If you have HIV, starting antiretroviral therapy (ART) is a huge step. At first, taking daily medication for the rest of your life may feel intimidating or frustrating.
But with ART, people with HIV can expect to enjoy a full life. That’s because ART can stop the virus from replicating.
Since the introduction of the first protease inhibitor in the 1990s, treatment for HIV has steadily improved. What was once an almost certain fatal infection has become a chronic but largely manageable condition.
ART isn’t a cure. But it significantly lowers the risk of developing opportunistic life threatening infections.
In fact, ART can get the viral load down so low as to be undetectable in the blood. With continued therapy, you can maintain an undetectable viral load. That means that the virus can’t be transmitted through sexual activity.
You can develop the infection and still feel perfectly fine. You won’t feel the virus replicating. But without treatment, the viral load can rise to a very high level within the first 6 months. This is known as “acute infection.”
That means you’re more vulnerable to other infections and illnesses. If you’re sexually active, you also have a chance of transmitting HIV.
The only way to know you have HIV is to get tested. The Centers for Disease Control and Prevention (CDC)Trusted Source recommends that everyone between the ages of 13 and 64 gets tested at least once as part of routine care. Those at higher risk should be tested once per year.
If you believe you’ve been exposed to HIV, get tested right away. Starting treatment during the acute stage can help get the viral load under control before you get sick or pass the infection to others.
ART can greatly reduce the viral load in your body. Having less than 200 copiesTrusted Source of HIV per milliliter of blood is called viral suppression. ART can lower the viral load to an undetectable level, but this can take as long as 6 monthsTrusted Source.
A low or undetectable HIV viral load allows your immune system to do a better job of protecting you from illness. ResearchTrusted Source suggests that starting ART as early as the day of diagnosis can optimize the health of people living with HIV.
People who continue to take ART and maintain an undetectable viral load cannot sexually transmit the virus to others. According to the National Institutes of Health (NIH)Trusted Source, evidence that “undetectable equals untransmittable” (U=U) is overwhelming.
There’s effectively no risk of transmission through oral, anal, or vaginal sex. There may be a slight riskTrusted Source of transmission during pregnancy, labor, and delivery. People with HIV shouldn’t breastfeed their infants, per the CDC guidelines.
The NIH recommends that people with HIV start taking HIV medicines as soon as possible after diagnosis.
Your doctor can address any concerns you may have about starting ART.
ART involves a combination of medications that you take every day. It usually consists of two or three drugs from at least two drug classes.
- Nucleoside reverse transcriptase inhibitors (NRTIs) target a protein called reverse transcriptase and stop the virus from replicating.
- Non-nucleoside reverse transcriptase inhibitors (NNRTIs) bind to and block an enzyme called reverse transcriptase and prevent the virus from making new copies of itself.
- Protease inhibitors (PIs) block protease and prevent immature HIV from maturing and infecting CD4 cells.
- Integrase strand transfer inhibitors (INSTIs) block an enzyme called integrase, which HIV needs for replication.
- Entry inhibitors prevent the virus from inserting itself into human cells. Fusion inhibitors, CCR5 antagonists, attachment inhibitors, and post-attachment inhibitors are all types of entry inhibitors.
Pharmacokinetic enhancers, drugs that boost another drug’s effectiveness, are sometimes included in HIV regimens.
Your HIV regimen will be tailored to your specific needs and may change over time. These medications must be taken exactly as prescribed.
Missing doses allows the virus to multiply. And once you achieve an undetectable viral load, you must continue to take ART to maintain it. Periodic testing will determine how well the therapy is working for you.
Side effects depend on your drug combination and not everyone responds the same way. Some side effects resolve within a few days or weeks of starting therapy. Others may appear later or last longer.
Some commonly reported side effects are:
- nausea, vomiting
- dry mouth
- difficulty sleeping
Over the longer term, some HIV medicines can cause high cholesterol. HIV medications can also interact with other medications, so be sure to let your doctor and pharmacist know about all your medications.
If you’re having troublesome side effects, stick to your regimen, but speak with your doctor as soon as possible. You may be able to switch to another drug.
HIV medications are expensive. ResearchTrusted Source published in 2020 suggests that ART prices are higher in the United States compared to Britain, Australia, and Canada. The researchers found that in 2018, ART costs were more than $36,000 per patient per year, with an average annual increase of 6 percent since 2012.
Some insurance plans cover all or some of the cost of HIV medications. Overall costs and copays vary widely depending on medical and prescription plans. Pharmaceutical companies may offer financial assistance for their drugs.
High costs can affect access to treatment and adherence to a treatment regimen. For more information on covering the cost of HIV medications, visit:
Financial barriers to care include:
- lack of health insurance
- lower socioeconomic status
- lack of housing, job, or transportation
According to the CDCTrusted Source, other barriers to consistent care include:
- drug or alcohol dependence
- untreated depression, poor mental health or cognitive abilities
- personal or cultural beliefs
If you need help accessing care, your state’s HIV/AIDS hotline may be able to point you toward programs and services in your area.
Learning you have HIV is life-altering. But ART has significantly improved the outlook and made a long, healthy life with HIV possible.
Experts recommend starting ART immediately upon diagnosis, and for good reason. ART can lower the viral load so that it’s undetectable, which also means untransmittable. With an undetectable viral load, your immune system will be better able to fend off other infections and illnesses.
If you think you’ve been exposed to HIV, get tested. And if you test positive, consider starting treatment right away. Discuss any concerns with your doctor. Together, you can choose the best HIV regimen for you.