Understanding HIV treatment doesn’t need to be difficult, and the Positively Aware Annual HIV Drug Guide is here to help! Below are tips to help give you the knowledge you need to work with your providers to make empowered, informed choices about your treatment. Medications that are included in the HIV Drug Guide are only those drugs in the U.S. that are either FDA approved, expected to be approved this year, or are available through an expanded access program (EAP).
There are several changes to this year’s HIV Drug Guide that will improve your experience and the way that you use this guide.
When we started this guide 19 years ago, we listed drugs in the order they were approved. There have been several variations since then in how drugs have been listed in the guide as new treatments and new classes of drugs became available. Today, with so many good options out there, we wanted to try to highlight those drugs that are the best options and list them first, followed by other drugs in the same drug class that are less frequently used or prescribed. You can quickly find your HIV drug here.
The Department of Health and Human Services (DHHS) and the International AIDS Society-USA (IAS-USA) both publish recommendations for the use of HIV antiretroviral drugs. These recommendations focus on drug regimens more than single agents, but are essential tools that help providers and individuals choose a regimen that’s best suited for them. This year we include information on some of these recommendations at the top of each drug page, as well as the pull-out drug chart. DHHS and IAS-USA guidelines are very similar in their recommendations, so for consistency we reference the DHHS guidelines. For the full list of recommendations go to aidsinfo.nih.gov or ias-usa.org/guidelines.
HIV drugs that are no longer recommended for use are published online only at positivelyaware.com; however, they are still included in the HIV Drug Chart. This includes six of some of the oldest HIV drugs that either have intolerable side effects or for which there are better options now available.
A fixed-dose combination (FDC) combines two or more drugs in one tablet, such as Epzicom (lamivudine/abacavir). A single-tablet regimen (STR) contains drugs from different classes and is a complete regimen in one pill, such as Triumeq (dolutegravir/lamivudine/abacavir). Atripla, Complera, Stribild, and Triumeq are the four single-tablet regimens that are now available.
When a drug is a co-formulation (combination) of different drugs, the generic names will be separated by slashes—for example, Stribild is the co-formulation of elvitegravir/cobicistat/emtricitabine/tenofovir.
Remember that anti-HIV drugs should always be taken in combination using two or more drug classes (for example, a boosted protease inhibitor plus two non-nukes). While not a drug class, single-tablet regimens (STRs) are in their own category. STRs are widely used for first-time treatment and for their convenience, but they are not for everybody. For those who are treatment-experienced or have multi-drug resistance, they may not be able to use these STRs and will still have to combine two to three or more single agents from different drug classes, the old-fashioned way.
There are also several non-HIV drugs that are used commonly by people with HIV which are included in this guide. In addition, there is a Truvada for PrEP (pre-exposure prophylaxis, for prevention) page that is online only.
When a drug is in development and before it’s approved, it’s first given a “generic” name (such as dolutegravir), which health care providers may identify it with even after approval. Once it is approved, it’s given its brand name (Tivicay is the brand name of dolutegravir), which most consumers know it by. At medical conferences and presentations you will often see three-character abbreviations used (DTG in the case of dolutegravir). A good rule of thumb is, brand names are always capitalized and generic names are always lower case. Within each drug’s page, you will see the drug referred to by any or all of its names, including in a few cases the “street” or common name it’s known by (such as Reyataz [atazanavir or ATV]). All of each drug’s names appear at the top of its page and also on the pullout drug chart, so if you’re confused, look them up there!
Viread (tenofovir) is a drug of special circumstances. It is the only “nuke” that is a nucleotide reverse transcriptase inhibitor, as opposed to nucleoside; however, both types of nukes have a similar mechanism of action. Viread is also in three out of the four single-tablet regimens (STRs) currently available, as well as being one of the two drugs in Truvada, the only drug FDA approved for PrEP. You’ll also notice that Viread is referred to by its generic name, tenofovir DF (disoproxil fumarate), but also just by “tenofovir”—another version, tenofovir alafenamide (TAF), is on its way. For now, whenever you see “tenofovir” without the DF, assume that it’s the DF version.
The Average Wholesale Price (AWP) is a way to compare costs of drugs. It is not necessarily what you would pay if you had to pay the full retail price.
HIV drugs are not cheap and with all the continuing changes in drug coverage due to the Affordable Care Act (ACA), figuring out how to pay for them can be a challenge. Luckily, there are programs that can help cover all or part of the costs and help facilitate access. Of course many of us take drugs for conditions other than HIV, so see our drug co-pay and patient assistance chart where we include information on drugs used to treat hepatitis B and C, as well as several other non-HIV drugs that are often used by people with HIV.
There is a wealth of information available about HIV and the drugs used to treat it. Knowing where to look and understanding some of the basics will help you sort through it all, giving you peace of mind and the knowledge you need to live a better, healthier life with HIV.