DentalCare Logo

HIV: Infection Control/Exposure Control Issues for Oral Healthcare Personnel

Course Number: 97

Antiretroviral Therapy

To reduce the risk of disease progression and to prevent the transmission of the virus to others, antiretroviral therapy (ART) is recommended for all patients with HIV infection. The Food and Drug Administration has approved 10 mechanistic classes of drugs to manage HIV infection and numerous combination formulations (Tables 4 and 5).14,26 Recommended regimens are those with durable virologic efficacy, favorable tolerability and toxicity profiles, and ease of use (combination formulations).

Table 4. Drugs for Antiretroviral Therapy (ART).14

ClassGeneric NameBrand NameMechanisms of Action
Nucleoside reverse transcriptase inhibitors (NRTIs)
abacavir (ABC)
emtricitabine (FTC)
lamivudine (3TC)
tenofovir (TDF)
zidovudine (AZT, ZDV)
Ziagen
Emtriva
Epivir
Viread
Retrovir
Mimic deoxyribonucleoside triphosphate, the natural substrate for reverse transcriptase – they become incorporated into the growing DNA chain, terminate elongation and decrease or prevent HIV replication
Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
doravirine (DOR)
efavirenz (EFV)
etravirine (ETR)
nevirapine (NVP)
rilpivirine (RPV)
Pifeltro
Sustiva
Intelence
Viramune
Edurant
Bind near the catalytic site of reverse transcriptase and inhibit a crucial step in the transcription of the RNA genome into double-stranded retroviral DNA
Protease inhibitors (PIs)
atazanavir (ATV)
darunavir (DRV)
fosamprenavir (FPV)
ritonavir (RTV)
saquinavir (SQV)
tipranavir (TPV)
Reyataz
Prezista
Lexiva
Norvir
Invirase
Aptivus
Prevent cleavage of viral proteins during assembly and maturation – a process essential for the newly formed virus to become infectious
Fusion inhibitors
Enfuvirtide (T-20)
Fuzeon
An anti-HIV peptide structurally similar to a segment of the HIV protein (gp 41) – blocks membrane fusion
CCR5 antagonists
maravoric (MVC)
Selzentry
Blocks CCR5, one of the two major co-receptors used by HIV-1 to attach to host cells
Integrase strand transfer inhibitors (INSTI)
cabotegravir (CAB)
dolutegravir (DTG)
raltegravir (RAL)
Vocabria
Tivicay
Tivicay PD
Isentress
Isentress HD
Blocks HIV-1 integrase – prevents viral DNA from integrating with host cell DNA
Attachment inhibitors
Fostemsavir (FTR)
Rukobia
Bind to the gp120 protein on the outer surface of HIV, preventing HIV from entering CD4 cells
Post-attachment inhibitors
ibalizumab-uiyk
(TMB-355)
Trogarzo
Blocks CD4 receptors on the surface of certain immune cells – preventing entry of HIV into cell
Capsid inhibitors
Lencapavir
Sunlenca
Interferes with the HIV capsid, a protein shell that protects HIV's genetic material and enzymes needed for replication
Pharmacokinetic enhancers
cobicistat (COBI)
Tybost
Inhibit the breakdown of ATV and DRV – enhancing efficacy

Table 5. Available Antiretroviral Combinations.14

Generic NamesBrand Name
ABC / 3TCEpzicom
ABC / DTG / 3TCTriumeq, Triumeg PD
ABC / 3TC / ZDVTrizivir
ATV / COBIEvotaz
BIC / FTC / TAFBiktarvy
CAB / RPVCabenuva
DRV / COBIPrezcobix
DRV / COBI / FTC / TAFSymtuza
DTG / 3TCDovato
DTG / RPVJuluca
DOR / 3TC / TDFDelstrigo
EFV / FTC / TDFAtripla
EFV / 3TC / TDFSymfi Lo
EVG / COBI / FTC / TAFGenvoya
EVG / COBI / FTC / TDFStribild
FTC / RPV / TAFOdefsey
FTC / RPV / TDFComplera
FTC / TAFDescovy
FTC / TDFTruvada
3TC / TDFCimduo
3TC / ZDVCombivir
LPV / RTVKaletra