DRUG GUIDE

Real Talk Rx: Human Immunodeficiency Virus (HIV)

A Patient Guide to Treatment Options, Side Effects, Dosing, and Savings

Overview

Human Immunodeficiency Virus (HIV) is a viral infection that attacks white blood cells and, if untreated, can progressively weaken your immune system. Compared to the past, the virus is now manageable and treatable, with those living with it capable of living long lives with the right medication.

However, Black people tend to be hit the hardest with HIV,accounting for 39 percent of new HIV diagnoses in 2024, despite being only 12 percent of the U.S. population. Black people with HIV are also among the least likely of any race to receive medical care within a month of diagnosis.

To reduce these care gaps, Black people need to be included in more HIV clinical research. Better representation is important because Black Americans are disproportionately affected by HIV and adequate representation helps ensure evidence reflects the population using these treatments. For example, Biktarvy, an HIV regimen, was studied in a clinical trial monitoring how it affects Black American adults with HIV.

Today, people living with HIV have multiple treatment options, including daily oral medications and long-acting injectable regimens. This guide breaks down selected HIV medications, how they work, potential side effects, dosing considerations, and ways to make paying for treatment more accessible. It also highlights research and considerations that may be relevant for Black patients, and those who love them.

While treatment options have expanded, Black Americans are disproportionately affected by HIV and adequate representation in HIV clinical research can help ensure evidence reflects the population using these treatments. This guide also includes selected medications and research that involve Black American adult patients with HIV.

Medicines:

BiktarvyCabenuvaDovatoIdvynso


What Causes HIV?

Human immunodeficiency virus (HIV) is a viral infection that causes gradual weakening of the immune system by latching onto CD4 cells in your body, a type of immune cell that protects you from disease. The virus then makes copies of itself, gradually destroying enough CD4 cells that help your body fight off even the smallest of infections.

HIV is typically spread through bodily fluids shared during sex without a condom or prevention medication or through shared needles and syringes. It is also possible for HIV to be spread from an infected mother to her child during pregnancy, childbirth and breastmilk. Contrary to myths, HIV is not spread from kissing, hugging, sharing food or drinks, toilet seats, or by living with someone with HIV.

The most advanced stage of HIV is acquired immunodeficiency syndrome (AIDS), where the body’s immune system has been badly damaged or a severe infection develops. Without treatment, the average person with an AIDS diagnosis is about three years, while the average person with HIV lives up to nine to 11 years, with those diagnosed in their late teens and 20s tending to live longer than those diagnosed in their 40s and 50s.

Having HIV is nothing to be ashamed of, nor is it a moral failing. It is a virus that anyone can contract regardless of race, gender, sexual orientation, character, or other protected status.

Why Getting HIV Treatment ASAP Matters

Black patients have the lowest rates of receiving medical care within a month of HIV diagnosis compared to other races, despite accounting for 39 percent of HIV diagnoses and 41 percent of HIV deaths as of 2024. It is imperative that these numbers do not become greater. The earlier you receive HIV treatment, the greater are your odds of survival, as well as protecting those you love. 

Late diagnosis (stage 3) is common, accounting for roughly 22 percent of new diagnoses. The American South also accounts for just over half of HIV diagnoses and deaths, making rural Black Americans the most vulnerable. The later your diagnosis, the more likely HIV has done damage to your immune system.

The sooner you are diagnosed, the sooner you should start treatment. There are many clinics offering a rapid start, where you can begin treatment as soon as your first or second visit.

How to Get the Right Diagnosis

Many people can present without HIV symptoms for years, and some may get a flu-like illness a few weeks after exposure.

The only way to get an accurate HIV diagnosis is to get tested. You can receive an HIV test at your doctor’s office, a local community health clinic, pharmacies, and even at home with a personal test kit. The CDC recommends that anyone ages 13 to 64 get tested for HIV at least once, and even more if you have unprotected sex, multiple sex partners, or are frequently exposed to needles and syringes, even in healthcare settings.

There are three types of HIV tests: antibody, antigen, and nucleic acid. Antibody tests can be done with a finger prick, a mouth swab, or an at-home kit, and take the longest to receive a positive result, usually 23 to 90 days after exposure to HIV. An antigen/antibody test is taken from a lab blood draw from a vein and receives faster positive results, usually 18 to 45 days after exposure. Nucleic acid tests detect the virus the quickest, usually 10 to 33 days after exposure, but are only done under certain circumstances and are expensive to receive.7   

HIV Stigma in Black Patients

Stigma against having HIV, especially HIV in Black populations, is a major factor in why many delay treatment or even an official diagnosis. This can also bring up unfair conversations around one’s drug use, sexuality and sexual activity, or even who “gets” HIV. This stigma can result in hiding pills and treatment from family and friends, or skipping injection appointments.

Some patients can also have concerns that storing pills in the home can be potentially dangerous or revealing of your HIV condition, livelihood and well-being. Many patients opt for injection treatments that can be received once a month or sometimes once every two months.

If the stigma of having HIV may play a role in managing your condition, be sure to bring it up to your provider. You are not required to reveal your HIV status to anyone who is not your sexual partner or part of your medical care team, and having HIV, especially as a Black person, is nothing to be ashamed of.

What Kinds of HIV Treatments Are There?

There is currently no cure for HIV, so the goal of HIV treatment is to live a long, healthy life with an undetectable viral load that prevents transmission to a sexual partner.  When a person takes HIV treatment as prescribed and maintains an undetectable viral load, they cannot transmit HIV through sex. Remember, U=U: undetectable = untransmittable.

There are around five standard classes of HIV drugs that work depending on the stage of the virus’ lifecycle, and many treatments combine multiple medicines from different classes, typically into one easy-to-take pill.

The Main Classes of HIV Drugs

There are many medications available to treat HIV, and this guide does not cover every option. Your healthcare provider can help determine which treatment is appropriate for you. 

  • Integrase strand transfer inhibitors (INSTIs)(Featured in this guide)  
    • INSTI-containing regimens are the foundation of HIV treatment for most people living with HIV. These therapies include both oral and long-acting injectable options and may combine an INSTI with one or more additional antiretroviral drug classes to achieve durable viral suppression.  
    • Examples: Biktarvy, Dovato, Cabenuva (INSTI + NNRTI)
  • Nucleoside/Non-nucleoside reverse transcriptase/translocation inhibitors (NRT[T]I + NNRTIs) (Featured in this guide) 
    • NRTI + NNRTI-containing regimens are an effective treatment option for select patients based on treatment history, resistance profile, and clinical considerations. This category includes both traditional NNRTI-based therapies and newer regimens incorporating novel mechanisms of action.  
    • Example: Idvynso (NNRTI + NRTTI)  
  • Protease inhibitors (PI)
    • PI-containing regimens play an important role in individualized HIV care, particularly for patients with prior treatment experience, resistance, or other complex clinical needs.  
    • Examples: Symtuza®, Prezcobix®, Prezista®  
  • Entry & attachment inhibitors  
    • These therapies prevent HIV from entering immune cells and are primarily used for treatment-experienced patients with multidrug-resistant HIV when additional treatment options are needed.  
    • Examples: Rukobia®, Trogarzo®, Selzentry®  
  • Capsid inhibitors  
    • The newest antiretroviral drug class, capsid inhibitors target a specific protein in the HIV life cycle and are an important treatment option for heavily treatment-experienced patients with multidrug-resistant HIV.  
    • Example: Sunlenca®11

HIV Treatment Routes

There are two main ways to take HIV medication.

Orally (By Mouth)

Most HIV patients take a daily pill by mouth at home, with or without food. Pills like Dovato, Idvynso and Biktarvy contain two to three drugs in one tablet and are a complete regimen.

Injections (Via Shot)

Some HIV medicines are given as intramuscular shots by a healthcare provider rather than taken at home, anywhere from every month to every six months depending on the medicine. Cabenuva is an example of an injectable regimen for people already on HIV pills who have an undetectable viral load and no history of treatment failure or resistance. 

Other Parts of HIV Care

While medication is at the center of a HIV regimen, those with HIV should also receive:

  • Hepatitis B and C testing
  • Regular kidney, liver, cholesterol, blood sugar and weight monitoring
  • Immune-system focused vaccines like flu, COVID, hepatitis and others
  • Screening and care for any other physical and mental conditions
  • Prevention for sexual partners, like PrEP

How Do I Take Care of Myself During HIV Treatment?

As a reminder, having HIV is not a moral or personal failing. Absolutely anyone can have HIV, and it is not reserved for a specific kind of person. In order to properly care for yourself during HIV treatment:

  • Incorporate your pill as part of your daily schedule that you never forget, like brushing your teeth.
  • Tell your provider if you’ve missed any doses.
  • Tell your provider about any and all medications and supplements you’re taking, even over-the-counter ones. Any of them could interact with the absorption of your HIV medication
  • Track your weight changes regularly after your first dose, and raise the alarm for any significant gains or losses.
  • Keep every single appointment you have, even if you feel fine. That means the medication is working, not a means to stop.
  • Ask about local HIV/AIDS assistance programs, just in case drug cost becomes a barrier to taking your medication.
  • Have at least one person outside of your core healthcare team that you can share your HIV status with to feel supported and to fight stigma.

Questions to Ask Your HIV Healthcare Team

  • “How many Black patients were studied for this particular drug?”
  • “Can I start treatment as soon as possible? Why or why not?”
  • “Do any of the medications or vitamins I’m taking interact with my HIV medication?”
  • “What if I am pregnant or desire to become pregnant? Can I still take this medication?”
  • “What side effects should I be aware of?”
  • “Why are you recommending this specific medication or regimen for me?”
  • “What happens if I miss a dose or injection?”
  • “What should I know about potential treatment resistance?”
  • “How much does this medication cost, and how can I apply for assistance?”
  • “Are there any clinical trials for HIV I should know about or apply for?”

Conclusion

To be Black with HIV is to be somewhat of a majority within a minority. Knowing and understanding your treatment options can make a world of difference in your overall health and happiness. The sooner you can receive treatment, the greater the odds of a long, healthy life. 

The medicines in this guide are just a small frame of reference to the possibilities of treating and living with HIV. They all have varying benefits, side effects and monitoring requirements that you should discuss with your healthcare provider to know what will work best for you.

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking any drug or commencing or discontinuing any course of treatment.

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