What are antiretroviral medicines?

Antiretrovirals are a type of medicine used to treat people infected with HIV (human immunodeficiency virus). Antiretroviral medicines are also called ‘ART’, which is short for antiretroviral therapy.

HIV damages your immune system by attacking the blood cells that help fight infection. If HIV is not treated, acquired immunodeficiency syndrome (AIDS) develops.

With antiretroviral treatment, HIV is now a chronic (long-term) condition. Antiretroviral medicines support people with HIV to live long and healthy lives.

A quick diagnosis and starting treatment early are important. You will need to take antiretrovirals for life.

While there is currently no cure for HIV, antiretroviral treatment today is simple and has fewer side effects.

How do antiretrovirals work?

Antiretrovirals work by stopping HIV replicating in your body. This allows your immune system to repair itself and stops further damage caused by HIV.

Antiretrovirals will help you:

• improve your health
• live a longer life
• have less chance of getting other serious illnesses
• lower your chance of passing on HIV through sex

Antiretroviral treatment can lower the amount of virus in your body to such low levels that it’s undetectable. This means that you cannot transmit HIV to other people. But remember that you can still catch other sexually transmitted infections (STIs) if you have unprotected sex.

ART also helps stop HIV being passed to your baby during pregnancy.

What types of antiretrovirals might I be prescribed?

There are 6 antiretroviral medicines available for use in Australia. These are:

1. nucleoside and nucleotide reverse transcriptase inhibitors (NRTIs)
2. non-nucleoside reverse transcriptase inhibitors (NNRTIs)
3. protease inhibitors (PIs)
4. integrase strand transfer inhibitors (INSTIs)
5. entry inhibitors: fusion inhibitors
6. attachment inhibitors: CCR5 inhibitors

Each medicine stops the virus replicating in a different way.

Antiretroviral therapy uses a combination of medicines to reduce your chance of becoming resistant to treatment. This is known as combination therapy.

Your doctor will choose the medicines best suited to your situation.

What are the side effects or risks of antiretrovirals?

Modern combination ART is taken as a single tablet that is generally well tolerated. This is important because sticking to your treatment is crucial.

Side effects from antiretroviral medicines may include:

• headache
• nausea
• diarrhoea
• weight gain

More severe side effects are:

• hypersensitivity reactions
• kidney or liver damage
• rhabdomyolysis (breakdown of muscle tissue)
• hyperlipidaemia (increased blood lipids)
• mental health issues

You may have an increased chance of side effects if you have other illnesses, such as reduced kidney function.

People who have side effects usually only have them for a few weeks after starting treatment. If you have side effects, especially if they last more than a few weeks, speak with your doctor. They can help you manage these side effects.

Interactions with other medicines

Many of the medicines used to treat HIV can interact with other medicines prescribed by your doctor or bought over-the-counter.

These include some:

• inhalers and nasal sprays
• herbal remedies — like St John's wort
• illicit drugs

Always check with your HIV doctor or pharmacist before taking any other medicines.

When will I be treated with antiretrovirals?

Since 2015, antiretroviral therapy in Australia has been recommended for all patients diagnosed with HIV. Anyone found to be living with HIV should start treatment as soon as possible.

After a diagnosis of HIV, your doctor will refer you for blood tests. These tests include measuring your viral load (the level of HIV in your blood) and CD4 T-cell count. CD4 is the type of immune cell that is affected by HIV.

These tests will help to work out if you need treatment. The blood tests can also be done to work out if:

• your treatment is working
• you need to change your treatment

Will I develop resistance to medication?

Resistance means your medicine won’t work on you as well as it should. Your doctor will consider the chance of antiretroviral drug resistance before starting you on antiretroviral medicines.

If antiretroviral medicines are used individually, resistance rapidly develops. Your doctor can help lower your chance of resistance to HIV medicines by prescribing a combination of medicines instead of just one.

If you skip doses of your HIV medicines regularly, you might also develop resistance. You can help lower your chances of developing resistance by taking each dose on time. If you do develop resistance, your doctor may change your medicines.

When you are newly infected with HIV, you may be infected with a drug-resistant strain. This is called ‘transmitted resistance’. You may be tested for this before starting treatment.

When should I see my doctors?

If you’re taking antiretroviral medicines for an HIV infection, you should see your doctor often. It’s normal to see your doctor about 2 to 4 weeks after starting treatment. You will then see them every 3 to 4 months if everything is going well.

Your doctor will measure the amount of HIV virus in your blood (viral load). This tells them how well your treatment is working.

HIV is undetectable when it can no longer be measured in your blood. Most people taking daily HIV treatment reach an undetectable viral load within 6 months of starting treatment.

After 2 years, the time between reviews with your doctor may be increased to 6 months if everything is going well.

Are there any alternatives to this medicine?

Taking ART is the best way to control HIV and stay healthy.

You may also need to see an experienced counsellor or psychologist.

Are antiretrovirals used at other times against HIV?

Antiretrovirals can also be taken to lower your chance of getting HIV.

PrEP (pre-exposure prophylaxis) is taken by people who don’t have HIV to prevent infection. You must be HIV negative before you take the first dose.

PEP (post-exposure prophylaxis) is a month-long course of antiretrovirals. You can take PEP if you might have been exposed to HIV. PEP reduces your chance of infection. To be effective, PEP must be started within 72 hours of exposure.

Resources and support

You can find out more about antiviral treatments for HIV at:

• the GET PEP website — for more information on PEP
• Ending HIV — for information on testing and treatment for HIV

If you are living with HIV you may want to get in touch with the organisations below:

• Health Equity Matters is the peak national organisation for Australia’s community HIV response.
• The National Association of People with HIV Australia (NAPWHA) offers advocacy and support for people living with HIV.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.