HIV Antiretroviral Drugs: How They Work and Support Health

“HIV Antiretroviral Drugs” or Antiretroviral Therapy (ART) is a treatment method that plays a role in controlling and managing the HIV virus in the body. This method helps people living with HIV to live long, healthy lives and have a quality of life nearly equivalent to that of normal people. Today, treatment with antiretroviral drugs has made many notable advances. People diagnosed with HIV can start treatment earlier and have a better chance of effectively controlling the disease. However, using antiretroviral drugs is not simply about taking pills every day but is also related to important factors such as the timing of starting treatment, treatment adherence, possible side effects, and the benefits of reducing Viral Load to an undetectable level. This helps significantly reduce the risk of transmitting the virus to others.

This article will help you understand HIV antiretroviral drugs from various perspectives, aiming to help you care for your own or a loved one's health more effectively and confidently.

What are HIV antiretroviral drugs and why are they important?

HIV antiretroviral drugs, or Antiretroviral Therapy (ART), are the main treatment for people infected with the HIV virus — a virus that attacks the immune system, especially CD4 white blood cells, which play an important role in fighting infections.

Antiretroviral drug treatment cannot completely eliminate HIV from the body. However, it can control the virus at a very low level, even reaching a level of “undetectable” (Undetectable). This has significant meaning: not only does it help prevent disease complications but also helps people living with HIV not transmit the virus to others — a concept known as U=U (Undetectable = Untransmittable).

Starting treatment immediately after an HIV diagnosis plays an important role in protecting the immune system and reducing the risk of death from HIV-related diseases such as tuberculosis, certain types of cancer, or other opportunistic infections.

Mechanism of action of HIV antiretroviral drugs

HIV antiretroviral drugs are responsible for preventing the virus from replicating in the body. Each group of drugs will intervene in different stages of the HIV replication cycle.

For example, the NRTIs group works by mimicking natural nucleotides, thereby hindering the virus's DNA creation process. This prevents HIV from completing the replication of its genetic material.

Meanwhile, the INSTIs group prevents the virus from integrating its genetic material into the DNA of immune cells.

Using combination therapy with multiple drugs helps increase the effectiveness of virus control and reduce the risk of drug resistance — a major challenge in long-term treatment.

When patients adhere well to treatment, the amount of virus in the body will decrease to a very low level, even undetectable, helping improve long-term health.

Current types of HIV antiretroviral drugs

HIV antiretroviral drugs are divided into several groups based on their mechanism of action. In treatment, doctors often use combination regimens of multiple drugs to increase the effectiveness of virus control and reduce the risk of drug resistance. The main drug groups include:

• NRTIs (Nucleoside/Nucleotide Reverse Transcriptase Inhibitors)
• NNRTIs (Non-Nucleoside Reverse Transcriptase Inhibitors)
• PIs (Protease Inhibitors)
• INSTIs (Integrase Strand Transfer Inhibitors)
• Entry and Fusion Inhibitors

In many healthcare systems today, regimens containing Tenofovir, Lamivudine, or Dolutegravir are commonly used due to their high efficacy and few side effects.

Side effects of HIV antiretroviral drugs

Although HIV antiretroviral drugs are highly effective in controlling the virus and extending the lifespan of patients, some side effects may still occur, depending on the regimen and the body's response of each individual.

Common symptoms include:

• Nausea
• Vomiting
• Diarrhea
• Headache
• Insomnia
• Lively dreams

These symptoms often appear in the early stages of treatment and tend to decrease as the body adapts to the medication. In some cases, doctors may adjust or change the regimen to better suit the patient.

Regular health monitoring and blood tests as directed by the doctor are essential to ensure the treatment process is safe and effective.

Common misconceptions about HIV antiretroviral drugs

Although medicine has made many advances in treating HIV, there are still many misconceptions in society, such as:

• Believing that antiretroviral drugs will weaken the body
• Thinking that treatment should only be started when symptoms are present

These notions are not in line with current scientific evidence and can be harmful to the health of people living with HIV.

Raising community awareness and reducing stigma around HIV is an important factor that helps many people confidently access treatment earlier.

The importance of taking medication regularly

HIV treatment is most effective when patients take their medication on time and consistently every day. If medication intake is interrupted, the virus may adapt and lead to drug resistance (drug resistance). At that point, the current treatment regimen may no longer be effective, forcing patients to switch to more complex regimens with more side effects or higher costs.

How to start treatment with HIV antiretroviral drugs

The treatment process usually includes the following steps:

• Blood tests to confirm HIV infection
• Consulting with a doctor to assess health status
• Testing for CD4 and Viral Load
• Starting treatment according to the prescribed regimen
• Regular follow-ups every 3–6 months

How are HIV antiretroviral drugs related to CD4?

CD4 is an important type of white blood cell in the immune system that helps the body fight disease-causing agents. HIV attacks and destroys these cells, weakening the immune system.

When using ART, the virus's replication process is inhibited, helping reduce the amount of virus in the body and preventing CD4 destruction. As a result, CD4 counts can recover over time and the immune system gradually improves.

The earlier treatment is started, the higher the chance of CD4 recovery.

HIV antiretroviral drugs and Viral Load

Viral Load is an indicator measuring the amount of HIV virus in the blood and is an important measure of treatment effectiveness.

When patients take their medication regularly, Viral Load will decrease over time. After a period, the virus level can decrease to below the detection threshold of the test (usually <50 copies/ml).

Maintaining an Undetectable status not only helps people living with HIV to be healthier but also prevents transmission of the virus to others through sexual contact.

HIV antiretroviral drugs help reduce new infections

When many people living with HIV achieve an undetectable Viral Load, the risk of transmission in the community will significantly decrease. This contributes to reducing the number of new infections and helps the healthcare system use resources more effectively.

HIV antiretroviral drugs are not only a treatment method but also an important tool to improve quality of life and prevent HIV transmission. Taking medication regularly, continuously, and under the supervision of healthcare professionals will help people living with HIV to live long, healthy lives and integrate into society like others.

References

• Thai Ministry of Public Health, Department of Disease Control. (2023). Guidelines for the care and treatment of people living with HIV in Thailand 2023. https://ddc.moph.go.th/uploads/ckeditor2/2023/04/files/hiv-guidelines-2023.pdf
• World Health Organization (WHO). (2022). Comprehensive guidelines on HIV prevention, testing, treatment, and monitoring services. https://www.who.int/publications/i/item/9789240051280
• Centers for Disease Control and Prevention (CDC), United States. (2023). HIV treatment: Basic things to know. https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html