antiretroviral therapy

Antiretroviral therapy (ART) is a combination of medicines used to treat HIV. The treatment doesn’t completely eliminate the virus, but it does stop the virus from replicating in the body and causing damage. It also prevents spread to others.

If not stopped, HIV continues to attack the immune system and eventually progresses to AIDS, which is fatal if left untreated.

The Centers for Disease Control and Prevention recommends that people who are HIV positive start ART right away. That way, HIV has less time to attack the immune system.

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How Does ART Work?

ART works by interfering with important proteins that the virus uses to replicate itself and spread. For example, some medicines block the action of reverse transcriptase, a protein the virus needs to create more copies. Others block a protein called integrase, which HIV uses to insert itself into your DNA so it can make more copies of itself.

Once on ART, the amount of virus in your body (known as the “viral load”) starts to drop. After three to six months of taking ART, most people achieve an undetectable viral load in their blood.

This means that the virus exists in the body at such low levels that it isn’t picked up in testing. At this stage, HIV can’t spread to another person.

While the HIV viral load drops due to ART, the CD4 count — the level of infection-fighting white blood cells, or T cells, in your immune system — increases. This means the immune system is recovering from HIV’s attacks.

Doctors often prescribe pills that combine two to three types of ART, to pack a more powerful punch. The Food and Drug Administration has approved more than 20 combination antiretroviral drugs. Today, most people start on a daily combination pill.

To be clear, ART doesn’t eliminate the virus altogether, because the virus is able to hide in a dormant form in some immune cells. If you stop taking ART, the virus starts to replicate again. Treatment does not cure HIV, but turns it into a manageable condition as long as ART is taken every day.

How to Decide What ART to Take

Your doctor will determine the best ART combination for you based on a number of factors. First, your doctor will run a test to see if the HIV in your body has mutations that make it resistant to any ART.

Your doctor will then ask about other health problems you have and any medicines you take. This is because different types of medicines could be better or worse for people with certain health problems, like diabetes, kidney disease, or hepatitis. Similarly, some ART can interfere with medicines like birth control pills.

Cost also can be a factor. Payment assistance programs may be available to help cover the cost of ART.

It is important to let your doctor know all of your health problems and any other medicines (including over-the-counter herbal medicines) you take so that you can get the correct ART.

Are There Side Effects to ART?

Some people experience no side effects of ART. Others may experience one or more of the following:

  • Nausea.
  • Vomiting.
  • Diarrhea.
  • Headaches.
  • Difficulty sleeping.
  • Dry mouth.
  • Dizziness.
  • Fatigue.
  • Pain.

If the side effects persist and interfere with your quality of life, your doctor might change your ART. Or your doctor may recommend additional medicines or dietary changes to resolve the side effects. Advances in treatment are making side effects less of a problem with ART.

Over a long period of time, ART can increase the risk of liver and kidney issues, as well as high cholesterol and diabetes. Doctors monitor ART patients for these issues.

What Is Drug-Resistant HIV ?

Starting and stopping meds — or only taking them intermittently — can allow the virus to change as it replicates.

In some cases, these changes can give the virus advantages, like being able to make copies and infect cells even with ART present in the body. The possibility of developing a drug-resistant infection is why it’s especially important to take ART as directed.

Some people get infected with a strain of HIV that has become resistant to some types of ART. One major United States study found 14% of new infections were resistant to at least one form of ART.

Thanks to a wide range of available ART, drug-resistant strains are treatable, but may require more complex courses of therapy. If you stop ART at any time, or find yourself forgetting to take it as directed, tell your doctor so they can help you.

About Infectious Diseases

If you have a disease caused by bacteria, fungi, parasite, or virus, the UPMC Center for Care of Infectious Diseases can help. We have specialty units for prevention and treatment of HIV-AIDs, postsurgical and transplant infections, and illnesses caused by international travel. Our faculty research infectious diseases and participate in clinical trials to learn more and develop better treatment and prevention methods.