What is the role of antiretroviral therapy (ART) for HIV infection?

Updated: Jul 01, 2019
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Effective antiretroviral therapy is the most important intervention in terms of improving longevity and preventing opportunistic infections in patients with human immunodeficiency virus (HIV) infection. Therapy should involve combinations of drugs recommended by current guidelines. Recommendations are specific for various patient groups (eg, treatment naïve, treatment experienced, coinfection with hepatitis C). [5] Antiretroviral drug classes and agents within each class are listed in Table 1, below (see individual medication tables for more detail).

Many of the antiretroviral drugs that have been approved for HIV-infected adults and adolescents are gaining FDA approval for use in younger children. For more information, see Pediatric HIV Infection.

Of the antiretroviral drugs that have been approved, several are no longer being manufactured either because of the development of improved formulations (ie, amprenavir replaced by fosamprenavir) or because of limited use (ie, delavirdine and zalcitabine [ddC]).

Several combination products that contain tenofovir alafenamide (TAF) are now approved in the United States. TAF is a more targeted form of tenofovir that has demonstrated high antiviral efficacy at a dose that is 10 times lower than that of tenofovir DF, as well as an improved renal and bone safety profile.

Table 1. Antiretroviral Drug Classes and Agents (Open Table in a new window)

Nucleoside reverse transcriptase inhibitors (NRTIs)

Abacavir (Ziagen, ABC)

Didanosine (Videx, Videx EC, ddI)

Emtricitabine (Emtriva, FTC)

Lamivudine (Epivir, 3TC)

Stavudine (Zerit, Zerit XR, d4T)

Tenofovir DF (Viread, TDF)

Tenofovir AF (TAF)

Zalcitabine (Hivid, ddC)*

Zidovudine (Retrovir, ZDV, AZT)

Protease inhibitors (PIs)

Amprenavir (Agenerase, AVP)*

Atazanavir (Reyataz , ATV)

Darunavir (Prezista, DRV)

Fosamprenavir (Lexiva, f-APV)

Indinavir (Crixivan, IDV)

Lopinavir and ritonavir (Kaletra, LPV/r)

Nelfinavir (Viracept, NFV)

Ritonavir (Norvir, RTV)

Saquinavir (Invirase [hard gel] capsule, SQV)

Tipranavir (Aptivus, TPV)

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

Delavirdine (Rescriptor, DLV)

Efavirenz (Sustiva, EFV)

Etravirine (Intelence, ETR)

Nevirapine (Viramune, NVP)

Rilpivirine (Edurant)

Doravirine (Pifeltro, DOR)

Fusion inhibitors

Enfuvirtide (Fuzeon, T-20)

Cellular chemokine receptor (CCR5) antagonists

Maraviroc (Selzentry, MVC)

Integrase inhibitors

Raltegravir (Isentress, RAL)

Dolutegravir (Tivicay, DTG)

Elvitegravir (Vitekta, EVG)

Entry inhibitors (post-attachment inhibitors) Ibalizumab

*No longer available on market


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