What are the treatment options for patients with Human Immunodeficiency Virus (HIV)?

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Last updated: April 3, 2025 • View editorial policy

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From the Guidelines

Treatment for patients with HIV involves antiretroviral therapy (ART), which should be started immediately after diagnosis regardless of CD4 count, as recommended by the 2018 International Antiviral Society-USA panel 1. The standard first-line regimen typically includes two nucleoside reverse transcriptase inhibitors (NRTIs) such as tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), combined with an integrase strand transfer inhibitor (INSTI) like bictegravir, dolutegravir, or raltegravir. Some key points to consider when treating patients with HIV include:

  • Starting ART as soon as possible after diagnosis, regardless of CD4 count 1
  • Using a combination of two NRTIs and an INSTI as the standard first-line regimen 1
  • Monitoring viral load, CD4 count, kidney and liver function, and screening for comorbidities regularly 1
  • Adherence to treatment is crucial to prevent viral resistance and achieve undetectable viral load (<50 copies/mL) 1
  • Patients should also receive prophylaxis for opportunistic infections if CD4 counts are low, particularly Pneumocystis pneumonia prophylaxis with trimethoprim-sulfamethoxazole when CD4 count is below 200 cells/mm³. It's worth noting that older studies, such as those from 1998 1, may not reflect the current standard of care for HIV treatment, and therefore should not be used to guide treatment decisions. The most effective treatment regimen is one that is individualized to the patient's specific needs and circumstances, and is based on the most recent and highest quality evidence available 1.

From the FDA Drug Label

Maraviroc is indicated in combination with other antiretroviral agents for the treatment of only CCR5‑tropic human immunodeficiency virus type 1 (HIV‑1) infection in adult and pediatric patients 2 years of age and older weighing at least 10 kg. Tenofovir disoproxil fumarate is indicated in combination with other antiretroviral agents for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and pediatric patients 2 years of age and older weighing at least 10 kg. Darunavir, co-administered with ritonavir (darunavir/ritonavir), in combination with other antiretroviral agents, is indicated for the treatment of human immunodeficiency virus (HIV-1) infection in adult and pediatric patients 3 years of age and older

The treatment for patients with HIV includes:

  • Maraviroc in combination with other antiretroviral agents for CCR5-tropic HIV-1 infection 2
  • Tenofovir disoproxil fumarate in combination with other antiretroviral agents for HIV-1 infection 3
  • Darunavir co-administered with ritonavir, in combination with other antiretroviral agents, for HIV-1 infection 4 Key considerations:
  • Maraviroc is only recommended for patients with CCR5-tropic HIV-1 infection
  • Tenofovir disoproxil fumarate and darunavir can be used in combination with other antiretroviral agents for HIV-1 infection
  • Patient selection and treatment regimens should be individualized based on viral tropism, resistance patterns, and other factors.

From the Research

Treatment Options for HIV Patients

  • The primary goal of antiretroviral therapy for HIV infection is suppression of viral replication, which can be achieved by initiating combination therapy with two or more antiretroviral agents 5.
  • Recommended starting antiretroviral therapy regimens include ictegravir plus tenofovir alafenamide (TAF)/emtricitabine (FTC), dolutegravir (DTG) plus abacavir/lamivudine, DTG plus TAF (or TDF)/FTC, or DTG plus 3TC 6.
  • Emtricitabine is an orally administered nucleoside reverse transcriptase inhibitor (NRTI) that is indicated in combination with other antiretroviral agents in the treatment of HIV infection in adults 7.

Initiation of Antiretroviral Therapy

  • Antiretroviral therapy should be started as soon as possible after HIV diagnosis, regardless of the baseline viral load 6.
  • Current recommendations suggest that antiretroviral therapy be considered in any patient with a viral load higher than 5,000 to 20,000 copies per mL, regardless of the CD4+ count 5.

Selection of Antiretroviral Regimens

  • The selection of the combination regimen must take into account the patient's prior history of antiretroviral use, the side effects of these agents, and drug-drug interactions that occur among these agents and with other drugs as well 5.
  • Initial laboratory evaluation includes CD4+ cell count, plasma HIV-1 RNA, and testing for HIV reverse transcriptase and protease resistance mutations 6.

Outcomes of Antiretroviral Therapy

  • Patients with continuously undetectable viral load on antiretroviral therapy pose virtually no risk of transmitting infection through sexual contact 6.
  • Antiretroviral therapy regimens do not need to be altered for virologic blips due to release of virus from chronically latently infected cells in patients otherwise exhibiting viral suppression 6.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

5
Research

Combination antiretroviral therapy for HIV infection.

American family physician, 1998

6
Research

HIV 101: fundamentals of antiretroviral therapy.

Topics in antiviral medicine, 2019

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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