support group for people living with HIV.

Don’t panic if you forget to take your HIV medicines.

Unless your health care provider tells you otherwise, take a medicine you missed as soon as you realize you skipped it. But if it’s almost time for the next dose of the medicine, don’t take the missed dose and just continue on your regular medication schedule. Don’t take a double dose of a medicine to make up for a missed dose.

Discuss medication adherence at each appointment with your health care provider.

Tell your health care provider if you’re having difficulty following your regimen. Don’t forget to mention any side effects you’re having. Side effects from HIV medicines are a major reason medication adherence can be difficult.

Let your health care provider know if your regimen is too complicated to follow. Your health care provider may recommend another regimen that involves taking fewer pills.

Discuss any personal issues that are causing you to skip medicines. Your health care provider can recommend resources to help you deal with the issues.

This fact sheet is based on information from the following sources:

HIV Treatment

HIV and Immunizations

(Last updated 9/29/2013; last reviewed 9/29/2013)

Key Points

  • Vaccines are products designed to protect people from disease, for example, chicken pox, flu, and polio. Vaccines are given by needle injections, by mouth, or by aerosol sprays. The process of getting a vaccine is called vaccination or immunization.
  • There is no vaccine to prevent or cure HIV, but people with HIV can benefit from vaccines against other diseases. The following vaccines are recommended for all people with HIV: hepatitis B; influenza (flu); human papillomavirus (HPV) (for those up to age 26); pneumococcal (pneumonia); and tetanus, diphtheria, and pertussis (a single vaccine that protects against the three diseases). Every 10 years, a repeat vaccine against tetanus and diphtheria is also recommended. Other vaccines may be recommended for some people with HIV.
  • In general, people with HIV should not get live, attenuated vaccines unless the benefit outweighs the risk.
  • Because HIV medicines strengthen the immune system and reduce HIV viral load, whenever possible people with HIV may want to start antiretroviral therapy (ART) before getting immunizations. 

What are vaccines?

Vaccines are products designed to protect people from disease. There are vaccines against many diseases, for example, chicken pox, flu, and polio. The process of getting a vaccine is called vaccination or immunization.

Most vaccines are designed to prevent a person from ever having a particular disease or to only have a mild case of the disease. When a person gets a vaccine (by needle injection, by mouth, or by aerosol spray), the body responds by mounting an immune response against the particular disease. An immune response includes all the actions of the immune system to defend the body against the disease-causing bacteria, virus, or other foreign organism. 

Vaccines not only protect individuals from disease, they protect communities as well. When most people in a community get immunized against a disease, there is little chance of a disease outbreak.   

Is there a vaccine against HIV?

Testing is underway on experimental vaccines to prevent and treat HIV/AIDS, but no HIV vaccine is approved for use outside of clinical trials. Even though there isn’t a vaccine to prevent or cure HIV, people with HIV can benefit from vaccines against other diseases.

Can HIV infection affect the safety and effectiveness of vaccines?

Yes. Damage to the immune system due to HIV can reduce the body’s immune response to a vaccine. A weakened immune response makes a vaccine less effective.  In general, vaccines work best when an HIV-infected person’s CD4 count is above 200 copies/mm3

By stimulating the immune system, vaccines may also cause a person’s level of HIV (viral load) to increase temporarily. 

Because HIV medicines strengthen the immune system and reduce HIV viral load, people with HIV may want to start antiretroviral therapy (ART) before getting vaccinated whenever possible. In some situations, however, immunizations should not be delayed to start ART. For example, it’s important for people with HIV to get vaccinated against the flu at the time of year when the risk of flu is greatest. 

Are all types of vaccines safe for people with HIV?

The design of a vaccine depends on several factors, such as how a microbe infects the body and how the immune system responds. For this reason, there are several types of vaccines, including live, attenuated vaccines and inactivated vaccines.

A live, attenuated vaccine contains a weakened but live form of a disease-causing microbe. Although the attenuated (weakened) microbe cannot cause the disease (or can cause only mild disease), the vaccine can still trigger an immune response.

Inactivated vaccines are made from microbes that have been killed with chemicals, heat, or radiation. There is no chance that an inactivated vaccine can cause the disease it was designed to prevent.

In general, to be safe, people with HIV should get inactivated vaccines to avoid even the remote chance of getting a disease from a live, attenuated vaccine. However, for some diseases, only live, attenuated vaccines are available. In this case, the protection offered by the live vaccine may outweigh the risks. Vaccines against chicken pox and shingles are examples of live, attenuated vaccines that, in certain situations, may be recommended for people with HIV.

Do vaccines cause side effects?

In general, side effects from vaccines are minor (for example, a sore arm or low-grade fever) and go away within a few days. Severe reactions to vaccines are rare. Before getting a vaccine, talk to your health care provider about the benefits and risks of the vaccine and possible side effects.

Which vaccines are recommended for people with HIV?

The following vaccines are recommended for people with HIV:

  • Hepatitis B
  • Influenza (flu)
  • Pneumococcal (pneumonia)
  • Tetanus, diphtheria, and pertussis. A single vaccine called Tdap protects against the three diseases. Every 10 years, a repeat vaccine against tetanus and diphtheria (called Td) is recommended.
  • Human papillomavirus (HPV) (for those up to age 26)  

Additional vaccines may be recommended on the basis of an HIV-infected person’s age, previous vaccinations, risk factors for a particular disease, or certain HIV-related factors, For more information, read this information from the Centers for Disease Control and Prevention (CDC): HIV Infection and Adult Vaccination.

What about travel and immunizations?

Regardless of destination, all travelers should be up to date on routine vaccinations. Those traveling to destinations outside the United States may need immunizations against diseases present in other parts of the world, for example, cholera or yellow fever.

If you have HIV, talk to your health care provider about any vaccines you may need before you travel. If a required immunization is only available as a live, attenuated vaccine, your health care provider can give you a letter that excuses you from getting the vaccine. If your CD4 count is less than 200 copies/mm3, your health care provider may recommend that you delay your trip to give HIV medicines time to strengthen your immune system. To prepare for your trip, read information from CDC on Travelers with Weakened Immune Systems.

This fact sheet is based on information from the following sources: