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 8 mechanistic classes of drugs to manage HIV infection and numerous combination formulations (Tables 4 and 5).25,26 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).25,26
| Class | Generic Name | Brand Name | Mechanisms of Action |
|---|
| CCR5 antagonists | maravoric (MVC) | Selzentry | Blocks CCR5, one of the two major co-receptors used by HIV-1 to attach to host cells |
| Fusion inhibitors | Enfuvirtide (T-20) | Fuzeon | An anti-HIV peptide structurally similar to a segment of the HIV protein (gp‑41) – blocks membrane fusion |
| 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 |
| Integrase strand transfer (InST) inhibitors | dolutegravir (DTG)
raltegravir (RAL) | Tivicay
Isentress, Isentress HD | Blocks HIV-1 integrase – prevents viral DNA from integrating with host cell DNA |
| Post-attachment inhibitors | ibalizumab-uiyk (TMB-355) | Trogarzo | Blocks CD4 receptors on the surface of certain immune cells – preventing entry of HIV into cell |
| Pharmacokinetic enhancers | cobicistat (COBI) | Tybost | Inhibit the breakdown of ATV and DRV – enhancing efficacy |
Table 5. Available Antiretroviral Combinations.26
| Generic Names | Brand Name |
|---|
| ABC / 3TC | Epzicom |
| ABC / DTG / 3TC | Triumeq |
| ABC / 3TC / ZDV | Trizivir |
| ATV / COBI | Evotaz |
| BIC / FTC / TAF | Biktarvy |
| DRV / COBI | Prezcobix |
| DRV / COBI / FTC / TAF | Symtuza |
| DTG / 3TC | Dovato |
| DTG / RPV | Juluca |
| DOR / 3TC / TDF | Delstrigo |
| EFV / FTC / TDF | Atripla |
| EFV / 3TC / TDF | Symfi Lo |
| EVG / COBI / FTC / TAF | Genvoya |
| EVG / COBI / FTC / TDF | Stribild |
| FTC / RPV / TAF | Odefsey |
| FTC / RPV / TDF | Complera |
| FTC / TAF | Descovy |
| FTC / TDF | Truvada |
| 3TC / TDF | Cimduo |
| 3TC / ZDV | Combivir |
| LPV / RTV | Kaletra |
