Key Points

• The treatment for HIV is called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines (called an HIV treatment regimen) every day.
• ART is recommended for everyone who has HIV. People with HIV should start taking HIV medicines as soon as possible. ART cannot cure HIV, but HIV medicines help people with HIV live longer, healthier lives. ART also reduces the risk of HIV transmission.
• A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners through sex.

What is the treatment for HIV?

The treatment for HIV is called antiretroviral therapy (ART). ART involves taking a combination of HIV medicines (called an HIV treatment regimen) every day.

ART is recommended for everyone who has HIV. ART cannot cure HIV, but HIV medicines help people with HIV live longer, healthier lives. ART also reduces the risk of HIV transmission.

How do HIV medicines work?

HIV attacks and destroys the infection-fighting CD4 cells (CD4 T lymphocyte) of the immune system. Loss of CD4 cells makes it hard for the body to fight off infections and certain HIV-related cancers.

HIV medicines prevent HIV from multiplying (making copies of itself), which reduces the amount of HIV in the body (called the viral load). Having less HIV in the body gives the immune system a chance to recover and produce more CD4 cells. Even though there is still some HIV in the body, the immune system is strong enough to fight off infections and certain HIV-related cancers.

By reducing the amount of HIV in the body, HIV medicines also reduce the risk of HIV transmission. A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners through sex.

When is it time to start taking HIV medicines?

People with HIV should start taking HIV medicines as soon as possible after an HIV diagnosis. It is especially important for people with AIDS-defining conditions or early HIV infection to start HIV medicines right away. (Early HIV infection is the period up to 6 months after infection with HIV.)

Women with HIV who become pregnant and are not already taking HIV medicines should also start taking HIV medicines as soon as possible.

What HIV medicines are included in an HIV treatment regimen?

There are many HIV medicines available for HIV treatment regimens. The HIV medicines are grouped into seven drug classes according to how they fight HIV.

The choice of an HIV treatment regimen depends on a person's individual needs. When choosing an HIV treatment regimen, people with HIV and their health care providers consider many factors, including possible side effects of HIV medicines and potential drug interactions.

What should people know about taking HIV medicines?

Taking HIV medicines keeps people with HIV healthy and prevents HIV transmission. Taking HIV medicines every day and exactly as prescribed (called medication adherence) also reduces the risk of drug resistance.

But sometimes, HIV medicines can cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious. Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV medicines cause fewer side effects than medicines used in the past. As HIV treatment continues to improve, people are less likely to have side effects from their HIV medicines.

HIV medicines can interact with other HIV medicines in an HIV treatment regimen or with other medicines a person is taking. Health care providers carefully consider potential drug interactions before recommending an HIV treatment regimen.

Key Points

• Testing positive for HIV often leaves a person overwhelmed with questions and concerns. It is important to remember that HIV can be treated effectively with HIV medicines. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission.
• The first step after testing positive for HIV is to see a health care provider, even if you do not feel sick. Prompt medical care and treatment with HIV medicines as soon as possible is the best way to stay healthy.
• After testing positive for HIV, a person’s first visit with a health care provider includes a review of the person’s health and medical history, a physical exam, and several lab tests.

What is the next step after testing positive for HIV?

Testing positive for HIV often leaves a person overwhelmed with questions and concerns. It is important to remember that HIV can be treated effectively with HIV medicines. Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission.

The first step after testing positive for HIV is to see a health care provider, even if you do not feel sick. Prompt medical care and treatment with HIV medicines as soon as possible is the best way to stay healthy.

After testing positive for HIV, what can a person expect during their first visit with a health care provider?

After testing positive for HIV, a person’s first visit with a health care provider includes a review of the person’s health and medical history, a physical exam, and several lab tests. The health care provider also explains the benefits of HIV treatment and discusses ways to reduce the risk of passing HIV to others.

The information collected during a person’s initial visit is used to make decisions about HIV treatment.

Which lab tests are used to make decisions about HIV treatment?

A health care provider reviews a person’s lab test results to:

• Determine how far the person’s HIV infection has advanced (called HIV progression)
• Decide which HIV medicines to recommend

The following lab tests are used to make decisions about HIV treatment.

CD4 count

A CD4 count measures the number of CD4 cells in a sample of blood. CD4 cells are infection-fighting cells of the immune system. As HIV advances, a person’s CD4 count drops, which indicates increasing damage to the immune system. Treatment with HIV medicines prevents HIV from destroying CD4 cells.

Viral load

A viral load test measures how much virus is in the blood (HIV viral load). As HIV progresses to acquired immunodeficiency syndrome (AIDS), a person’s viral load increases. HIV medicines prevent HIV from multiplying, which reduces a person’s viral load. A goal of HIV treatment is to keep a person’s viral load so low that the virus cannot be detected by a viral load test. This is known as having an undetectable viral load.

Once HIV treatment is started, the CD4 count and viral load are used to monitor whether the HIV medicines are controlling a person’s HIV.

Drug-resistance testing

Health care providers consider many factors when recommending HIV medicines, including a person’s drug-resistance test results. Drug-resistance testing identifies which, if any, HIV medicines will not be effective against a person’s strain of HIV. The HIVinfo infographic What do my lab results mean? has more information about tests used to monitor HIV infection and treatment.

After testing positive for HIV, how soon do people start taking HIV medicines?

People with HIV should start taking HIV medicines as soon as possible after their HIV is diagnosed. However, before starting treatment, people with HIV must be prepared to take HIV medicines every day for the rest of their lives.

Issues, such as lack of health insurance or an inability to pay for HIV medicines, can make it hard to take HIV medicines consistently. Health care providers can recommend resources to help people deal with any issues before they start taking HIV medicines.

During a person’s first visit with a health care provider, is there time to ask questions?

Yes, an initial visit with a health care provider is a good time to ask questions. The following are some questions that people with newly diagnosed HIV typically ask:

• Because I have HIV, will I eventually get AIDS?
• What can I do to stay healthy and avoid getting other infections?
• How can I prevent passing HIV to others?
• How will HIV treatment affect my lifestyle?
• How should I tell my partner that I have HIV?
• Is there any reason to tell my employer and those I work with that I have HIV?
• Are there support groups for people with HIV?
• Are there resources available to help me pay for my HIV medicines?

Key Points

• Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV. HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission.
• People with HIV should start taking HIV medicines as soon as possible after HIV is diagnosed. For people with HIV who have the following conditions, it is especially important to start taking HIV medicines right away: pregnancy, AIDS-defining conditions, and early HIV infection. (Early HIV infection, also known as acute HIV infection, is the period up to 6 months after infection with HIV.)
• Before starting HIV treatment, people with HIV should discuss the importance of medication adherence—taking HIV medicines every day and exactly as prescribed—with their health care provider.

When is it time to start taking HIV medicines?

Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV. People with HIV should start taking HIV medicines as soon as possible after HIV is diagnosed.

A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test. Maintaining an undetectable viral load helps a person with HIV live a longer, healthier life. People with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners through sex.

To reduce their viral load, it is important for people with HIV to start taking HIV medicines as soon as possible. Starting HIV medicines right away is especially important for people with HIV who have certain conditions.

What conditions make it especially important to start HIV medicines right away?

The following conditions make it especially important to start HIV medicines right away:

• Pregnancy
• Early HIV infection
• AIDS-defining conditions

Pregnancy

All pregnant women with HIV should take HIV medicines to protect their health and prevent perinatal transmission of HIV. Women with HIV who become pregnant and are not already taking HIV medicines should start taking HIV medicines as soon as possible and throughout pregnancy. In most cases, women who are already on an effective HIV treatment regimen when they become pregnant should continue using the same regimen throughout their pregnancies.

The risk of perinatal transmission of HIV during pregnancy and childbirth is lowest when a woman with HIV has an undetectable viral load. Maintaining an undetectable viral load also helps keep the mother-to-be healthy.

Early HIV infection

Early HIV infection, also known as acute HIV infection, is the period up to 6 months after infection with HIV. During early HIV infection, a person’s viral load is often very high.

Studies suggest that even at this early stage of HIV infection, HIV medicines can begin to protect a person’s health. In addition, starting HIV medicines during early HIV infection reduces the risk of HIV transmission.

AIDS-defining conditions

AIDS-defining conditions are certain infections and cancers that are life-threatening in people with HIV. Having an AIDS-defining condition indicates that a person has the immune system of a person with acquired immunodeficiency syndrome (AIDS); starting HIV medicines as soon as possible can improve immune function.

Once a person starts taking HIV medicines, why is medication adherence important?

Medication adherence means sticking to an HIV treatment regimen—taking HIV medicines every day and exactly as prescribed. Medication adherence is key to maintaining an undetectable viral load, which protects the immune system and reduces the risk of HIV transmission.

Before starting HIV treatment, it is important to talk to your health care provider about any issues that can make adherence difficult. For example, a busy schedule or lack of health insurance can make it hard to take HIV medicines consistently. Health care providers can recommend resources to help people deal with any issues that may interfere with adherence.

Treatment with HIV medicines is called antiretroviral therapy (ART). ART is recommended for everyone with HIV, and people with HIV should start ART as soon as possible. People on ART take a combination of HIV medicines (called an HIV treatment regimen) every day. A person's initial HIV treatment regimen generally includes three HIV medicines from at least two different HIV drug classes.

The following table lists HIV medicines recommended for the treatment of HIV infection in the United States, based on the U.S. Department of Health and Human Services (HHS) HIV/AIDS medical practice guidelines. All of these drugs are approved by the U.S. Food and Drug Administration (FDA). The HIV medicines are listed according to drug class and identified by generic and brand names.

FDA-Approved HIV Medicines

Key Points

• The use of HIV medicines to treat HIV infection is called antiretroviral therapy (ART). People on ART take a combination of HIV medicines (called an HIV treatment regimen) every day.
• The U.S. Food and Drug Administration (FDA) has approved more than 30 HIV medicines to treat HIV infection.
• The choice of HIV medicines to include in an HIV treatment regimen depends on a person's individual needs. When choosing an HIV treatment regimen, people with HIV and their health care providers consider many factors, including possible side effects of HIV medicines and potential drug interactions.

What is an HIV treatment regimen?

An HIV treatment regimen is a combination of HIV medicines used to treat HIV infection. HIV treatment (also called antiretroviral therapy or ART) begins with choosing a regimen. People on ART take the HIV medicines in their HIV regimens every day. ART helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission.

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

HIV medicines are grouped into seven drug classes according to how they fight HIV.

What are the HIV drug classes?

The seven HIV drug classes are:

• Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• Nucleoside reverse transcriptase inhibitors (NRTIs)
• Protease inhibitors (PIs)
• Fusion inhibitors
• CCR5 antagonists
• Integrase strand transfer inhibitors (INSTIs)
• Post-attachment inhibitors

The choice of HIV medicines to include in a treatment regimen depends on a person’s individual needs. Click here to see the HIVinfo fact sheet that lists the FDA-approved HIV medicines by drug class.

What factors are considered when choosing an HIV treatment regimen?

When choosing an HIV treatment 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 will not be effective against a person’s HIV.
• Convenience of the treatment regimen. For example, a regimen that includes two or more HIV medicines combined in one pill is convenient to follow.
• Any issues that can make it difficult to follow an HIV treatment regimen. For example, a lack of health insurance or an inability to pay for HIV medicines can make it hard to take HIV medicines consistently every day.

The best HIV treatment regimen for a person depends on their individual needs.

How long does it take for HIV medicines to work?

Viral load is the amount of HIV in a person’s blood. A main goal of HIV treatment is to reduce a person’s viral load to an undetectable level. An undetectable viral load means that the level of HIV in the blood is too low to be detected by a viral load test.

Once HIV treatment is started, it usually takes 3 to 6 months for a person’s viral load to reach an undetectable level. Although HIV medicines cannot cure HIV, having an undetectable viral load shows that the medicines are controlling a person’s HIV. Maintaining an undetectable viral load helps people with HIV live longer, healthier lives. In addition, people with HIV who maintain an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative partners through sex.

What Is Treatment as Prevention?

Treatment as Prevention (TasP) refers to taking HIV medicine to prevent the sexual transmission of HIV. It is one of the most highly effective options for preventing HIV transmission.

People with HIV who take HIV medicine (called antiretroviral therapy or ART) as prescribed and get and keep an undetectable viral load—a very low level of HIV in the blood—can live long and healthy lives and will not transmit HIV to their HIV-negative partners through sex. This is sometimes called undetectable = untransmittable (U=U).

TasP works when a person with HIV takes HIV medicine exactly as prescribed and has regular follow-up care, including routine viral load tests to ensure their viral load stays undetectable.

Taking HIV Medicine to Stay Healthy and Prevent Transmission

HIV treatment involves taking highly effective medicine that reduces the amount of HIV in your body. HIV medicine is recommended for everyone with HIV, and people with HIV should start HIV medicine as soon as possible after diagnosis, even on that same day.

People on HIV treatment take a combination of HIV medicines (called an HIV treatment regimen). A person's initial HIV treatment regimen generally includes three HIV medicines from at least two different HIV drug classes that must be taken every day. Many people with HIV take two or more different HIV medicines combined in one pill. Long-acting injections of HIV medicine, given every two months, are also available if your health care provider determines that you meet certain requirements.

If taken as prescribed, HIV medicine reduces the amount of HIV in your blood (also called your viral load) to a very low level, which keeps your immune system working and prevents illness. This is called viral suppression, defined as 200 copies of HIV per milliliter of blood.

HIV medicine can also make your viral load so low that a standard lab test can’t detect it. This is called having an undetectable viral load. Almost everyone who takes HIV medicine as prescribed can achieve an undetectable viral load, usually within 6 months after starting treatment. Many will bring their viral load to an undetectable level very quickly, but it could take more time for a small portion of people just starting HIV medicine.

There are important health benefits to getting the viral load as low as possible. People with HIV who know their status, take HIV medicine as prescribed, and get and keep an undetectable viral load can live long and healthy lives.

There is also a major prevention benefit. People with HIV who take HIV medicine as prescribed and get and keep an undetectable viral load will not transmit HIV to their HIV-negative partners through sex.

Keep Your Viral Load Undetectable

HIV treatment is not a cure and HIV is still in your body, even when your viral load is undetectable, so you need to keep taking your HIV medicine as prescribed. If you skip doses of your HIV medicine, even now and then, you give HIV the chance to multiply rapidly. This could weaken your immune system, and you could become sick.

If you have stopped taking your HIV medicine or are having trouble taking all the doses as prescribed, talk to your health care provider as soon as possible. Your provider can help you get back on track and discuss the best strategies to prevent transmitting HIV to your sexual partners until your viral load is confirmed to be undetectable again.

How Do We Know Treatment as Prevention Works?

Large research studies with newer HIV medicines have shown that treatment is prevention. Over several years, these studies monitored thousands of male-female and male-male couples in which one partner has HIV and the other does not. No HIV transmissions were observed when the HIV-positive partner was virally suppressed. This means that if you keep your viral load undetectable, you will not transmit HIV to someone you have vaginal, anal, or oral sex with.

In addition to preventing sexual transmission of HIV, studies have shown that there are other prevention benefits of taking HIV medicine to get and keep an undetectable viral load:

• It reduces the risk of HIV transmission to the child during pregnancy, labor, and delivery. If a pregnant person takes HIV medicine daily as prescribed throughout pregnancy, labor, and delivery and gives HIV medicine to the infant for 4-6 weeks after giving birth, the risk of transmitting HIV to the baby can be 1% or less.
• It substantially reduces, but does not eliminate, the risk of transmitting HIV through breastfeeding. The current recommendation in the United States is that mothers with HIV should not breastfeed their infants.
• It may reduce HIV transmission risk for people who inject drugs. Scientists do not have enough data to know whether having a suppressed or undetectable viral load prevents HIV transmission through sharing needles, syringes, or other injection drug equipment (for example, cookers). It very likely reduces risk, but it’s unknown by how much. Even if you are taking HIV medicine and have an undetectable viral load, use new equipment each time you inject and do not share needles and syringes with other people.

Talk with Your Health Care Provider about Getting to Undetectable

Talk with your health care provider about the benefits of HIV treatment and which HIV medicine is right for you. Discuss how frequently you should get your viral load tested to make sure you get and keep an undetectable viral load. If your lab results show that the virus is detectable or if you are having trouble taking every dose of your medicine, you can still protect your HIV-negative partner by using other methods of preventing sexual transmission of HIV such as condoms, safer sex practices, and/or pre-exposure prophylaxis (PrEP) for an HIV-negative partner until your viral load is undetectable again. Talk to your partner about post-exposure prophylaxis (PEP) if you think they may have had a possible exposure to HIV (for example, if the condom breaks during sex and you don’t have an undetectable viral load).

Taking HIV medicine to maintain an undetectable viral load does not protect you or your partner from getting other sexually transmitted infections (STIs), so talk to your provider about ways to prevent other STIs.

Talk to Your Partner

TasP can be used alone or in conjunction with other prevention strategies. Talk about your HIV status with your sexual partners and decide together which prevention methods to use. Some states have laws that require you to tell your sexual partner that you have HIV in certain circumstances.

Key Points

• Treatment adherence includes starting HIV treatment, keeping all medical appointments, and taking HIV medicines every day and exactly as prescribed (also called medication adherence). For people with HIV, treatment adherence is key to staying healthy.
• It is best to see a health care provider as soon as possible after testing positive for HIV. Once in medical care, people with HIV should start taking HIV medicines as soon as possible.
• Because HIV requires lifelong treatment, it is important for people with HIV to regularly visit their health care provider. Ongoing medical care includes monitoring to make sure a person's HIV treatment regimen is keeping the virus under control.

What is HIV treatment adherence?

For people with HIV, treatment adherence means:

• Starting HIV treatment
• Taking HIV medicines every day and exactly as prescribed (also called medication adherence)
• Keeping all medical appointments

Adherence to treatment is a key part of staying healthy with HIV.

How soon should a person start treatment after testing positive for HIV?

It is best to see a health care provider as soon as possible after testing positive for HIV. Once in medical care, people with HIV should start taking HIV medicines as soon as possible. Treatment with HIV medicines (called antiretroviral therapy or ART) is recommended for everyone with HIV. HIV medicines help people with HIV live longer, healthier lives. HIV medicines also reduce the risk of HIV transmission.

Because HIV requires lifelong treatment, it is important for people with HIV to regularly visit their health care provider. Ongoing medical care includes monitoring to make sure a person's HIV treatment regimen is keeping the virus under control. During regular medical appointments, health care providers can also recommend resources to help people deal with any issues that may interfere with medication adherence.

Why is medication adherence important?

Taking HIV medicines every day prevents HIV from multiplying, which reduces the risk that HIV will mutate and produce drug-resistant HIV. Skipping HIV medicines allows HIV to multiply, which increases the risk of drug resistance and HIV treatment failure.

Poor adherence to an HIV treatment regimen also allows HIV to destroy the immune system. A damaged immune system makes it hard for the body to fight off infections and certain cancers.

Key Points

• HIV medicines help people with HIV live longer, healthier lives and reduce the risk of HIV transmission. But HIV medicines can sometimes cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious.
• Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV medicines cause fewer side effects than medicines used in the past. As HIV treatment continues to improve, people are less likely to have side effects from HIV medicines.
• Different HIV medicines can cause different side effects. In addition, people taking the same HIV medicine can have different side effects.
• People starting HIV medicines can talk to their health care provider about possible side effects and ways to manage them.

Can HIV medicines cause side effects?

HIV medicines help people with HIV live longer, healthier lives. HIV medicines also reduce the risk of HIV transmission. But HIV medicines can sometimes cause side effects. Most side effects from HIV medicines are manageable, but a few can be serious.

Overall, the benefits of HIV medicines far outweigh the risk of side effects. In addition, newer HIV medicines cause fewer side effects than medicines used in the past. As HIV treatment continues to improve, people are less likely to have side effects from HIV medicines.

Before starting HIV medicines, people with HIV discuss possible side effects from HIV medicines with their health care providers. They work together to select an HIV treatment regimen based on the person’s individual needs.

Do all HIV medicines cause the same side effects?

Different HIV medicines can cause different side effects. In addition, people taking the same HIV medicine can have different side effects.

Side effects from HIV medicines may last only a few days or weeks. For example, nausea, fatigue, and trouble sleeping are some short-term side effects of HIV medicines.

Other side effects from some HIV medicines can lead to problems that may not appear for months or years after starting a medicine. For example, high cholesterol can be a side effect of some HIV medicines. High cholesterol is a risk factor for heart disease.

Having another medical condition or taking other medicines can increase the risk of side effects from HIV medicines. Drug-drug interactions between HIV medicines or with other medicines a person is taking can also cause side effects.

What are some ways to manage side effects from HIV medicines?

Before starting HIV medicines, talk to your health care provider about possible side effects.

Depending on the HIV medicines in your HIV treatment regimen, your health care provider will:

• Tell you which specific side effects to look out for.
• Give you suggestions on how to deal with side effects that are manageable. For example, to manage nausea and vomiting, eat small meals and avoid spicy foods.
• Tell you about the signs of life-threatening side effects that require immediate medical care. One example is swelling of the mouth and tongue.

Once you start taking HIV medicines, tell your health care provider about any side effect that you are having. Your health care provider can recommend ways to treat or manage the side effect.

In some cases, it may be necessary to change HIV medicines because of a side effect. However, do NOT cut down on, skip, or stop taking your HIV medicines unless your health care provider tells you to. Fortunately, there are many HIV medicines available to include in an HIV treatment regimen. The choice of HIV medicines to replace those causing side effects will depend on a person’s individual needs.

Key Points

• A drug interaction is a reaction between two (or more) drugs or between a drug and a food, beverage, or supplement. Taking a drug while having certain medical conditions can also cause a drug interaction. For example, taking a nasal decongestant if you have high blood pressure may cause an unwanted reaction.
• A drug interaction can affect how a drug works or cause unwanted side effects.
• Treatment with HIV medicines (called antiretroviral therapy or ART) helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission. But drug interactions can complicate HIV treatment.
• Health care providers carefully consider potential drug interactions before recommending an HIV treatment regimen. Before taking HIV medicines, tell your health care provider about all prescription and nonprescription medicines, vitamins, nutritional supplements, and herbal products you are taking or plan to take.

What is a drug interaction?

Medicines help us feel better and stay healthy. But sometimes drug interactions can cause problems. There are three types of drug interactions:

• Drug-drug interaction: A reaction between two (or more) drugs.
• Drug-food interaction: A reaction between a drug and a food or beverage.
• Drug-condition interaction: A reaction that occurs when taking a drug while having a certain medical condition. For example, taking a nasal decongestant if you have high blood pressure may cause an unwanted reaction.

A drug interaction can affect how a drug works or cause unwanted side effects.

Do HIV medicines ever cause drug interactions?

Treatment with HIV medicines (called antiretroviral therapy or ART) helps people with HIV live longer, healthier lives and reduces the risk of HIV transmission. But drug interactions, especially drug-drug interactions, can complicate HIV treatment.

Drug-drug interactions between different HIV medicines and between HIV medicines and other medicines are common. Before recommending an HIV treatment regimen, health care providers carefully consider potential drug-drug interactions between HIV medicines. They also ask about other medicines a person may be taking. For example, some HIV medicines may make hormonal birth control less effective, so women using hormonal contraceptives may need to use an additional or different method of birth control to prevent pregnancy.

Can drug-food interactions and drug-condition interactions affect people taking HIV medicines?

Yes, the use of HIV medicines can lead to both drug-food interactions and drug-condition interactions.

Food can affect the absorption of some HIV medicines and increase or reduce the concentration of the medicine in the blood. Depending on the HIV medicine, the change in concentration may be helpful or harmful. Directions on how to take HIV medicines specify whether to take the medicine with food or on an empty stomach. Some HIV medicines can be taken with or without food, because food does not affect their absorption.

Conditions, such as kidney disease, hepatitis, and pregnancy, can affect how the body processes HIV medicines. The dosing of some HIV medicines may need to be adjusted in people with certain medical conditions.

How can a person avoid drug interactions?

You can take the following steps to avoid drug interactions:

• Tell your health care provider about all prescription and nonprescription medicines you are taking or plan to take. Also tell your health care provider about any vitamins, nutritional supplements, and herbal products you take.
• Tell your health care provider about any other conditions you may have, such as high blood pressure or diabetes.
• Before taking a medicine, ask your health care provider or pharmacist the following questions:
  • What is the medicine used for?
  • How should I take the medicine?
  • While taking the medicine, should I avoid any other medicines or certain foods or beverages?
  • Can I take this medicine safely with the other medicines that I am taking? Are there any possible drug interactions I should know about? What are the signs of those drug interactions?
  • In the case of a drug interaction, what should I do?
• Take medicines according to your health care provider's instructions. Always read the information and directions that come with a medicine. Drug labels and package inserts include important information about possible drug interactions.

Key Points

• Once a person gets HIV, the virus begins to multiply in the body. As HIV multiplies, it sometimes changes form (mutates). Some HIV mutations that develop while a person is taking HIV medicines can lead to drug-resistant HIV.
• Once drug resistance develops, HIV medicines that previously controlled a person’s HIV are no longer effective. In other words, the HIV medicines cannot prevent the drug-resistant HIV from multiplying. Drug resistance can cause HIV treatment to fail.
• Drug-resistant HIV can be transmitted from person to person or develop after a person starts taking HIV medicines.
• Drug-resistance testing identifies which, if any, HIV medicines that will not be effective against a person’s HIV. Drug-resistance testing results help determine which HIV medicines to include in an HIV treatment regimen.
• Taking HIV medicines every day and exactly as prescribed (called medication adherence) reduces the risk of drug resistance.

What is HIV drug resistance?

Once a person gets HIV, the virus begins to multiply in the body. As HIV multiplies, it sometimes changes form (mutates). Some HIV mutations that develop while a person is taking HIV medicines can lead to drug-resistant HIV.

Once drug resistance develops, HIV medicines that previously controlled the person’s HIV are no longer effective. In other words, the HIV medicines cannot prevent the drug-resistant HIV from multiplying. Drug resistance can cause HIV treatment to fail.

Drug-resistant HIV can spread from person to person (called transmitted resistance). People with transmitted resistance have HIV that is resistant to one or more HIV medicines even before they start taking HIV medicines.

What is drug-resistance testing?

Drug-resistance testing identifies which, if any, HIV medicines that will not be effective against a person’s HIV. Drug-resistance testing is done using a sample of blood.

People with HIV should start taking HIV medicines as soon as possible after their HIV is diagnosed. But before a person starts taking HIV medicines, drug-resistance testing is done.

Drug-resistance test results help determine which HIV medicines to include in a person’s first HIV treatment regimen.

Once HIV treatment is started, a viral load test is used to monitor whether the HIV medicines are controlling a person’s HIV. If viral load testing indicates that a person’s HIV treatment regimen is not effective, drug-resistance testing is repeated. The test results can identify whether drug resistance is the problem and, if so, can be used to select a new HIV treatment regimen.

How can a person taking HIV medicines reduce the risk of drug resistance?

Taking HIV medicines every day and exactly as prescribed (called medication adherence) reduces the risk of drug resistance. Skipping HIV medicines allows HIV to multiply, which increases the risk that the virus will mutate and produce drug-resistant HIV.

Before starting HIV treatment, tell your health care provider about any issues that can make medication adherence difficult. For example, a busy schedule or lack of health insurance can make it hard to take HIV medicines consistently. Once you start treatment, use a 7-day pill box or other medication aid to stay on track.

Development of antiretroviral drugs to treat HIV has turned what was once an almost always fatal infection into a manageable chronic condition. Daily antiretroviral therapy can reduce the amount of HIV in the blood to levels that are undetectable with standard tests. Staying on treatment is crucial to keep the virus suppressed. NIAID-supported research has demonstrated that achieving and maintaining a “durably undetectable” viral load (the amount of HIV in the blood) not only preserves the health of the person living with HIV, but also prevents sexual transmission of the virus to an HIV-negative partner.

What is viral suppression?

Antiretroviral therapy keeps HIV from making copies of itself. When a person living with HIV begins an antiretroviral treatment regimen, their viral load drops. For almost everyone who starts taking their HIV medication daily as prescribed, viral load will drop to an undetectable level in six months or less. Continuing to take HIV medications as directed is imperative to stay undetectable.

What does it mean to be durably undetectable?

Taking antiretroviral therapy daily as prescribed to suppress HIV levels leads to an “undetectable” status. A person is considered to have a “durably undetectable” viral load if their viral load remains undetectable for at least six months after their first undetectable test result. It is essential to continue to take every pill every day as directed to maintain an undetectable viral load.

Does being durably undetectable mean that the virus has left my body?

Even when viral load is undetectable, HIV is still present in the body. The virus lies dormant inside a small number of cells in the body called viral reservoirs. When therapy is halted by missing doses, taking a treatment holiday or stopping treatment, the virus emerges and begins to multiply, becoming detectable in the blood again. This newly reproducing virus is infectious. It is essential to take every pill every day as directed to achieve and maintain a durably undetectable status.

How does being durably undetectable affect my risk of transmitting HIV to a sexual partner?

People living with HIV who take antiretroviral medications daily as prescribed and who achieve and then maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.

Three large multinational research studies involving couples in which one partner was living with HIV and the other was not—HPTN 052, PARTNER and Opposites Attract—observed no HIV transmission to the HIV-negative partner while the partner with HIV had a durably undetectable viral load. These studies followed approximately 3,000 male-female and male-male couples over many years while they did not use condoms. Over the course of the PARTNER and Opposites Attract studies, couples reported engaging in more than 74,000 condomless episodes of vaginal or anal intercourse.

After I begin HIV treatment, how long does it take for the risk of sexually transmitting HIV to become effectively zero?

There is effectively no risk of sexual transmission of HIV when the partner living with HIV has achieved an undetectable viral load and then maintained it for at least six months. 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.

What happens if I stop taking antiretroviral therapy?

When therapy is stopped, viral load rebounds, and the risk of transmitting HIV to a sexual partner in the absence of other prevention methods returns. NIAID-supported research has provided clear-cut scientific evidence to support the benefits of staying on continuous antiretroviral treatment. In 2006, NIAID’s large clinical trial called SMART showed that people receiving intermittent antiretroviral treatment had twice the rate of disease progression compared to those receiving continuous treatment.

Taking antiretroviral treatment daily as directed to achieve and maintain durably undetectable status stops HIV infection from progressing, helping people living with HIV stay healthy and live longer, while offering the benefit of preventing sexual transmission. Stopping and re-starting treatment can cause drug resistance to develop, making that treatment regimen ineffective and limiting future treatment options.

How often do I need to be tested to confirm that I’m durably undetectable?

According to U.S. HIV treatment guidelines, viral load typically should be measured every three to four months. People living with HIV should talk with their health care teams to determine an appropriate schedule for viral load testing.

What are viral load “blips”?

Even if a person is durably undetectable and taking antiretroviral therapy daily as prescribed, they may experience small, transient increases in viral load called “blips” followed by a decrease back to undetectable levels. Having a blip is relatively common and does not indicate that antiretroviral therapy has failed to control the virus. Scientists are working to better understand what causes blips.

How do I talk to my partner about their risk of acquiring HIV?

People living with HIV can involve their partners in their treatment plans. Research shows that adhering to treatment often can improve with support from loving relationships and from the community.

Pre-exposure prophylaxis (PrEP), in which an HIV-negative person takes antiretroviral medication to prevent infection, can be part of the conversation.

Do I still need to worry about other sexually transmitted infections?

Neither HIV treatment nor PrEP prevents other sexually transmitted infections, or STIs.

Ways to reduce the risk of STIs include having both partners tested, limiting the number of sexual partners and using condoms. Vaccines are available to prevent some STIs, including hepatitis B and human papillomavirus (HPV).

Many people use complementary and integrative therapies and activities in addition to traditional medical care. With most complementary therapies, your health is looked at from a holistic (or “whole picture”) point of view. Think of your body as working as one big system. From a holistic viewpoint, everything you do, from what you eat to what you drink to how stressed you are, affects your health and well-being.

Do these therapies work?

Healthy people use these kinds of therapies to try to make their immune systems stronger and to make themselves feel better in general. People who have diseases or illnesses, such as HIV, use these therapies for the same reasons. They also can use these therapies to help deal with symptoms of the disease or side effects from the medicines that treat the disease.

If you want to try complementary treatments to help you cope with HIV, please remember these things:

• Always talk to your healthcare health care provider before you start any kind of treatment, even if you think it is safe.
• Just because something is “natural” (an herb, for example) doesn't mean that it is safe to take. Sometimes these products can interact with your HIV medications or cause side effects on their own. St. John's-wort, for example, decreases levels of some HIV medications in your blood.
• The federal government does not require that herbal remedies and dietary supplements be tested in the same way that standard medicines are tested before they are sold. Many of the treatments out there have not been studied as much as the HIV drugs you are taking. It is always a risk to take something or try something that hasn't been fully studied or researched.
• Be careful of treatments that claim to be “miracle cures”— ones that claim to cure HIV/AIDS. There are people out there who may try to trick you into buying an expensive product that doesn't work. Always do your research and ask your VA provider for help.
• Complementary therapies are not substitutes for the treatment and medicines you receive from your healthcare provider. Never stop taking your HIV medications just because you've started a complementary therapy.
• The federal government is funding studies of how well some complementary therapies work to treat disease, so look for news about these studies.