Antiretroviral therapy (ART)

What ART is

Antiretroviral therapy, or ART, is the treatment of HIV with a combination of antiretroviral medicines to keep the virus at the lowest possible level.

The heart of HIV treatment

ART is the main, standard treatment for everyone with HIV. It keeps the virus controlled, the immune system strong, and health good over the long term.

Several medicines together

Treatment uses several antiretrovirals together, because attacking the virus at more than one point at once works better and reduces the chance of resistance. See the full treatment overview at HIV treatment: what you should know.

Why several medicines

Using several medicines that act at different points controls the virus better than a single drug and reduces the chance of resistance, which is why a regimen usually has two or three medicines.

How ART works

ART works by blocking HIV at different stages of how it multiplies.

Stopping the virus's life cycle

HIV goes through several steps to multiply in the body, and each class of antiretroviral blocks a different step, so using them together stops the virus effectively.

The result

When the virus cannot multiply, the amount in the blood falls until it is undetectable, and the immune system gradually recovers. This is the principle that makes ART so effective.

The classes of antiretroviral

Antiretrovirals are grouped into several classes by how they block the virus.

The main classes used

• integrase inhibitors, a class widely used as the core of regimens today
• reverse transcriptase inhibitors, both nucleoside and non-nucleoside types
• protease inhibitors

A doctor chooses the right regimen

A regimen usually combines medicines from more than one class, and a doctor chooses what suits each person, considering effectiveness, side effects, and other health factors.

Single-tablet regimens

An important advance in ART is combining several medicines into a single tablet.

One pill once a day

There are now regimens that combine a whole antiretroviral regimen into a single tablet taken once a day, making treatment convenient and easier to take consistently.

Why it matters

Taking just one pill reduces the burden and hassle, helping people stay on treatment, which is the key to it working. It is an important step that has improved quality of life.

A range of options

Besides single-tablet regimens, there are other regimens to choose from to suit each person, and a doctor helps pick one that fits your health, lifestyle, and any other medicines you take.

Regimens used in Thailand

In Thailand, there is a standard antiretroviral regimen used as the main option in the national treatment programme.

The main regimen used

The main regimen used in Thailand today is often one based on an integrase inhibitor (dolutegravir) combined with other antiretrovirals, as a single tablet taken once a day, which is highly effective and well tolerated.

Accessible in the system

These regimens are available under the health security scheme, so people with HIV in Thailand can access standard treatment, and a doctor chooses and adjusts the regimen to suit each person.

Injectable antiretrovirals

Besides pills, there is now a long-acting injectable antiretroviral as a newer option.

An injection every 1 to 2 months

Injectable antiretrovirals, such as a two-drug regimen, are given by a doctor every 1 to 2 months instead of a daily pill.

Injections on schedule

Injectable treatment must be given on schedule, just like taking pills, and missing an injection can leave the drug level too low and risk resistance, so injections are planned with a doctor.

Who it suits

This option suits people who already have the virus well controlled on pills and want to switch to injections. However, injectable treatment has conditions for its use and may not be available everywhere yet, so those interested should ask their doctor whether it is suitable.

The goal: undetectable

The most important goal of taking ART is to bring the viral load down to an undetectable level.

What undetectable means

When ART is taken consistently, the amount of virus in the blood falls to a level that cannot be detected by standard tests, showing the treatment is working well and the virus is controlled.

Undetectable = untransmittable

When the virus stays undetectable, a person does not pass HIV on sexually, under U=U, which is an important benefit of treatment. Read the detail at what U=U is.

Adherence and resistance

Taking medicine consistently is the single most important thing for ART to work and to prevent resistance.

Why consistency matters

ART works best when the drug level in the body stays steady. If it is taken irregularly, the virus can multiply again and develop resistance, so a medicine that once worked no longer does.

What resistance is

Resistance happens when the virus changes so that a medicine can no longer control it, which is often linked to inconsistent dosing. Taking your medicine fully and on time keeps it effective, and if you have trouble taking it, talk to your provider.

Tools to help you stay on track

There are several tools to help you take your medicine consistently, such as setting an alarm, a reminder app, a daily pill box, or tying it to a daily routine, all of which help you not forget.

Side effects of ART

Modern antiretrovirals are very safe and well tolerated, but there are side effects worth knowing.

Possible side effects

Early on, some people have mild effects such as nausea, headache, or tiredness, which usually go away as the body adjusts, and newer medicines generally have far fewer side effects than older ones.

Managing and monitoring

If you have side effects that bother you, talk to your doctor, who may adjust the regimen. Do not stop on your own, because stopping partway lets the virus return and risks resistance.

Monitoring your treatment

Treatment with ART comes with regular monitoring to make sure it is working.

What is monitored

• viral load, to see whether the virus is controlled to undetectable
• CD4 count, to see the immune system recovering
• overall health, such as liver and kidney function

Why monitoring matters

Monitoring lets the doctor confirm the treatment is working and adjust care promptly if needed, so keeping your appointments is an important part of good treatment.

Good results are encouraging

When results show the virus is undetectable and the immune system is improving, it is encouraging proof that looking after yourself is working, and seeing progress helps people stay motivated to keep taking their medicine.

Starting and accessing ART in Thailand

Starting ART involves some important steps, and in Thailand treatment is accessible under the health system.

When to start

Current guidelines recommend starting ART as soon as possible after diagnosis, and everything begins with an HIV test. Read about testing at HIV testing: the complete guide.

Access in Thailand

People with HIV in Thailand can access antiretrovirals under the health security scheme, so treatment is not an out-of-reach financial burden and is a right. Read about rights at HIV treatment rights.

There is no need to wait

There is no reason to delay starting treatment — the sooner you start, the more it protects your health and the sooner you can reach an undetectable viral load, so if you are diagnosed, start talking to a doctor about treatment right away.

In summary

Antiretroviral therapy (ART) is the main treatment for HIV, using several medicines together to control the virus until it is undetectable. There are now convenient single-tablet regimens taken once a day, and an injectable option for people who already have the virus well controlled.

The goal is to make the virus undetectable, which keeps you healthy and means no transmission, under U=U. Taking medicine consistently is the most important thing to prevent resistance. In Thailand, treatment is accessible under the health security scheme.

If you want to test for HIV, start treatment, or talk about antiretrovirals, find and book a clinic at Love2Test.