Antiretrovirale

Antiretrovirals are medicines used to treat HIV infection. They inhibit viral replication and, when taken in combination as antiretroviral therapy (ART), can suppress HIV RNA to undetectable levels, preserve or restore immune function, and reduce the risk of transmission. ARVs can also be used for prevention, including pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

ART regimens usually include at least two nucleotide reverse transcriptase inhibitors (NRTIs) plus a third drug from another class. Modern first-line regimens typically rely on an integrase strand transfer inhibitor (INSTI) with two NRTIs. Effective ART requires high adherence; incomplete dosing can lead to virologic failure and resistance.

Major drug classes include NRTIs (for example, tenofovir and emtricitabine), NNRTIs (such as efavirenz and rilpivirine), protease inhibitors (often boosted, e.g., darunavir or atazanavir), INSTIs (such as dolutegravir, bictegravir, or raltegravir), and entry inhibitors (maraviroc) or fusion inhibitors (enfuvirtide). New agents are continually evaluated, and not all are available in every country. Side effects vary by drug and regimen.

Side effects depend on the specific drugs and can include gastrointestinal symptoms, sleep disturbance, metabolic changes, liver or kidney effects, and drug interactions. Monitoring typically includes regular measurement of viral load and CD4 counts, organ function tests, and resistance testing if treatment fails. ART is generally lifelong; stopping treatment risks rebound viremia and the development of resistance. Pregnancy and co-infections require specific considerations.

Public healthly, widespread ART reduces HIV-related illness and death and, when viral load is suppressed, virtually eliminates sexual transmission (U=U). Access to treatment and adherence support are critical components of HIV control.