How HIV/AIDS Is Treated

The main treatment for a human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) is antiretroviral therapy (ART), which stops the virus from multiplying in the body. It reduces the amount of HIV in the blood, which can help the infected individual stay healthy and avoid passing the virus on to others. People on ART usually take a combination of medications.

The U.S. Food and Drug Administration (FDA) has approved 222 antiretroviral (ARV) medications to treat HIV infections and AIDs as of 2020. While these medications can’t cure HIV or AIDS, they can help people with an HIV infection or AIDS control the virus and slow the progression of the disease.

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What Is Antiretroviral Therapy?

ART is a combination of drugs used to treat an HIV infection. It is sometimes called triple-drug therapy. It prevents the virus from making copies of itself in the infected individual's body.

HIV attacks infection-fighting CD4 cells in the immune system, and can allow different types of life-threatening infections and cancers to develop. By keeping the amount of virus in the body (known as the viral load) low, ART gives the immune system a chance to recover and produce more CD4 cells to protect the body.

ARV drugs work by targeting and blocking different stages of the HIV life cycle. When one stage is blocked, the next step cannot occur, which disrupts the entire life cycle of the virus. HIV cannot replicate itself. If a patient continues to steadily take ART, eventually their viral load will be so low that HIV will become undetectable in the body. However, if a person stops their ART treatment, the virus can re-emerge. 

HIV Life Cycle

There are seven stages in the HIV life cycle:

  • Binding: When HIV attacks a CD4 cell, the virus binds to molecules on the surface of the CD4 cell.
  • Fusion: The HIV viral envelope fuses with the CD4 cell membrane, which allows the virus to enter the CD4 cell.
  • Reverse transcription: HIV releases and uses reverse transcriptase (an HIV enzyme) to convert its genetic material, HIV RNA, into HIV DNA. This allows the virus to enter the CD4 cell nucleus and combine with the cell’s genetic material—cell DNA.
  • Integration: Once inside the host CD4 cell nucleus, HIV releases integrase, an HIV enzyme, which the virus uses to insert its viral DNA into the DNA of the host cell.
  • Replication: Once integrated, the virus begins to use the machinery of the CD4 cell to create long chains of HIV proteins.
  • Assembly: During this stage, new HIV RNA and HIV proteins made by the host CD4 cell move to the surface of the cell and assemble into noninfectious HIV.
  • Budding: Noninfectious HIV, which can't invade other CD4 cells, pushes itself out of the host CD4 cell during this stage. Once outside, the new HIV releases protease, an HIV enzyme that breaks up the long protein chains in the immature virus to create the infectious virus.

A combination of drugs, also called the HIV treatment regimen, are used to ensure the success of treatment. In the 1990s, the term "highly active antiretroviral therapy" (HAART) was coined to describe the success of using more than one drug to treat HIV. Prior to this, using one medication had limited success.

Types of Medication

FDA-approved HIV medications are classified into different drug classes, including:

  • Nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs) are the first FDA-approved class of antiretroviral drugs. HIV makes copies of itself by using reverse transcriptase. This drug prevents the enzyme from completing its interaction.
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to and block the same HIV enzyme. 
  • Fusion inhibitors block the HIV envelope from merging with the host CD4 cell membrane, which prevents HIV from entering the CD4 cell.
  • Protease Inhibitors block protease, an HIV enzyme, and prevent new HIV from becoming a mature virus that can infect other CD4 cells.
  • CCR5 antagonists block the CCR5 coreceptor on the surface of certain immune cells, such as CD4 T lymphocytes, which prevents HIV from entering the cell.
  • Integrase strand transfer inhibitors (INSTIs) block integrase, another HIV enzyme that the viruses uses to insert its viral DNA into the DNA of the host CD4 cell.
  • Attachment inhibitors bind to the gp120 protein on the outer surface of HIV, preventing the virus from binding to and entering CD4 cells.
  • Post-attachment inhibitors bind to the CD4 receptor on a host CD4 cell. This blocks HIV from attaching to the CCR5 and CXCR4 coreceptors and entering the cell.

Antiretroviral drugs are typically taken once a day without any food. Some are taken twice a day. It depends on the HIV regimen prescribed by your doctor. Do not skip or miss a dose since this can lead to HIV drug resistance, which can cause treatment to fail.

How Long Does It Take for ART to Work?

Most people living with HIV who start taking antiretroviral therapy daily as prescribed achieve an undetectable viral load within one to six months after beginning treatment. A person’s viral load is considered durably undetectable when all viral load test results are undetectable for at least six months after their first undetectable test result. This means that most people will need to be on treatment for 7 to 12 months to have a durably undetectable viral load. It is essential to take every pill every day to maintain durably undetectable status.

Starting a Medication Regimen

The U.S. Department of Health and Human Services recommends that treatment should start right away after a person is diagnosed with an HIV infection. By starting treatment immediately, a person can prevent damage to their immune system, decrease the chances of HIV-related illnesses, and reduce transmission to others. People who begin ART right away are 53% less to develop illnesses related to HIV and illnesses that are not related. 

When choosing 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, such as heart disease or pregnancy
  • 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). Drug-resistance testing identifies which, if any, HIV medicines won’t be effective against a person’s HIV
  • Convenience of the regimen
  • Any issues that can make it difficult to follow an HIV regimen such as a lack of health insurance or an inability to pay for HIV medicines

Side Effects of Medications

Like other medications, ARV drugs come with side effects, including:

  • Nausea and vomiting
  • Diarrhea
  • Difficulty sleeping
  • Dry mouth
  • Headache
  • Rash
  • Dizziness
  • Fatigue
  • Pain

More serious side effects include:

  • Bone loss
  • Heart disease
  • High blood sugar and diabetes
  • Kidney damage
  • Liver damage
  • Pancreas damage
  • Nerve problems

When to See a Doctor

Most side effects from ART are mild and do not require immediate medical attention. Within the first few days, you may expect to have a few of the side effects, but if they persist, your health care provider can change your medication or regimen. 

Treatment to Prevent HIV

Post-Exposure Prophylaxis (PEP)

Post-exposure prophylaxis (PEP) is given after a possible exposure to HIV to prevent the virus from taking hold in the body. It has to be taken within 72 hours of exposure to be effective, and needs to be taken for 28 days.

Talk to your health care provider, an emergency physician, or an urgent care provider about PEP if you think you’ve recently been exposed to HIV:

  • During sex
  • Through sharing needles, syringes, or other equipment to inject drugs
  • If you’ve been sexually assaulted.

PEP is highly effective in preventing HIV. But to be safe, you should take other actions to protect your partners while you are taking PEP. This medication usually has mild side effects that can be treated or go away on its own. PEP may interact with other medications, so be sure to inform your doctor of other drugs you are taking.

Pre-Exposure Prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is a combination of two different HIV drugs in a single pill given to people who don't have HIV but are at high risk of an HIV infection. PrEP can stop HIV from taking hold and spreading throughout your body. Currently, there are only two FDA-approved medications for PrEP.

The once-daily pill reduces the risk of getting HIV from sex by more than 90%. Among people who inject drugs, it reduces the risk by more than 70%. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other HIV prevention methods.

Those at high risk include people who:

  • Have an HIV-positive partner
  • Have multiple sexual partners
  • Share needles or other drug equipment with others

Some people taking PrEP may have side effects, like nausea, but these side effects are usually not serious and disappear over time. If you are taking PrEP, tell your doctor if you have any side effect that bothers you or that does not go away. Be aware that PrEP protects you from HIV but not other sexually transmitted diseases.

Home Remedies and Lifestyle

Besides starting ART right away, people who are infected with HIV or have AIDS can implement protective practices in their lives to ensure a healthy life. 

Quit Smoking

Smoking is damaging to everyone's health, including people living with HIV. Smokers with HIV are more likely than nonsmokers with HIV to develop serious illnesses, including:

  • Lung cancer, head and neck cancers, cervical and anal cancers, and other cancers
  • Heart disease and stroke
  • Chronic obstructive pulmonary disease (COPD)
  • Serious HIV-related infections, including bacterial pneumonia

Smoking can also potentially wipe out the benefits of ART. One study found that people with HIV who were on ART were six to 13 times more likely to die from lung cancer than from traditional AIDS-related causes.

Stay Up-to-Date on Vaccines

People who have HIV need to make sure they get vaccinated because HIV weakens their bodies and make them more vulnerable to infections and diseases.

These immunizations are recommended for people with HIV:

  • Hepatitis B
  • Human papillomavirus (HPV) (for those up to age 26)
  • Influenza
  • Meningococcal series, which protects against meningococcal disease
  • Pneumococcal (pneumonia)
  • Tetanus, diphtheria, and pertussis (whooping cough)

Live attenuated vaccines like the chickenpox vaccine contain a weakened but live form of the germ that causes the disease, and can potentially cause an infection for people living with HIV. Be sure to check with your doctor to see which vaccines for safe for you.

Take Vitamins

Lower bone mineral density is common for folks living with HIV. Because of this, bone and hip fractures are also common. Low bone mineral density is typically a side effect of ART and begins within the first two years of starting treatment. 

Taking a daily supplement of vitamin B and calcium may reduce bone fractures. In addition to this, taking vitamin D every day can also help keep your bones healthy. 

Exercise

Exercising can release any tension associated with an HIV diagnosis, improve sleep, and promote a healthier lifestyle. Physical activity can also help reduce the risk of developing cardiovascular disease, high blood pressure, type 2 diabetes, and several types of cancer, which can all affect people living with HIV. People living with HIV can do the same types of physical activity and exercise as individuals who do not have HIV, such as brisk walking, running, biking, dancing, jumping rope, and swimming.

Prognosis With Treatment

A 2017 study found that between 1996 and 2010, life expectancy in 20-year-old patients adhering to ART increased by nine to 10 years. With 1.2 million people in the United States living with HIV, treatment has improved exponentially in the past few decades. Between 2014 and 2018, the number of HIV infections dropped by 7%.

Most importantly, treatment for HIV prevents patients from entering stage 3 of HIV infection or AIDS. People in today’s world can live long, healthy lives compared with individuals with HIV 30 years ago. Routine screening and testing are incredibly important if you are at high risk of an HIV infection. By beginning treatment right away, a good outlook is possible. 


If you're having a difficult time with your diagnosis, seek out a therapist. If you need immediate help, call the 24-hour toll free HIV hotline to find a therapist in your state. Use the HIV.gov locator to find a provider close to you. The Centers for Disease Control and Prevention also offer many resources for housing, mental health care, traveling, and combating the stigma surrounding HIV. 

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Article Sources
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