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
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)
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) inhibitors dolutegravir (DTG)
raltegravir (RAL)
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