Treat 4

Be Healthy, Prevent HIV

What is HIV treatment and how does it work?

Antiretrovirals (ARVs) are prescribed medications that work to reduce the amount of virus in the body (viral load) of an individual with HIV. The vast majority of people who take their ARVs everyday as prescribed and remain in care are able to achieve and maintain an undetectable viral load.1

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.

  1. Lee FJ, Amin J, Carr A. Efficacy of initial antiretroviral therapy for HIV-1 infection in adults: A systematic review and meta-analysis of 114 studies with up to 144 weeks’ follow-up. PLoS ONE. 2014;9(5). doi:10.1371/journal.pone.0097482.

How effective is HIV treatment?

Highly effective. An individual diagnosed with HIV today who takes their antiretroviral (ARV) medication as prescribed can live a normal, healthy lifespan.1 They can also have children without HIV. 2

ARVs work to lower the viral load of an individual with HIV, often to levels that are undetectable by standard lab tests.3 In addition to improving health, getting and keeping a low viral load also prevents the spread of the virus.4 5

  1. The Antiretroviral Therapy Cohort Collaboration. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017; 4: e349–356. DOI: 10.1016/S2352-3018(17)30066-8.
  2. Preventing Mother-to-Child Transmission of HIV. United States Department of Health and Human Services Wfcdceb site. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/50/preventing-mother-to-child-transmission-of-hiv#. Updated May 16, 2017. Accessed September 6, 2017.
  3. Lee FJ, Amin J, Carr A. Efficacy of initial antiretroviral therapy for HIV-1 infection in adults: A systematic review and meta-analysis of 114 studies with up to 144 weeks’ follow-up. PLoS ONE. 2014; 9(5). doi:10.1371/journal.pone.0097482.
  4. Evidence in HIV Treatment and Viral Suppression in Preventing the Sexual Transmission of HIV. Centers for Disease Control and Prevention Technical Fact Sheet. https://www.cdc.gov/hiv/pdf/risk/art/cdc-hiv-art-viral-suppression.pdf. Accessed January 12, 2018.
  5. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. 2016;316(2):171-181. http://jama.jamanetwork.com/article.aspx?articleid=2533066.

When should HIV treatment begin?

U.S. Department of Health & Human Services HIV treatment guidelines recommend that people with HIV begin treatment as soon as possible after diagnosis.1 Research shows that starting treatment early improves health outcomes and prevents transmission.2

  1. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: Initiation of Antiretroviral Therapy. United States Department of Health and Human Services Web site. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/10/initiation-of-antiretroviral-therapy. Updated January 28, 2016. Accessed August 3, 2017.
  2. The INSIGHT Start Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015; 373:795-807. DOI: 10.1056/NEJMoa1506816.

What are the potential side effects of HIV medications?

As with all drugs, 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).1 If symptoms persist, a health care provider can figure out alternate treatment plans.

  1. HIV Medicines and Side Effects. United States Department of Health and Human Services Web site. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/22/63/hiv-medicines-and-side-effects. Updated January 17, 2017. Accessed September 22, 2017.

Can HIV medications be taken during pregnancy?

Antiretrovirals (ARVs) not only keep expectant mothers with HIV healthy, but are also highly effective at preventing mother to child transmission.1 2 If a woman with HIV takes ARVs as prescribed throughout pregnancy, labor and delivery, and treatment is provided to the baby after birth for 4-6 weeks, the risk of transmitting the virus is one percent or less.3

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.

  1. The INSIGHT START Study Group. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015; 373:795-807. DOI: 10.1056/NEJMoa1506816.
  2. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States: General Principles Regarding Use of Antiretroviral Drugs during Pregnancy:Teratogenicity. United States Department of Health and Human Services Web site. https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/170/teratogenicity. Updated October 26, 2016. Accessed August 3, 2016.
  3. Preventing Mother-to-Child Transmission of HIV. United States Department of Health and Human Services Web site. https://aidsinfo.nih.gov/understanding-hiv-aids/fact-sheets/20/50/preventing-mother-to-child-transmission-of-hiv. Updated May 16, 2017. Accessed September 22, 2017.

Can HIV medications be taken while on antidepressants?

Yes, though it is important to work together with a health care provider(s) to choose the most effective and safest possible combinations of medications.1 2 3

People should always tell their health care providers and pharmacists about all of the medications and supplements they are taking in case there are any harmful combinations among them.

  1. Benton T, Blume J, Dubé B. Treatment considerations for psychiatric syndromes associated with HIV infection. HIV Ther. 2010 ;4(2):231-245. http://www.medscape.com/viewarticle/719976.
  2. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. United States Department of Health and Human Services Web site. https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/367/overview. Updated October 17, 2017. Accessed October 24, 2017.
  3. Database of Antiretroviral Drug Interactions:Interactions between Antidepressants and Antiretrovirals. University of California, San Francisco HIV Web site. http://hivinsite.ucsf.edu/insite?page=ar-00-02&post=10&param=4. Accessed August 3, 2017.

Does insurance (including Medicaid and Medicare) cover HIV treatment? 

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.1 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 the 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.2 (See: What options are available to help pay for HIV treatment and care?)

  1. Paying For HIV Care and Treatment. United States Government HIV Web site. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/paying-for-hiv-care-and-treatment. Accessed August 3, 2017.
  2. Paying For HIV Care and Treatment. United States Government HIV Web site. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/paying-for-hiv-care-and-treatment. Accessed August 3, 2017.

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.1 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).2

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].

  1. Paying for HIV Care. HIV.gov Web site. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/paying-for-hiv-care-and-treatment. Updated May 15, 2017. Accessed September 22, 2017.
  2. Part B: AIDS Drug Assistance Program. Health Resources & Services Administration Web site. https://hab.hrsa.gov/about-ryan-white-hivaids-program/part-b-aids-drug-assistance-program. Updated January 2017. Accessed September 22, 2017.

What about people with HIV who do not have insurance?

Many people with HIV qualify for Medicaid.1 In most cases, if an individual enrolls in Medicaid, they will not be charged a premium or have to meet a deductible before Medicaid pays for health care expenses. Co-payments also are limited.

Another option is to purchase coverage through the marketplaces offered by the Affordable Care Act. Financial help, in the form of tax credits and other subsidies is available to make coverage affordable for people with lower incomes.2

To find out whether an individual may be eligible for Medicaid or how much they would have to pay for health coverage in the marketplace, go to Greater Than AIDS Health Coverage, HIV & You.

  1. Insurance Coverage Changes for People with HIV Under the ACA. Kaiser Family Foundation Web site. http://www.kff.org/health-reform/issue-brief/insurance-coverage-changes-for-people-with-hiv-under-the-aca/. Published February 14, 2017. Accessed September 22, 2017.
  2. Paying for HIV Care and Treatment. HIV.gov Web site. https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/paying-for-hiv-care-and-treatment. Updated May 15, 2017. Accessed September 22, 2017.