HIV Treatment

Antiretrovirals (ARVs) are prescribed medications that work to reduce the amount of virus in the body (viral load) of an individual with HIV, which keeps the immune system working and prevents illness. In addition to improving health, getting and keeping a low viral load also prevents the spread of the virus to others.

There are many different ARVs available today that are highly effective at treating HIV, including some that are combined into a single pill. A health care provider can advise on the best treatment regimen.

CDC, HIV Basics, Living with HIV, Treatment. August 2019.
CDC, HIV Risk and Prevention, Treatment as Prevention. July 2019.

HIV treatment is highly effective. A person diagnosed with HIV today who is on ongoing antiretroviral (ARV) medication and in medical care can live a normal, healthy lifespan and have children without HIV.

ARVs work to lower the amount of virus in the body (viral load), often to levels that are undetectable by standard lab tests. The vast majority of people who take their ARVs every day as prescribed and remain in care are able to achieve and maintain an undetectable viral load. In addition to improving health, getting and keeping a low viral load also prevents the spread of the virus to others.

To get the full health and preventive benefits of ARVs, it is important that an individual with HIV stays connected to medical care and continues to take their medications as prescribed, even if they don’t feel sick.

See: What does it mean to be HIV undetectable?

CDC, HIV Risk and Prevention, Treatment as Prevention. July 2019.

Clinical guidelines recommend that antiretroviral (ARV) treatment for HIV begin as soon as possible after diagnosis. Given the strong health and preventative benefits, ARVs are recommended for all people living with HIV, regardless of how long they have had the virus or how healthy they are.

See: How effective is HIV treatment?

NIH, Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: Initiation of Antiretroviral Therapy. October 2017.
CDC, HIV Basics, Living with HIV. August 2019.

Treatment as prevention refers to the use of antiretrovirals (ARVs), the prescription medications used to treat HIV, to prevent transmission through sex, needle sharing, or perinatally (mother to child).

In addition to offering preventative benefits, ARVs when taken as prescribed, importantly, prevent illness and improve the health of individuals with HIV.

See: What does it mean to be HIV undetectable?

CDC, HIV Risk and Prevention, Treatment as Prevention. July 2019.

When a person living with HIV is undetectable it means the amount of virus in their blood (viral load), is so low that standard lab tests do not detect it. This is also referred to as being virally suppressed. The U.S. Centers for Disease Control & Prevention (CDC) considers someone with HIV to be virally suppressed when their viral load is fewer than 200 copies of virus per milliliter of blood.

Being HIV undetectable does not mean you are cured of HIV. Your HIV test will still be positive. But, having a low viral load improves health and prevents the spread of the virus to others. According to the CDC, there is effectively no risk of transmission to sexual partners when the viral load is undetectable, or virally suppressed.

Taking antiretrovirals (ARVs), the prescription medications used to treat HIV, is the best way to keep your viral load low. Most who take their medications every day are able to achieve and maintain viral suppression. Ongoing viral load testing by a health care provider is critical to making sure you remain virally suppressed.

If you are having difficulty keeping up with your treatment, or are experiencing issues with your current medication, talk with your health provider. They can work with you to help get you back on track, including trying different ARVs if needed.

Click here to read more from the CDC about treatment as prevention.

See: How often should an HIV viral load be checked?

When antiretrovirals (ARVs) are taken as prescribed most people with HIV will become HIV undetectable, also referred to as virally suppressed, within six months. For some it may take longer.

Once you become undetectable, it’s important that you continue to take your ARVs every day, even if you don’t feel unwell, to keep the virus suppressed. Ongoing viral load testing by a health care provider is also required to make sure your medication is working and your virus remains suppressed. Most who take their ARVs as prescribed are able to achieve and maintain viral suppression.

If you are having difficulty keeping up with your treatment, or are experiencing issues with your current medication, talk with your health provider. They can work with you to help get you back on track, including trying different ARVs if needed.

See: How often should an HIV viral load be checked?

CDC, HIV Risk and Prevention, Treatment as Prevention. July 2019.

HIV viral load refers to the amount of virus in a blood sample of a person diagnosed with HIV. A person’s viral load is checked by a lab test ordered by a health care provider. Regular viral load testing is used to determine how well HIV treatment is working.

Having a low viral load both keeps you healthy and prevents transmission of the virus to others. Taking antiretroviral (ARV) medication is the best way for an individual living with HIV to keep their viral load low. When ARVs are taken every day as prescribed most people will be able to lower their viral load so low that it is considered undetectable. This is also referred to as being virally suppressed.

See: How does someone become HIV undetectable (or virally suppressed)? 

CDC, HIV Risk and Prevention, Treatment as Prevention, July 2019.

Missing doses of antiretrovirals (ARVs) can cause the amount of virus in the body of an individual with HIV to rise. If an individual stops taking their ARVs their viral load can increase very quickly (e.g. within a few days) and return to the same level it was before starting treatment. This may result in the virus becoming resistant to a particular HIV treatment, possibly making that treatment not work as well, including reducing the preventative benefits.

If you are having difficulty keeping up with your treatment, or are experiencing issues with your current medication, talk with your health care provider as soon as possible. They can work with you to help get you back on track, including trying different ARVs if needed.

See: How often should an HIV viral load be checked?

CDC, HIV Risk and Prevention, Treatment as Prevention. July 2019.

Clinical guidelines recommend that individuals with HIV receive viral load testing when they start care and treatment and continue, typically, every three to four months.

Once an individual is virally suppressed for more than two years straight and tests show their immune system is doing well, health care providers may switch to ordering viral load tests only every six months.

Regular viral load testing is the only way to know that an individual with HIV has achieved and is maintaining an undetectable viral load. Just because someone was virally suppressed in the past does not guarantee they are still virally suppressed.

See: How does someone become HIV undetectable (or virally suppressed)?

NIH, Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: Initiation of Antiretroviral Therapy. October 2017.
CDC, HIV Risk and Prevention, Treatment as Prevention. July 2019.

No. The test used to check an HIV viral load is a lab test ordered by health care providers to measure the amount of virus in a blood sample of a person known to have HIV. It is used to determine how well HIV treatment is working. This is a different test from the one used to initially diagnose someone with HIV.

The test used to diagnose HIV looks for antibodies produced by the body to fight the virus. There are a number of different types of HIV diagnostic tests, including blood draws, finger sticks and oral swabs. An HIV test will continue to be positive even for individuals with a low or undetectable HIV viral load.

See: What does it mean to be HIV undetectable?

CDC, HIV Guidelines, Testing. March 2018.

As with all drugs, antiretrovirals (ARVs), the medications used to treat HIV, may cause side effects.

For many people, the side effects are manageable, and often go away after the first month. Among the more common side effects reported by some people at the start of treatment are fatigue (feeling tired), nausea (upset stomach), vomiting, diarrhea, headache, fever, muscle pain, dizziness, and insomnia (trouble sleeping). If symptoms persist, a health care provider can figure out alternate treatment plans.

NIH, HIV Medicines & Side Effects. August 2018.

Taking HIV treatment every day as prescribed both prevents illness and the spread of the virus to others.

Missing doses of antiretrovirals (ARVs) can cause the amount of virus in the body to rise. This may result in the virus becoming resistant to a particular HIV treatment, possibly making that treatment not work as well, including reducing the preventative benefits.

If you are having difficulty taking or keeping up with your treatment, talk with your health care provider as soon as possible and consider using additional strategies to prevent sexual HIV transmission. Your provider can work with you to help get you back on track, including trying different ARVs if needed.

CDC, HIV Risk and Prevention, Treatment as Prevention. July 2019.

Antiretrovirals (ARVs) not only keep expectant mothers with HIV healthy, but are also extremely effective at preventing HIV from mother to child.

If a woman with HIV takes ARVs as prescribed throughout pregnancy, labor and delivery, and treatment is provided to the baby after birth, usually for 4-6 weeks, the risk of passing the virus is one percent or less.

Women with HIV who are pregnant or planning on becoming pregnant should talk with a health care provider to determine the best health care options for them and their baby.

CDC, HIV Among Pregnant Women, Infants, and Children. June 2019.

Most health insurance—including Medicaid, Medicare, and private insurance—covers HIV medication and care. However, depending on the plan, individuals with HIV may be responsible for paying certain out-of-pocket expenses, including co-pays, coinsurance, and deductibles.

Plans (especially private plans) may also have different formularies, which means that not all plans will cover all HIV drugs available on the market. Check the details of your health plan to see what is covered.

If your health plan does not cover all your HIV care needs, or if the out-of-pocket expenses are unaffordable, certain government or private programs may be able to help.

See: What options are available to help pay for HIV treatment and care?

The Ryan White HIV/AIDS Program and its AIDS Drug Assistance Program (ADAP) may be available to provide additional assistance to people living with HIV. ADAPs can help with the cost of medications for those without insurance coverage and with some costs associated with coverage for those with insurance. ADAPs operate in every state and US territory and can assist those with low to moderate incomes (actual eligibility varies from state to state).

There are also Patient Assistance Programs (PAPs) that offer free HIV medication to people who do not qualify for assistance programs such as Medicaid, Medicare, or ADAP.

Click here to access the PAP common application [PDF].

For more about health insurance options for people with HIV, go to Greater Than AIDS Health Coverage, HIV & You.