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 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

ClassGeneric NameBrand NameMechanisms of Action
CCR5 antagonistsmaravoric (MVC)SelzentryBlocks CCR5, one of the two major co-receptors used by HIV-1 to attach to host cells
Fusion inhibitorsEnfuvirtide (T-20)FuzeonAn 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)
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)
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)
Prevent cleavage of viral proteins during assembly and maturation – a process essential for the newly formed virus to become infectious
Integrase strand transfer (InST) inhibitorsdolutegravir (DTG)
raltegravir (RAL)
Isentress, Isentress HD
Blocks HIV-1 integrase – prevents viral DNA from integrating with host cell DNA
Post-attachment inhibitorsibalizumab-uiyk (TMB-355)TrogarzoBlocks CD4 receptors on the surface of certain immune cells – preventing entry of HIV into cell
Pharmacokinetic enhancerscobicistat (COBI)TybostInhibit the breakdown of ATV and DRV – enhancing efficacy

Table 5. Available Antiretroviral Combinations.26

Generic NamesBrand Name
ABC / 3TCEpzicom
ABC / DTG / 3TCTriumeq
ABC / 3TC / ZDVTrizivir
ATV / COBIEvotaz
BIC / FTC / TAFBiktarvy
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