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HIV Treatment and Prevention

Human immunodeficiency virus (HIV)

For medical students2 min readUpdated 2026-10-10

Modern management of HIV infection relies on lifelong antiretroviral therapy (ART), aiming to maximally suppress viral replication. Although a complete cure is not yet possible, well-chosen drug regimens can convert the disease into a chronic condition and significantly prolong the patient's life.

Primary GoalSuppression of viral RNA below the limit of detection
Therapy BasisCombination of multiple drug classes
VaccinationAn effective vaccine is currently unavailable
ComplicationsRequires monitoring and management of opportunistic infections

Antiretroviral Therapy Strategy

To effectively suppress the virus, combination therapy—also known as cART (combination antiretroviral therapy)—is exclusively used. Using multiple drugs simultaneously is a critical condition for success.

Clinical practice has shown that monotherapy (treatment with a single drug) is largely ineffective. HIV has a high mutation rate, and when only a single medication is used, the pathogen quickly develops resistance. A combination approach attacks the virus from multiple angles, preventing the development of drug resistance. The primary clinical benchmark and criterion for successful therapy is reducing plasma viral RNA concentration below the limit of standard assay detection.

Classification of HIV Medications

All drugs used to suppress viral replication are divided into five main classes based on their mechanism of action. Medical students must know the representative drugs for each group:

  1. Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTIs). A classic example from this group is zidovudine (azidothymidine).
  2. Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). A typical representative is nevirapine.
  3. Protease Inhibitors (PIs). A characteristic example for this group is indinavir.
  4. Integrase Strand Transfer Inhibitors (INSTIs). An example is raltegravir.
  5. Entry (Fusion) Inhibitors. This group is further subdivided into two subgroups based on their specific targets:
  6. CCR5 co-receptor antagonists (example — maraviroc).
  7. gp41 fusion inhibitors (example — enfuvirtide).

Supportive Treatment and Prevention

In addition to suppressing the virus itself, a vital part of patient management is treating conditions arising from immunodeficiency. The key focus here is the treatment and targeted prevention of opportunistic infections, which pose the greatest threat to the patient's life.

Regarding the prevention of HIV transmission itself, it is generally divided into two areas:

Frequently asked questions

Which drugs belong to the nucleoside reverse transcriptase inhibitors?

Nucleoside and nucleotide reverse transcriptase inhibitors are drugs that act as false analogs of natural nucleosides. This group includes:

  • Zidovudine (azidovudine) — thymidine analog.
  • Stavudine — thymidine analog.
  • Phosphazide — nucleotide thymidine analog.
  • Lamivudine — cytidine analog.
  • Emtricitabine — cytidine analog.
  • Zalcitabine — cytidine analog.
  • Didanosine — adenine analog.
  • Tenofovir — nucleotide adenine analog.
  • Abacavir — guanine analog.

Fixed-dose NRTI combinations are also used, such as zidovudine + lamivudine or abacavir + lamivudine.

Which drugs belong to HIV protease inhibitors?

HIV protease inhibitors are peptidomimetic compounds that inactivate the viral aspartyl protease. This group includes the following drugs:

  • Indinavir — protease inhibitor.
  • Saquinavir — the first drug in the protease inhibitor class.
  • Atazanavir — protease inhibitor.
  • Darunavir — protease inhibitor.
  • Lopinavir — protease inhibitor.
  • Ritonavir — protease inhibitor.
  • Fosamprenavir — protease inhibitor.

In clinical practice, boosted combinations are frequently used, such as lopinavir/ritonavir, darunavir/ritonavir, or atazanavir/ritonavir.

Which opportunistic infections are characteristic of the AIDS stage?

The AIDS stage is characterized by the development of severe opportunistic infections of protozoal, fungal, bacterial, and viral origin. The main ones include:

  • Protozoal and parasitic — cerebral toxoplasmosis, cryptosporidiosis, strongyloidiasis (Strongyloides stercoralis), leishmaniasis.
  • Fungal — Pneumocystis jirovecii pneumonia, candidiasis (Candida species), cryptococcosis (Cryptococcus neoformans), aspergillosis, histoplasmosis.
  • Bacterial — tuberculosis (the leading cause of death), bacterial pneumonias (most commonly Streptococcus pneumoniae), bacillary angiomatosis, syphilis.
  • Viral — cytomegalovirus (CMV) infection.
Which drugs belong to non-nucleoside reverse transcriptase inhibitors?

Non-nucleoside reverse transcriptase inhibitors are drugs that suppress viral replication by binding to the reverse transcriptase enzyme. This group includes:

  • Nevirapine — non-nucleoside reverse transcriptase inhibitor.
  • Efavirenz — non-nucleoside reverse transcriptase inhibitor.
  • Etravirine — non-nucleoside reverse transcriptase inhibitor.
  • Rilpivirine — non-nucleoside reverse transcriptase inhibitor.

Some of these drugs, such as rilpivirine, may be used as part of fixed-dose combination antiviral regimens.

Which drugs belong to HIV integrase inhibitors?

HIV integrase inhibitors are drugs that prevent the integration of viral DNA into the host cell's genetic material. This group includes:

  • Raltegravir (Isentress) — blocks the catalytic center of the integrase enzyme.
  • Dolutegravir — exhibits a very high degree of CNS penetration.
  • Elvitegravir — used as part of fixed-dose combination regimens.
  • Bictegravir — also used in fixed-dose combinations.
What are the first-line antiretroviral therapy regimens?

First-line antiretroviral therapy regimens consist of starting combinations of three antiretroviral drugs:

  • Backbone — two nucleoside or nucleotide reverse transcriptase inhibitors (2 NRTIs).
  • Third drug — one agent from another class of choice.

Possible starting regimen formulas:

  • 2 NRTIs + 1 Protease Inhibitor (PI);
  • 2 NRTIs + 1 Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI);
  • 2 NRTIs + 1 Integrase Strand Transfer Inhibitor (INSTI).

Monotherapy, dual therapy, or three-NRTI regimens are not recommended.

Why is monotherapy not used in HIV infection?

Monotherapy is ineffective due to the high mutation rate of the virus. Using only one drug quickly leads to the development of HIV resistance to treatment.

Can HIV be completely cured with modern therapy?

No, current therapy does not provide a complete cure. However, it effectively suppresses viral load and significantly prolongs the patient's life.

Is there an HIV vaccine?

No, specific prophylaxis in the form of an effective vaccine has not yet been developed, and all previous attempts to create one have been unsuccessful.

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