The Advancements in HIV Treatment
By Alexandra Fuhs
The first case of HIV was reported in the U.S. in 1981. The prognosis for those infected was grim and patients faced a lot of stigma for their condition — most doctors wouldn’t even touch infected patients. Today, the mortality rate is 4.7%. It’s now considered a manageable health condition, and while there currently isn’t a cure, advancements in treatment and clinical care are allowing HIV-positive people to live longer, fuller lives.
HIV stands for human immunodeficiency virus and attacks the cells that help the body fight infections, putting an individual at risk of severe infections and certain cancers. It’s considered a retrovirus, meaning it uses RNA as its genetic material. Because it’s a virus, the main treatment method is to use antiretroviral medications, which reduce the amount of virus in the body to nearly undetectable levels.
The first drug that was approved to treat HIV is known as Zidovudine, a nucleotide reverse transcriptase inhibitor (NRTI). NRTIs prevent HIV-containing cells from replicating by interrupting the reconstruction of the virus’s DNA chain. The initial use of NRTIs saw decreased rates of HIV transmission, allowing patients to manage the condition though still with a low quality of life.
Currently, the life expectancy for those with HIV is increasing and is nearing those who do not have the condition. There are about 40 medication options for those infected, allowing doctors to take the approach of “testing and treating” patients to find out which treatment works the best.
The most common approach to treating HIV in today’s world is combination pills. These contain multiple HIV-fighting drugs within one pill. There are currently 12 combination pills containing three or more antiretroviral drugs. The first one to be developed was Atripla, which was approved in 2006 but is used less often now due to side effects like rashes and kidney issues. Drugs like Biktarvy and Genvoya are recommended now because of their efficacy and minimal side effects.
However, because many of these treatments are relatively new, the long-term effects are unknown as well as drug-drug interactions. This is a concern for patients diagnosed young who will need medication for the remainder of their lifetime. Another challenge is the global access to treatment — as of June 2020, 75% of HIV-positive people had access to antiretroviral therapy.
There are many promising advancements in the world of HIV drugs. One possible future medication is nanosuspensions of antiretrovirals, which would be taken every 4-8 weeks. This could improve adherence by reducing the number of pills people need to take. Shots are also gaining traction as treatment. Leronlimab is a weekly injection for those resistant to HIV treatment and has seen success in clinical trials. As for prevention, scientists are currently working on an HIV vaccine.
Healthline. “The Evolution of HIV Treatments”. HIV-AIDS, 1 March 2021.
NIH. “Long acting slow effective release antiretroviral therapy.”, 6 February 2017.
TheBodyPro. “The Evolution of Antiretroviral Therapy: Past, Present, and Future”. HIV Treatment Strategies, 18 April 2018.
aidsmap. “Life expectancy for people living with HIV”. Treatment outcomes & life expectancy, November 2021.