There are many available antiretroviral medications in the United States today. Many of these can be prescribed in combination form making the total number of different "pills" available closer to 30. Many medications have two or three names and may be referred to by the generic name, trade name or a three letter abbreviation (for example, AZT is also known by its generic name, zidovudine, and by its trade name, Retrovir). Currently available antiretroviral drugs include:
Nucleoside reverse transcriptase inhibitors (NRTIs), such as zidovudine (Retrovir, AZT), didanosine (Videx, ddI), stavudine (Zerit, d4T), abacavir (Ziagen, ABC), emtricitabine (Emtriva, FTC) and lamivudine (Epivir, 3TC) block HIV reproduction at the virus' "reverse transcriptase." Tenofovir (Viread) is a commonly prescribed drug in a related family (nucleotide reverse transcriptase inhibitors). There are many NRTI combination pills including lamivudine and zidovudine (called Combivir) and emtricitabine and tenofovir (called Truvada).
Non-nucleoside reverse transcriptase inhibitors (NNRTIs), such as nevirapine (Viramune) and efavirenz (Sustiva) act on the same HIV reverse transcriptase that the NRTIs block, but at a different location.
Protease inhibitors (PIs), such as atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), , , and Tipranavir (Aptivus) block the assembly of new HIV virus particles (they inhibit the virus' "protease"). The PIs are often "boosted" with ritonavir to increase their potency. Lopinavir and ritonavir are combined into one pill (Kaletra) for this purpose.
Cell entrance blockers. A fusion inhibitor called enfuvirtide (Fuzeon) and a CCR5 co-receptor antagonist called maraviroc (Selzentry) are currently the only medications available that block HIV from getting inside the cell in the first place. These medications block the virus at the cell surface. Enfuvirtide is only available in injectable form.
Integrase inhibitor. Raltegravir (Isentress) is the only medication available today that blocks the "integration" of the virus' genetic material with the cell's genetic material. This blocks HIV from reproducing inside the cell.
Numerous combinations can be made depending on patient and doctor preference. Because many of these drugs have side effects, such as nausea and diarrhea, the exact medications prescribed for a particular person may depend on side effects (which will be different from person to person).
A commonly recommend initial therapy is a combination of the NNRTI efavirenz (Sustiva) and two NRTIs. A potential choice for people who are likely to miss doses of medication is a combination pill called Atripla. It contains efavirenz, emtricitabine and tenofovir. Atripla is taken as one pill, once per day.
It is very important to tell your doctor about ALL other medications you take (including herbals and non-prescription medications) because there can be serious drug-drug interactions with commonly used medications. Also, no one should take an antiretroviral medication that was not specifically prescribed for them by a health care provider.
In addition to antiretrovirals, people with low CD4 counts should take drugs to prevent the development of opportunistic infections. For example, people with CD4 cell counts below 200 cells per milliliter of blood should take trimethoprim-sulfamethoxazole (known as Bactrim or Septra) to protect themselves against Pneumocystis pneumonia.