FDA Approved HIV Medications That Are Available For Treatment

HIV Medications

FDA-Approved HIV Medicines

Treatment with HIV medications is known as antiretroviral therapy (ART). ART is suggested for everyone with HIV, and people with HIV should start ART as soon as possible. Patients on ART take a mix of HIV medicines (known as an HIV treatment program) daily. An individual’s first HIV regimen usually involves three HIV medications from at least two distinct HIV drug classes. We will discuss all medications currently available to be discussed with your physician. Also, the article will touch on a new subject to see if any of these medications may potentially help slow down the Covid-19 coronavirus?

What is an HIV Regimen?

An HIV Regimen is a mix of HIV medications used to treat HIV disease. HIV treatment (also known as antiretroviral treatment or ART) starts with picking an HIV regimen. People on ART are prescribed to take the HIV medicines in their HIV regimens daily. ART helps people with HIV live healthier, longer lives and reduces the probability of HIV transmission.

The U.S. Food and Drug Administration (FDA) has approved over 30 HIV medications to treat HIV infection. Some HIV medicines can be found in combination (in other words, two or more different HIV medicines combined in one pill).

HIV Medications are grouped into seven drug classes based on the way they fight HIV:

What are the HIV drug classes?

The seven HIV drug classes are:

  1. Nucleoside reverse transcriptase inhibitors (NRTIs)
  2. Fusion inhibitors
  3. Integrase strand transfer inhibitors (INSTIs)
  4. Protease inhibitors (PIs)
  5. Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
  6. Post-attachment inhibitors
  7. CCR5 antagonists

The HIV medicines to include in an HIV regimen is decided on a person’s individual needs.

What factors are considered when deciding on an HIV regimen?

When deciding on an HIV regimen, individuals with HIV and their medical care providers consider the following variables:

  • Other diseases or conditions that the individual with HIV may have, such as heart disease or pregnancy.
  • Potential side effects of HIV medicines.
  • Possible interactions between HIV medications or between HIV medicines and other medications the individual with HIV is taking.
  • Results of drug-resistance testing (and other tests). Testing describes which, if any, HIV medicines will not be effective against an individual’s HIV.
  • The convenience of this regimen. A regimen that involves two or more HIV medicines combined in one pill is easy to follow.
  • Any problems that can make it hard to follow the HIV regimen. By way of instance, a lack of health insurance or the inability to pay for HIV medicines can make it tough to take HIV medicines consistently regularly.

The best regimen for a person is dependent upon their needs.

How long does it take to work?

Viral Load is the amount of HIV in the blood of a person. An objective of HIV treatment is to decrease an individual’s viral load. An undetectable viral load indicates the amount of HIV in the blood is too low to be detected by a viral load test.

Once HIV treatment is started, it takes 3 to 6 months for an individual’s viral load to reach an undetectable level. However, HIV medicines can’t treat HIV completely, having an undetectable viral load demonstrates that an individual’s HIV is being controlled by the medications. Having an undetectable viral load lets people with HIV live longer, healthier lives. Moreover, individuals have no chance of transmitting HIV through sex to their HIV-negative partners.

When Is It Time To Start Taking HIV Medicines?

Treatment with HIV medications (known as antiretroviral treatment or ART) is advised for everyone with HIV. After HIV is diagnosed, people with HIV should begin taking HIV medications.

The main aim of HIV treatment is to decrease someone’s viral load to an undetectable level. An undetectable viral load implies the amount of HIV in the blood is too low to be detected by a viral load test. Managing an undetectable viral load help people with HIV live a healthier life. People have no chance of transmitting HIV through to their partners through sex.

To reduce their load, it is essential for those who have HIV to begin taking HIV medicines. Starting HIV medicines immediately is particularly necessary for individuals with HIV who have certain conditions.

Conditions that make it essential to start HIV medicines

The following conditions make it particularly important to start HIV medicines immediately:

  • Pregnancy
  • Early HIV disease
  • AIDS-defining conditions

Pregnancy

All pregnant women with HIV should take HIV medications to protect their health and protect against mother-to-child HIV transmission. All pregnant women with HIV must start taking HIV medicines as soon as possible.

In most cases, women that are already on a stable HIV regimen when they get pregnant should keep on using the same regimen during their pregnancies. Women with HIV who aren’t already taking HIV medications and become pregnant should start taking HIV medicines right away.

The risk of mother-to-child HIV transmission during childbirth and pregnancy is lowest when a woman having HIV has an undetectable viral load. Having an undetectable viral load helps keep the mother healthy.

Early HIV Infection

Early HIV disease is the period up to 6 months after infection with HIV. During early HIV infection, an individuals’ viral load is quite high.

Studies show that even at this early stage of HIV infection, HIV medications can start to protect an individual’s health. Also, HIV drugs during early HIV infection lowers the risk of HIV transmission.

AIDS-Defining Conditions

AIDS-defining conditions are certain infections and cancers which are life-threatening in people with HIV. Having an AIDS-defining condition means that a person has AIDS, that’s the final, most severe stage of HIV disease. Although HIV has already seriously damaged the immune system of an individual with AIDS, starting HIV medicines as soon as possible can make immune function better.

Once a person begins taking HIV medicines, is medication adherence significant?

Medication Adherence means sticking to an HIV regimen—taking HIV medicines regularly and exactly as prescribed. Medication adherence is vital to maintaining an undetectable viral load, which lowers the chance of HIV transmission and protects the immune system.

Before starting HIV treatment, it’s essential to speak with your health care provider. By way of example, a busy schedule or lack of health insurance may make it tough to take HIV medicines. Physicians can recommend resources to help people deal with any issues that may interfere with adherence.

Image source: www.nih.gov

The following table lists HIV medicines approved for treating HIV disease in the USA, according to the U.S. Department of Health and Human Services (HHS) HIV/AIDS medical practice regulations. All these medications are approved by the U.S. Food and Drug Administration (FDA). The HIV medications identified by brand and generic names and are listed according to the drug names. Click on a drug name to see information on the medicines from the AIDSinfo Drug Database. Or install the AIDSinfo Drug Database app to see the information on your Android or Apple devices.

Drug Class Generic Name
(Other names and acronyms)
Brand Name FDA Approval Date
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
NNRTIs bind to and later alter reverse transcriptase, an enzyme HIV needs to make copies of itself. nevirapine
(extended-release nevirapine, NVP)
Viramune XR (extended release March 25, 2011
Viramune June 21, 1996
efavirenz
(EFV)
Sustiva September 17, 1998
doravirine
(DOR)
Pifeltro August 30, 2018
rilpivirine
(rilpivirine hydrochloride, RPV)
Edurant May 20, 2011
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
NRTIs block reverse transcriptase, an enzyme HIV needs to make copies of itself. zidovudine
(azidothymidine, AZT, ZDV)
Retrovir March 19, 1987
lamivudine
(3TC)
Epivir November 17, 1995
abacavir
(abacavir sulfate, ABC)
Ziagen December 17, 1998
tenofovir disoproxil
fumarate

(tenofovir DF, TDF)
Viread October 26, 2001
emtricitabine
(FTC)
Emtriva July 2, 2003
Combination HIV Medicines lopinavir and ritonavir
(ritonavir-boosted lopinavir, LPV/r, LPV / RTV)
Kaletra September 15, 2000
lamivudine and zidovudine
(3TC / ZDV)
Combivir September 27, 1997
lamivudine and tenofovir disoproxil fumarate
(Temixys, 3TC / TDF)
Cimduo February 28, 2018
emtricitabine and tenofovir disoproxil fumarate
(emtricitabine / tenofovir DF, FTC / TDF)
Truvada August 2, 2004
emtricitabine and tenofovir alafenamide
(emtricitabine / tenofovir AF, emtricitabine / tenofovir alafenamide fumarate, FTC / TAF)
Descovy April 4, 2016
emtricitabine, rilpivirine, and tenofovir disoproxil fumarate
(emtricitabine / rilpivirine hydrochloride / tenofovir disoproxil fumarate, emtricitabine / rilpivirine / tenofovir, FTC / RPV / TDF)
Complera August 10, 2011
emtricitabine, rilpivirine, and tenofovir alafenamide
(emtricitabine / rilpivirine / tenofovir AF, emtricitabine / rilpivirine / tenofovir alafenamide fumarate, emtricitabine / rilpivirine hydrochloride / tenofovir AF, emtricitabine / rilpivirine hydrochloride / tenofovir alafenamide, emtricitabine / rilpivirine hydrochloride / tenofovir alafenamide fumarate, FTC / RPV / TAF)
Odefsey March 1, 2016
elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate
(QUAD, EVG / COBI / FTC / TDF)
Stribild August 27, 2012
elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide
(elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide fumarate, EVG / COBI / FTC / TAF)
Genvoya November 5, 2015
efavirenz, lamivudine, and tenofovir disoproxil fumarate
(EFV / 3TC / TDF)
Symfi Lo February 5, 2018
lamivudine,efavirenz, and tenofovir disoproxil fumarate
(EFV / 3TC / TDF)
Symfi March 22, 2018
emtricitabine, efavirenz, and tenofovir disoproxil fumarate
(emtricitabine / efavirenz / tenofovir DF, EFV / FTC / TDF)
Atripla July 12, 2006
lamivudine, doravirine, and tenofovir disoproxil fumarate
(lamivudine /doravirine / TDF, doravirine / lamivudine / tenofovir DF, DOR / 3TC / TDF)
Delstrigo August 30, 2018
dolutegravir and rilpivirine
(dolutegravir sodium / rilpivirine hydrochloride, DTG / RPV)
Juluca November 21, 2017
dolutegravir and lamivudine

(dolutegravir sodium / lamivudine, DTG / 3TC)

Dovato April 8, 2019
darunavir, cobicistat, emtricitabine, and tenofovir alafenamide
(tenofovir alafenamide, darunavir / cobicistat / cobicistat / emtricitabine / tenofovir AF, darunavir ethanolate / emtricitabine / cobicistat / emtricitabine / tenofovir AF, darunavir / cobicistat / emtricitabine / tenofovir alafenamide /darunavir ethanolate / fumarate,  DRV / COBI / FTC / TAF)
Symtuza July 17, 2018
 

 

darunavir and cobicistat
(darunavir ethanolate / cobicistat, DRV / COBI)
Prezcobix January 29, 2015
bictegravir, emtricitabine, and tenofovir alafenamide
(bictegravir sodium / emtricitabine / tenofovir alafenamide fumarate, BIC / FTC / TAF)
Biktarvy February 7, 2018
atazanavir and cobicistat
(atazanavir sulfate / cobicistat, ATV / COBI)
Evotaz January 29, 2015
abacavir, lamivudine, and zidovudine
(abacavir sulfate / lamivudine / zidovudine, ABC / 3TC / ZDV)
Trizivir  

November 14, 2000

abacavir, dolutegravir, and lamivudine
(abacavir sulfate / dolutegravir sodium / lamivudine, ABC / DTG / 3TC)
Triumeq August 22, 2014
abacavir and lamivudine

(abacavir sulfate / lamivudine, ABC / 3TC)

Epzicom August 2, 2004
Protease Inhibitors (PIs)
PIs block HIV protease, an enzyme HIV requires to make copies of itself. ritonavir
(RTV)*However ritonavir is a PI, it is commonly used as a pharmacokinetic enhancer as adviced in the Instructions for the Use of Antiretroviral Agents in Adults and Adolescents with HIV and the  Instructions for the Use of Antiretroviral Agents in Pediatric HIV Infection.
Norvir March 1, 1996
darunavir
(darunavir ethanolate, DRV)
Prezista June 23, 2006
atazanavir
(atazanavir sulfate, ATV)
Reyataz June 20, 2003
fosamprenavir
(fosamprenavir calcium, FOS-APV, FPV)
Lexiva October 20, 2003
saquinavir
(saquinavir mesylate, SQV)
Invirase December 6, 1995
tipranavir
(TPV)
Aptivus June 22, 2005
CCR5 Antagonists
CCR5 antagonists block CCR5 coreceptors on the surface of some immune cells that HIV requires to enter the cells. maraviroc
(MVC)
Selzentry August 6, 2007
Pharmacokinetic Enhancers
Pharmacokinetic enhancers are used in HIV treatment to increase the effectiveness of an HIV medicine included in an HIV regimen. cobicistat
(COBI, c)
Tybost September 24, 2014
Post-Attachment Inhibitors
Post-attachment inhibitors block CD4 receptors on the surface of some immune cells that HIV requires to enter the cells. ibalizumab-uiyk
(Hu5A8, IBA, Ibalizumab, TMB-355, TNX-355)
Trogarzo March 6, 2018
Integrase Inhibitors
Integrase inhibitors block HIV integrase, an enzyme HIV needs to make copies of itself. dolutegravir
(DTG, dolutegravir sodium)
Tivicay August 13, 2013
raltegravir
(raltegravir potassium, RAL)
Isentress October 12, 2007
Isentress HD May 26, 2017
Fusion Inhibitors
Fusion inhibitors block HIV from entering the CD4 cells of the immune system. enfuvirtide
(T-20)
Fuzeon March 13, 2003

 

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

  • From FDA: HIV and AIDS: Medicines to Help You
  • The National Institute of Allergy and Infectious Diseases: Drugs That Fight HIV-1
  • From the National Library of Medicine: Drug information from the DailyMed website”
  • From the Department of Health and Human Services:
    • Instructions for the Use of Antiretroviral Agents in Adults and Adolescents with HIV:
      • Initiation of Antiretroviral Therapy
      • Acute and Recent (Early) HIV Infection
    • Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States: Recommendations for Use of Antiretroviral Drugs During Pregnancy:
      • Overview
      • Pregnant Women Living with HIV Who Are Currently Receiving Antiretroviral Therapy
      • Pregnant Women Living with HIV Who Have Never Received Antiretroviral Drugs (Antiretroviral Naive)
    • From the Department of Health and Human Services: Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV:
      • Adherence to the Continuum of Care
      • Antiretroviral Therapy to Prevent Sexual Transmission of HIV (Treatment as Prevention)
      • Treatment Goals
      • What to Start: Initial Combination Regimens for the Antiretroviral-Naive Patient
    • From the Department of Veterans Affairs: Treatment Decisions for HIV

 

HIV Medications “Did Not” Work As A Coronavirus Treatment In A Clinical Trial

The doctors, medical officials, and researchers scrambling to find treatments for coronavirus-infected might have encountered one hope.  The researchers had expected that antiviral drugs used to treat HIV may also work against the coronavirus, called SARS-CoV-2 (SN: 3/10/20). Both the coronavirus and HIV need an enzyme known as a protease to produce an infectious virus. The drugs inhibit the activity of the protease.

A trial of 199 people assigned randomly to get the medication plus care — such as antibiotics for follow-on bacterial infections, supplemental oxygen, and other methods as required— or regular care alone has discouraged those hopes. The analysis in Wuhan, China, tested HIV drugs, is known as ritonavir and lopinavir on individuals who were ill with pneumonia caused by COVID-19.

Comparing results from 94 people who obtained the drugs with results from 100 patients who received regular care revealed no advantage to the medication, researchers describe in the New England Journal of Medicine on March 18.

The drugs reduced the time it took to see clinical improvement from 16 days in the regular care group to 15 days in the treatment group. But that shorter improvement time happened just for patients who got the medication within 12 days of symptoms appearing. That conclusion may imply that the people in the trial were severely ill already to benefit from the medicine, and treatment earlier in the infection may work better, the researchers indicate. That possibility has not yet been tested.

The HIV drugs did not stop viral replication as estimated by analyzing for RNA, the genetic material of the virus . Researchers do not know whether people who got medicines produced fewer infectious viruses.

Severe diarrhea or other gastrointestinal disorders caused 13 patients to be taken off HIV drugs.

Slightly fewer people taking HIV medicines died than in the standard care group. However, the result is tough to interpret due to the small number of individuals in the trial. Since the standard care group appears to have been sicker from the start of the trial, an editorial also released on March 18 in the New England Journal of Medicine notes.

Other medicines being tested for the COVID-19 include remdesivir, a drug that reduces RNA replication, and the antimalarial drug, chloroquine. Side effects of chloroquine include blurry vision, low blood sugar, heart problems, muscle weakness, and nausea. A less harmful variant of chloroquine called hydroxychloroquine prevented SARS-CoV-2 from easily infecting monkey cells in laboratory tests, researchers report March 18 in Cell Discovery.

President Donald Trump declared March 19 in a White House news conference that the U.S. Food and Drug Administration would make hydroxychloroquine available to treat patients “almost instantaneously.” Because the medication is approved for other uses, physicians may be able to prescribe it for “compassionate use,” which enables doctors to treat people with life-threatening conditions or diseases with medications when no other options are available. Although, the hydroxychloroquine drug has not been shown to work against the coronavirus in trials of individuals.

Currently, many studies and trials are going on world-wide to find a medication to help treat Covid-19 or create a vaccine.

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