Tables and diagrams

When not on treatment, your immune system works in overdrive

CD4 increases on ART

Drug levels with good adherence

Drug doses are calculated so that average drug levels are high enough to be active against HIV for 24 hours a day. They are also low enough to minimise the risk of side effects.

A missed or late dose increases the risk of resistance

Missing or being late with a drug lets the drug levels fall to a level where resistance can develop. The more often you are late, the greater the chance of resistance.

The main types of HIV drugs

Table 1: Types of HIV drugs
Abbreviation	Full name(s)
NRTIs/NtRTIs (“nukes”)	Nucleoside/tide reverse transcriptase inhibitors or nucleoside/tide analogues. These were the first types of HIV drugs.
NNRTIs (“non-nukes”)	Non-nucleoside reverse transcriptase inhibitors.
PIs	Protease inhibitors.
INIs (or INSTIs)	Integrase (strand transfer) inhibitors.
CCR5 inhibitors	CCR5 inhibitors are a type of entry inhibitor.
mAbs	Monoclonal antibodies – which also block entry to the CD4 cell.
Capsid inhibitors	Capsid inhibitors are a new class that works both early and late in the viral life cycle.
Fusion inhibitors	Fusion inhibitors are a type of entry inhibitor.

Table 1: Types of HIV drugs

Abbreviation

Full name(s)

NRTIs/NtRTIs (“nukes”)

Nucleoside/tide reverse transcriptase inhibitors or nucleoside/tide analogues. These were the first types of HIV drugs.

NNRTIs
(“non-nukes”)

Non-nucleoside reverse transcriptase inhibitors.

PIs

Protease inhibitors.

INIs (or INSTIs)

Integrase (strand transfer) inhibitors.

CCR5 inhibitors

CCR5 inhibitors are a type of entry inhibitor.

mAbs

Monoclonal antibodies – which also block entry to the CD4 cell.

Capsid inhibitors

Capsid inhibitors are a new class that works both early and late in the viral life cycle.

Fusion inhibitors

Fusion inhibitors are a type of entry inhibitor.

HIV lifecycle – how drugs work in different ways

If a CD4 cell is infected by HIV, this cell is used to produce hundreds of new copies of HIV. Different drugs block different parts of this HIV life cycle.

First combination meds

Table 2: Summary recommendations for choice of ART in the UK
	PREFERRED	ALTERNATIVE*
Two nukes	tenofovir (TD) + emtricitabine (Truvada)	abacavir + lamivudine (Kivexa) ** or tenofovir (TAF) + emtricitabine.
Plus a third component	Unboosted INSTI: bictegravir or dolutegravir or darunavir – boosted PI or doravirine – NNRTI *	boosted INSTI (elvitegravir) or rilpivirine* (NNRTI) ***

Table 2: Summary recommendations for choice of ART in the UK

PREFERRED

ALTERNATIVE*

Two nukes

tenofovir (TD) + emtricitabine (Truvada)

abacavir + lamivudine (Kivexa) ** or

tenofovir (TAF) + emtricitabine.

Plus a third component

Unboosted INSTI: bictegravir or dolutegravir or
darunavir – boosted PI or
doravirine – NNRTI *

boosted INSTI (elvitegravir) or rilpivirine* (NNRTI) ***

* Drugs that can only be used in some situations. Rilpivirine can only be used when viral load is less than 100,000 copies/mL. Abacavir can only be used if the HLA B-5701 test is negative.

** abacavir + lamivudine (Kivexa) can be used at any viral load when used with dolutegravir. Otherwise, Kivexa can only be used when viral load is less than 100,000 copies/mL

*** Although efavirenz is no longer a prefered drug, it might still be offered in some clinics.