Managing HIV: Treatments, Choices, and Ongoing Care

How antiretroviral therapy (ART) controls HIV

Antiretroviral therapy (ART) uses a combination of medicines to stop HIV from reproducing and spreading to new cells. By halting viral replication, ART lowers the amount of virus in the bloodstream (viral load), allowing the immune system to recover and reducing the risk of opportunistic infections and HIV-related complications.

There are several major classes of HIV drugs, each targeting a different step in the virus’s lifecycle:

• Nucleoside reverse transcriptase inhibitors (NRTIs): mimic natural building blocks and interrupt viral DNA synthesis.
• Non-nucleoside reverse transcriptase inhibitors (NNRTIs): bind to and disable the reverse transcriptase enzyme.
• Protease inhibitors (PIs): prevent the virus from maturing by blocking the protease enzyme.
• Integrase strand transfer inhibitors (INSTIs): stop viral DNA from integrating into the host’s genome.
• Entry inhibitors: block the virus from entering host cells.

Combining drugs from different classes reduces the chance that HIV will develop resistance and improves the durability of treatment. The overall goal is to achieve and sustain an undetectable viral load, which preserves immune function and lowers transmission risk.

Why treatment should start promptly

Current international and national guidelines support initiating ART as soon as possible after an HIV diagnosis. Starting treatment early offers several advantages:

• Rapid viral suppression, which helps restore and protect immune cells.
• Fewer HIV-related illnesses and long-term complications.
• Reduced likelihood of passing HIV to sexual partners, especially once viral load is undetectable.
• Better preservation of immune function over the long term.

ART is a lifelong therapy; stopping or interrupting treatment can allow the virus to rebound and may promote drug resistance. Consistent adherence is critical for long-term success.

How clinicians pick the right regimen

Choosing an effective, tolerable ART regimen is a shared decision between the patient and their healthcare team. Common considerations include:

• Overall health and any coexisting medical conditions (e.g., liver or kidney disease).
• Other medications being taken to avoid harmful drug interactions.
• Potential side effects and how they might affect daily life.
• The patient’s routine and likelihood of maintaining adherence.
• Results of resistance testing to identify drugs the virus may already resist.
• Pregnancy or plans to conceive, which influence safe drug choices.

Clinicians often start with regimens that combine potency, safety, and simplicity—options that make it easier for people to take their treatment consistently. Regimens can be adjusted over time if side effects, interactions, or other issues arise.

Tracking treatment success

Regular monitoring lets clinicians confirm that ART is working and identify problems early. Key tests and assessments include:

• Viral load testing: measures how much HIV is present and is the primary indicator of treatment success.
• CD4 cell count: evaluates immune system strength and helps guide preventive care.
• Drug resistance testing: performed when treatment fails or before selecting certain drugs.
• Routine health checks: monitor for side effects, metabolic changes, liver or kidney function, and other complications.

Frequent viral load checks are typical after starting or changing therapy, then spaced out once the virus is stably suppressed.

Side effects and how they’re managed

Modern ART regimens tend to be better tolerated than older options, but adverse effects can still occur. Common, usually manageable side effects include:

• Nausea or vomiting
• Diarrhea
• Fatigue
• Headaches
• Skin rashes
• Sleep changes

Less common but serious issues—such as liver or kidney injury, metabolic changes, or cardiovascular effects—may affect some people. Promptly reporting symptoms to a clinician is important because many side effects can be mitigated by switching drugs, adjusting doses, or using supportive therapies.

Treatment formats and preventive options

Prices, rates, or cost estimates mentioned in this article are based on the latest available information but may change over time. Independent research is advised before making financial decisions.

Living well with HIV

With today’s treatments, many people living with HIV lead long, healthy, and active lives. Success relies on regular medical care, taking medications as prescribed, and routine monitoring. Open communication with healthcare providers helps tailor therapy to changing needs—whether managing side effects, planning pregnancy, or addressing other health issues.

Ongoing research continues to expand options, with new medications, delivery methods, and approaches aimed at improving convenience, reducing toxicity, and overcoming resistance. For prevention, PrEP remains a powerful tool for HIV-negative individuals at risk.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.