Why HIV Medications Are Simpler and More Effective Than Ever

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HIV, or human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV/AIDS was first discovered in the early 1900s, but it was only in the late 1970s and 80s that it began to rapidly spread across the world. There was no HIV treatment until 1987, when the U.S. Food and Drug Administration (FDA) approved the anti-retroviral drug azidothymidine, or AZT. AZT was not an HIV cure, but it slowed down the virus’s ability to multiply, keeping the immune system strong and reducing the chances of developing AIDS. The good news is, now there are multiple medications available for those diagnosed with HIV. Because of these treatment advancements, a diagnosis of HIV is no longer a death sentence.

Treatment in the 80s, 90s, and Early 2000s

AZT was brought to market very quickly once researchers discovered it could reduce the amount of HIV in the body, called the viral load. The speed to develop and make the drug available was essential to save lives, but doctors didn’t know how much to give or how often, so patients were given high doses frequently–up to every four hours throughout the day and night. As more drugs were discovered, patients took them along with AZT, sometimes taking up to 20 pills a day. Side effects were not uncommon and some of them were quite severe.

The frequency of dosing and the sheer number of pills to be taken made following a treatment plan hard for some people with HIV, and they sometimes stopped taking their medications. It’s rare to notice HIV symptoms day to day, which is one reason many people don’t start taking medication or stop altogether. Unlike diseases like diabetes or high blood pressure, where you can see the effects of not taking your medications, the immediate effects of HIV are not so obvious. The consequences of skipping medication become apparent only when blood tests show a climbing viral load, or if your immune system has weakened so much that AIDS-related symptoms start. Unfortunately, once this occurs, HIV treatment is no longer effective. The lack of obvious symptoms can also make it easier for people to forget to take medications or to believe they may not need to take all of them. People who are newly diagnosed with HIV may find it difficult to imagine why they have to take so many medications, particularly if the drugs cause uncomfortable or serious side effects.

Another serious issue related to early treatments for HIV was drug resistance. The virus was able to mutate and change when exposed to the same drug over a long period, which made AZT and other newer drugs no longer effective. However, in the 1990s, researchers discovered that people with HIV who took a combination of drugs, rather than just one type, had consistently lower viral loads, as it was harder for the virus to change and become resistant to multiple therapies. After this discovery, we entered the era of combination therapy for HIV and things changed dramatically. Drug resistance is still a risk for people who stop and restart their medications, but today, treatments are easier to take and tolerate, so many people with HIV are able to commit to a daily treatment regimen.

Advances in HIV Treatment

Since researchers discovered they could effectively manage HIV infection with different combinations of drugs, HIV has become a chronic disease, with many people living long, full lives, especially if treatment is started as early as possible. Pills that combine several drugs into one capsule have reduced the number of pills per day, and the recommended doses have changed so the drugs don’t have to be taken as frequently. The severity and frequency of side effects also dropped with the new medications, because not only are doses lower, but also doctors have more options to offer their patients. If one medication causes uncomfortable side effects, there is now often another one in the same class that may work just as well, but without the side effects. Effective treatment of HIV infection can prevent the development of AIDS. Newer treatments for HIV also allow people to keep their viral loads low enough that the risk of transmitting HIV to others is significantly reduced, although some risk remains so precautions must still be taken to prevent spreading the virus.

There are currently more than 40 types of HIV medications in six different classes of drugs, so your doctor has many options available for your treatment that were not available in the 1970s and 1980s. Your doctor can prescribe several combinations of drugs in different doses until you find a regimen that keeps your viral load low without intolerable side effects.

The different classes of drugs affect the virus in different ways. Some drugs keep the virus from making copies of itself. Drugs in this category include nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors and integrase inhibitors. These medications block certain enzymes the virus needs to replicate itself. If the virus can’t copy itself, it can’t multiply; it stays in your body, but can’t spread.

Other drugs, called fusion inhibitors and CCR5 antagonists, block the virus from entering cells where they need to be in order to multiply. And medications called pharmacokinetic enhancers are taken with other HIV medications to increase their effectiveness.

The most effective HIV treatments usually consist of at least three drugs from at least two drug classes. By combining some of the more common drugs into single tablets, researchers have made taking treatment easier in recent years.

Adherence to HIV treatment is vital. Taking your medication regularly as prescribed is your best chance at preventing drug resistance and keeping the virus from multiplying, which would weaken your immune system and eventually lead to AIDS.

Generics Lower Cost

Now that HIV medications have been on the market for a while—some for up to three decades—many are available in generic form. Generic drugs can be significantly less expensive than brand name drugs. When medications were only available through certain manufacturers, some people with HIV found the drug costs were more than they could manage. The lower cost for generics may help ease the financial burden associated with having a chronic illness like HIV. However, it is important to keep in mind that generic drugs are not always available for all situations. However, if cost is a factor, ask your doctor if there are generic alternatives to your prescribed medications. Many drug companies also offer discount programs to help patients afford their prescriptions.

Treatment for HIV has come a long way since the virus began rapidly spreading across the world. Before 2000, people who were diagnosed with HIV often felt helpless and hopeless because they expected to develop full-blown AIDS. But the development of newer and better medications to treat HIV has given hope back to people diagnosed with the virus. The medications can keep the viral loads so low they’re almost undectable, allowing your body’s immune system to remain strong so you can live a full and long life.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 12
  1. FDA-Approved HIV Medicines. AIDSinfo. U.S. Department of
    Health and Human Services. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/19/58/fda-approved-hiv-medicines/
  2. History of HIV and AIDS Overview. Avert. https://www.avert.org/professionals/history-hiv-aids/overview
  3. Starting Antiretrovital Treatment for HIV. Avert. https://www.avert.org/living-with-hiv/starting-treatment
  4. HIV in Canada: A primer for service providers. CATIE. http://www.catie.ca/en/hiv-canada/6/6-1
  5. Antiretroviral
    Drug Discovery and Development. National Institute of Allergy and Infectious
    Diseases, part of the National Institutes of Health. https://www.niaid.nih.gov/diseases-conditions/antiretroviral-drug-development
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