Hesperian Health Guides
Medicines for HIV and AIDS
No medicines can cure HIV yet. But people who have HIV can live much longer, healthier lives by taking antiretroviral therapy (ART), a combination of several medicines that must be taken every day. ART medicines also help prevent the spread of HIV to others, including a baby during pregnancy and birth. Check with your local health authority about what ART medicines are available and how to use them.
See more information about HIV infection and how it spreads. Also see another medicine, cotrimoxazole, that prevents many infections in people with HIV. Women in areas where there is a lot of tuberculosis should talk to a health worker about taking isoniazid to prevent TB.
Where can people get ART? ART medicines are available from HIV or AIDS treatment programs, from clinics and hospitals, and from programs for prevention of mother-to-child (or parent-to-child) transmission, called PMTCT or PPTCT programs. In many places, the medicines are free. Anyone taking ART should have regular health care visits.
When should someone start ART? The best time to start ART is as soon as you know you are HIV positive. But some places ask for a CD4 test, a blood test that measures the strength of the immune system. Then start ART when the CD4 count is less than 350 (a healthy CD4 count is 500 to 1500). When CD4 tests are not available, ART may be started based on other illnesses a woman has. Women with HIV and tuberculosis should start ART 2 to 8 weeks after beginning tuberculosis treatment, no matter what their CD4 count is. Women with HIV and hepatitis B should also start ART as soon as possible.
All pregnant women with HIV should take ART, for their own health and to protect the baby from HIV. For best protection of a baby during pregnancy and birth, the mother should start taking ART as soon as she knows she has HIV.
Someone who takes ART must take it every day, without fail. If a person stops taking ART, their HIV will start making them ill again. Taking ART some days and not others lets HIV become resistant to the medicines, which means that those medicines will no longer work as well to treat their HIV. Midwives, as well as people who manage ART programs, can work to ensure there is a steady supply of ART for people with HIV.
Talking to another person using ART can help people find ways to deal with side effects of the medicines. Help identify who in the family or household can encourage and support them in taking ART. Keeping HIV a secret can make it difficult to take medicines at the right time.
What medicines are in ART? Usually 3 or 4 medicines make up an ART combination. Sometimes 2 or 3 medicines are combined in 1 pill. In some places, people are tested to see what medicines will be best for them. Where this testing is not available, a few combinations that work well for most people are used. We show some common combinations here. These same medicines can be used during pregnancy, birth, and breastfeeding to protect the baby from HIV.
Contents
How to take ART
- Take your medicines every day, at the same time each day.
- If medicines need to be taken 2 times a day, leave 12 hours between the 2 doses. For example, if you take the morning dose at 6:00, then the second dose should be taken at 6:00 in the evening. Having too little medicine in your body can cause drug resistance.
- If you forget to take a dose on time, take it as soon as you can. But if it is almost time for the next dose, do not take a double dose
- Do not stop taking any ART medicine without seeing a health worker to find out if your medicines should be stopped separately or all at the same time.
Side effects of ART
ART is helping many people with HIV live longer, healthier lives. But like many other medicines, ART can have side effects. People often find that as they get used to the medicines, side effects lessen and may go away completely. Common side effects for ART are diarrhea, tiredness, headaches, and stomach problems such as nausea, vomiting, stomach pain, or not feeling like eating. Even if you feel bad, keep taking all your medicines until your health worker tells you to change or stop.
Some serious side effects may mean that one of the medicines needs to be changed. Serious side effects include tingling or burning feelings in the hands and feet, fever, rashes, yellow eyes, tiredness along with shortness of breath, anemia and other blood problems, and liver problems. If you have serious side effects, see a health worker right away.
Preventing HIV soon after someone has been exposed
Midwives or others are sometimes exposed to HIV while doing health work. For example, someone might stick herself with a needle that was used on someone with HIV. Many women are also exposed to HIV through rape. If you think you have been exposed to HIV (see how HIV is spread), it is possible to prevent getting HIV by taking ART medicines for 4 weeks. This is called postexposure prophylaxis or PEP. Talk with a health worker you trust as soon as possible about whether you should take PEP.
PEP works best if you start taking medicines within a few hours, and no later than 3 days, after exposure. Start one of the ART combinations in the box âART Combinations for people 11 years old and olderâ below, preferably Combination 1 or 2. Other medicines may be available and recommended in your area. Whichever combination you use, the medicines must be taken for 28 days.
| ART Combinations for people 11 years old and older |  |
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| Combination 1 | ||||||
| Medicines | Dose | Warnings and side effects |
Advantages of combination | |||
| tenofovir (TDF) | 300 mg once a day | Can cause kidney problems For use by women over 18 years old |
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| lamivudine (3TC) or emtricitabine (FTC) | 300 mg once a day, or 200 mg once a day |
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| dolutegravir (DTG) | 50 mg once a day | Sleep problems, mood changes, dizziness | ||||
| Combination 2 | ||||||
| Medicines | Dose | Warnings and side effects |
Advantages of combination | |||
| tenofovir (TDF) | 300 mg once a day | Can cause kidney problems For use by women over 18 years old |
| |||
| lamivudine (3TC) or emtricitabine (FTC) | 300 mg once a day or 200 mg once a day |
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| lopinavir/ritonavir (LPV/r) | 1 tablet of 400 mg lopinavir/100 mg ritonavir 2 times a day | Liver problems | ||||
| Combination 3 | ||||||
| Medicines | Dose | Warnings and side effects |
Advantages of combination | |||
| zidovudine (AZT) | 250 to 300 mg 2 times a day | Anemia Low white blood count |
| |||
| lamivudine (3TC) | 150 mg 2 times a day or 300 mg once a day |
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| nevirapine (NVP) | 200 mg once a day for 14 days, then 200 mg 2 times a day | Skin rash Liver problems | ||||
| Combination 4 | ||||||
| Medicines | Dose | Warnings and side effects |
Advantages of combination | |||
| zidovudine (AZT) | 250 to 300 mg 2 times a day | Anemia Low white blood count |
| |||
| lamivudine (3TC) |
150 mg 2 times a day, or 300 mg once a day |
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| efavirenz (EFV) |
400 mg once a day | Dizziness, confusion, mood changes | ||||
WARNING! Stavudine (d4T) is sometimes used instead of zidovudine in Combinations 3 and 4. But long-term use causes serious side effects. Try not to use it.
Preventing HIV before and during exposure
Someone who does not have HIV may be regularly exposed to it from a partner with HIV. To protect against HIV infection, take 2 ART medicines every day as pre-exposure prophylaxis (PrEP).
To prevent HIV infection in people at high risk of HIV exposure
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by mouth, 1 time each day |
| AND | |
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by mouth, 1 time each day |
| OR | |
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by mouth, 1 time each day |
| AND | |
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by mouth, 1 time each day |
Preventing HIV in babies
A woman who is already on ART when she becomes pregnant should continue taking it. When her baby is born, he will also need to be given medicine for a few weeks. See below.
Medicines are only one part of preventing HIV in a baby. Safer sex during pregnancy, safe birth practices, careful feeding of the baby, and treatment of illnesses in both mother and child are also important to prevent babies from getting HIV.
The mother being on ART helps protect her baby from HIV, but the baby needs ART too.
Give the baby only nevirapine for 6 weeks if:
- the mother started taking ART before pregnancy or very early in the pregnancy.
Give the baby both nevirapine and zidovudine for 6 weeks if:
- the mother started taking ART less than 1 month before the birth.
- the mother thinks she was infected with HIV during pregnancy or breastfeeding.
- the mother has a lot of HIV in her blood (a viral load over 1000) or feels very sick.
If the mother is breastfeeding, continue giving the baby either nevirapine or zidovudine for an additional 6 weeks.
If the mother stops taking ART while breastfeeding, begin giving the baby nevirapine again. You can stop giving the baby nevirapine 6 weeks after the mother restarts ART, or a week after she stops breastfeeding.
dolutegravir (DTG)
Dolutegravir is used in combination with other medicines to treat HIV and to protect people from becoming infected with HIV after exposure (post-exposure prophylaxis, PEP).
- Often comes in:
- Tablets: 50 mg
- How to use:
- For HIV treatment, give 400 mg by mouth, 1 time each day, along with other medicines.
- Information you
should know - To treat or prevent HIV, you must give DTG with other medicines. It is important to take the recommended dose of this medicine every day.
- Side effects
- DTG may cause sleep problems, mood changes, dizziness, and headache. These usually go away after 2 to 4 weeks. If they do not or if they get worse, see a health worker
efavirenz (EFV)
Efavirenz is used in combination with other medicines to treat HIV.
- Often comes in:
- Capsules: 50 mg, 100mg, 200 mg
Tablets: 600 mg
Oral solution: 150 mg/5 ml.
- How to use:
- For HIV treatment, give 400 mg once a day, along with other medicines.
- Information you
should know - If EFV is given to a person who also taking rifampicin for tuberculosis (TB), a higher dose of EFV may be needed (800 mg instead of 600 mg).
To treat HIV, you must give EFV with other medicines. It is important to take this medicine every day, in the recommended dose.
- Side effects
- EFV may cause dizziness, confusion, mood changes, and strange dreams. These will usually go away after 2 to 4 weeks. If they do not, or if they get worse, see a health worker.
Seek care immediately for signs of allergy: red or purple areas on the skin, rashes or other spreading skin problems, fever, mental health problems.
emtricitabine (FTC)
Emtricitabine is used in combination with other medicines to treat HIV and to protect people from becoming infected with HIV before (pre-exposure prophylaxis, PrEP) or after exposure (post-exposure prophylaxis, PEP).
- Often comes in:
- Tablets: 200 mg
Oral solution: 10 mg/ml
- How to use:
- To prevent HIV infection after exposure (PEP), give 200 mg by mouth, 1 time each day for 28 days, along with other medicines.
To prevent HIV infection from ongoing exposure (PrEP), give 200 mg by mouth, 1 time each day. You must also give tenofovir (TDF).
For HIV treatment, give 200 mg by mouth, 1 time each day, along with other medicines.
- Information you
should know - To treat or prevent HIV, you must give FTC with other medicines. It is important to take the recommended dose of this medicine every day.
- Side effects
- FTC may cause dizziness, headache, and strange dreams. These usually go away after 2 to 4 weeks. If they do not or if they get worse, see a health worker.
lamivudine (3TC)
Lamivudine is used in combination with other medicines to treat HIV, to protect people from becoming infected with HIV before (pre-exposure prophylaxis, PrEP) or after exposure (post-exposure prophylaxis, PEP), and to prevent passing HIV to a baby.
- Often comes in:
- Tablets: 150 mg
Oral solution: 50 mg per 5 ml.
- How to use:
- For HIV treatment, give 150 mg by mouth 2 times a day, or 300 mg 1 time each day, along with other medicines.
To prevent HIV infection after exposure (PEP), give 300 mg by mouth, 1 time each day for 28 days, along with other medicines.
To prevent HIV infection from ongoing exposure (PrEP), give 300 mg by mouth, 1 time each day. You must also give tenofovir (TDF).
- Information you
should know - To treat HIV, you must give 3TC with other medicines. It is important to take the recommended dose of this medicine every day.
- Side effects
- Side effects are rare.
Seek care immediately for belly pain, nausea, vomiting, extreme tiredness with difficulty breathing, or muscle pain.
nevirapine (NVP)
Nevirapine is used in combination with other medicines to treat HIV and to prevent passing HIV to a baby during birth.
- Often comes in:
- Tablets: 200 mg
Suspension: 50 mg per 5 ml.
- How to use:
- For HIV treatment, give 200 mg by mouth once a day for 14 days, then give 200 mg 2 times a day, every day. Also give other medicines.
For any baby born to a woman with HIV, give the baby 2 mg by mouth for each kilogram of weight (or 6 mg if you cannot weigh the baby) immediately after the birth. Then give 2 mg/kg to the baby for 6 weeks if the mother is not breastfeeding. If she is breastfeeding, give 2 mg/kg of NVP to the baby until 1 week after breastfeeding has ended.
- Information you
should know - To treat HIV, you must give NVP with other medicines. It is important to take the recommended dose of this medicine every day. For fewer allergic reactions, which can be a problem with NVP, give once a day for the first 14 days.
- Side effects
- Rash, fever, nausea, headache.
Seek care immediately for signs of allergy: red or purple areas on the skin, rashes or other spreading skin problems, fever, yellow skin or eyes, or swollen liver.
- Warning
- Nevirapine can cause serious liver problems. Stop giving this drug if the person has signs of hepatitis and never use it again.
Women with CD4 counts over 250 are more likely to have an allergic reaction to nevirapine. If possible, they should use another ART medicine.
tenofovir (TDF)
Tenofovir is used in combination with other medicines to treat HIV.
- Often comes in:
- Tablets: 300 mg.
- How to use:
- For HIV treatment, give 300 mg once a day along with other medicines.
To prevent HIV infection after exposure (PEP), give 300 mg by mouth, 1 time each day for 28 days, along with other medicines.
To prevent HIV infection from ongoing exposure (PrEP), give 300 mg by mouth, 1 time each day. You must also give lamivudine (3TC) or emtricitabine (FTC).
- Information you
should know - To treat HIV, you must give TDF with other medicines. It is important to take the recommended dose of this medicine every day.
Do not give TDF to women who are less than 18 years old.
- Side effects
- Diarrhea, nausea, vomiting, headaches, weakness.
- Warning
- Tenofovir can cause kidney problems. Seek care immediately if the person has signs of kidney failure.
zidovudine (ZDV, AZT)
Zidovudine is used in combination with other medicines to treat HIV and to prevent passing HIV to a baby.
- Often comes in:
- Tablets: 300 mg
Capsules: 100 mg, 250 mg
Oral solution or syrup: 50 mg per 5 ml
Liquid for injection: 10 mg per ml in 20 ml vial.
- How to use:
- For HIV treatment, give 250 to 300 mg by mouth, 2 times a day, along with other medicines.
For a baby born to a woman with HIV with a high risk of transmission: give 4 mg per kg of weight by mouth, 2 times a day for a baby who is less than 2 kg; 10 mg 2 times a day for a baby who is 2 to 2.5 kg; or 15 mg 2 times a day for a baby who is more than 2.5 kg, for 6 weeks. You should also give nevirapine.
If the mother is breastfeeding, give 60 mg 2 times a day for an additional 6 weeks.
- Information you
should know - To treat HIV, you must give AZT with other medicines. It is important to take the recommended dose of this medicine every day.
- Side effects
- Diarrhea, nausea, belly pain, vomiting. These effects usually get somewhat better after a few weeks.
Seek care immediately for pale skin or other signs of anemia.
- Warning
- AZT can cause severe anemia. If testing is available, check the womanâs hemoglobin before starting AZT and regularly while she uses it, especially if you live where there is a lot of malaria.
Do not give AZT with stavudine (d4T).