HIV TREATMENT

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People living with HIV often adjust their medication over time for various reasons. Your HIV treatment regimen should be carefully tailored to you, ensuring it is the best option for you — that it works well, is safe, and is suitable for your individual needs and lifestyle.[1,2]

Reasons to change your HIV treatment

People living with HIV may want or need to change their treatment regimen for medical, personal, financial, or lifestyle reasons.[1,2]

  • Treatment is not working

    Some people living with HIV can experience virologic failure (VF) whilst on antiretroviral therapy (ART)—this is when ARV drugs are not effective at suppressing the HIV viral load.[3] An increased viral load can result in HIV-related illness, disease progression, and risks of HIV transmission.[3]

    VF can happen for a variety of reasons, including:[3]

    • Poor drug adherence
    • Drug resistance
    • Drug interactions
    • Poor drug absorption
    • Underlying medical conditions

    Usually, an undetectable viral load is expected within six months of starting ART.[4]
    The best way to check for VF is through a viral load test. If VF is confirmed, you and your doctor should explore alternative treatment options.[3,4]

  • Drug resistance

    HIV can become resistant to ARV drugs.[5] This happens when the virus changes, or mutates, making ARVs less effective at stopping the virus from multiplying, leading to treatment failure.[3,5] Drug-resistant HIV can be passed from one person to another, or it can develop after someone starts ART.[5]

    Poor ART adherence can lead to drug resistance.[5,6] Forgetting to take a dose once in a while is typically not a major concern, newer ARV drugs can remain effective when an occasional dose is missed.[6] If you do miss a dose, take it as soon as you remember, unless it’s almost time for your next dose—in that case, skip the missed dose and continue with your usual schedule.[7] Speak to your doctor or local clinic if you are unsure what to do or worried about missing a dose.[7]

    However, repeatedly missing doses may allow HIV to multiply and spread, increasing the risk of developing drug resistance.[6,7] The best outcomes for HIV treatment are seen when you take your HIV medication exactly as prescribed.[6,7]

    After an HIV diagnosis and before treatment begins, drug resistance testing should be carried out.[5] These tests identify any HIV medications that will be ineffective against a particular HIV strain.[5] Additionally, if viral load tests later indicate there is treatment failure, another drug resistance test will be conducted, and the ART regimen will be adjusted accordingly.[5]

  • Manage side effects

    People living with HIV may experience side effects from ART. Most of these side effects are mild, but a few can be serious. Short-term side effects may include diarrhoea, fatigue, nausea, sleep problems, rashes, and headaches that typically improve within days or weeks.[8,9]

    More serious and long-term side effects of ARVs can be

    • Weight gain
    • Bone density loss
    • Diabetes
    • Cardiovascular disease (CVD)
    • Kidney problems.[8,9]
    • Some people may also experience allergic reactions to certain ARVs.[9]

    To manage medication side effects, a treatment change may be recommended.[8,9]
    If any side effects are particularly bothersome or concerning, you should speak to your doctor to find alternative medications. But do not stop or interrupt your ART before consulting with your doctor.[9]

  • Drug interactions

    All ARV drugs can interact with other medications, supplements, and recreational drugs.[10,11] These interactions can reduce the effectiveness of either the HIV drug or the other medication, lead to harmful side effects, or even create toxic combinations.[10,11]

    People living with HIV who require treatment for other conditions like hepatitis B or cardiovascular disease (CVD) may use multiple medications and are therefore at risk of experiencing such drug interactions.[2,11]

    It’s therefore important to always discuss the use of any other medications, recreational drugs, or supplements with your doctor.[2]

  • Pregnancy

    Generally, pregnant people with HIV can continue using the same ARV drugs they used before pregnancy.[12] However, in some cases, changing the treatment regimen may be recommended during pregnancy.[12,13] This is because certain ARV drugs are linked to an increased risk of infant death and premature birth.[12,13]

    ART during pregnancy is very important for reducing the risk of HIV transmission to your baby.[13] If you are pregnant or plan to get pregnant, speak to your doctor, as they can provide the best advice regarding the most appropriate treatment.

  • Difficulty taking medication

    For some people living with HIV, their ART regimen may be challenging to follow or inconvenient.[1,2] Depending on the regimen you are taking, you may feel a “pill burden” — this is where the number of pills you need to take or how often you need to take them make a regimen more complex and harder to follow.[1,2]

    Additionally, some ART regimens come with dietary requirements that may not suit your lifestyle.[1,2,14] For example, certain ARVs need to be taken with food, while others must be taken on an empty stomach.[14] Meeting these requirements can be challenging for some people living with HIV.[1,2]

    HIV stigma can also make it harder to stick to ART. Fear of disclosure or stigma may lead people to hide their medication or avoid clinic visits, which ultimately reduces adherence to treatment.[15]

    Adhering to your HIV treatment is crucial for achieving an undetectable viral load.[4] If you find it challenging or inconvenient to stick to your current regimen, your doctor may recommend alternative options. HIV Treatments include single-pill regimens, fixed-dose combinations, or long-acting injections.[2,16]

  • Costs and insurance coverage

    In certain healthcare systems, streamlining ART by reducing the number of pills in a regimen can offer financial benefits for those living with HIV.[1] This may include lower copayments, especially when fewer medications are required.[1]

    Opting for less expensive generic versions of ARVs may also be a more cost-effective choice.[2] Generic medications match brand-name drugs in effectiveness, safety, potency, and quality.[17] Before making any changes to ART, it is crucial to assess access to newer treatments and the extent of insurance coverage. Some people living with HIV face insurance restrictions that limit their choice of ARVs.[2]

SpeakIng to your doctor about changIng HIV treatment

Speaking to your healthcare provider about any potential changes to your HIV treatment ensures that any adjustments should work to support your health goals.[17] Being honest about why you want to change your HIV treatment will also help your doctor to suggest the best alternative treatment options.

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There will be various factors to consider before you and your doctor settle on any new treatment, including:[1]
  • Your previous history of antiretroviral (ARV) drug use
  • Any potential for treatment side effects and what they may be
  • The potential for drug resistance
  • If there is the possibility of drug interactions with other medications
  • The pill burden (total number of tablets or capsules a person needs to take on a regular basis)
  • Your lifestyle and personal preference for how you take your medication

Usually, after changing treatment, there will be a monitoring period of approximately three months.[1] This is to assess for any side effects, confirm that the new treatment is achieving and maintaining viral suppression, and to address any concerns you may have.[1]

Abbreviations:

ARV, antiretroviral; ART, antiretroviral therapy; CVD, cardiovascular disease; VF, virologic failure

References:

  1. National HIV Curriculum. Wood B. Switching or Simplifying Antiretroviral Therapy. 2025. Available from: https://www.hiv.uw.edu/go/antiretroviral-therapy/switching-antiretroviral-therapy/core-concept/all#page-title [Accessed: March 2025]
  2. POZ. Switching HIV Treatment. 2022. Available from: https://www.poz.com/basics/hiv-basics/switching-hiv-treatment [Accessed: March 2025] 
  3. Foka FE, Mufhandu HT. Current ARTs, virologic failure, and implications for AIDS management: a systematic review. Viruses. 2023 Aug 13;15(8):1732. https://doi.org/10.3390/v15081732 
  4. NIH: National Institute of Allergy and Infectious Diseases. 10 Things to Know About HIV Suppression. 2024. Available from: https://www.niaid.nih.gov/diseases-conditions/10-things-know-about-hiv-suppression [Accessed: March 2025]
  5. NIH. HIV Drug Resistance. 2021.Available from: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/drug-resistance [Accessed: March 2025]
  6. AIDSMAP. Redzheb Z. What happens to HIV drugs in the body, and do missed doses matter? 2023. Available from: https://www.aidsmap.com/about-hiv/what-happens-hiv-drugs-body-and-do-missed-doses-matter
  7. HIV.gov. Taking Your HIV Medicine as Prescribed. 2024. Available from: https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/taking-your-hiv-medications-every-day [Accessed: March 2025]
  8. HIV.gov. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. 2023. Available from: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/adverse-effects-antiretroviral-agents [Accessed: March 2025]
  9. AIDSMAP. Jones A. Side-effects of HIV treatment. 2018. Available from: https://www.aidsmap.com/about-hiv/side-effects-hiv-treatment [Accessed: March 2025]
  10. AIDSMAP. Wilberg M. HIV treatment and drug-drug interactions. 2024. Available from: https://www.aidsmap.com/about-hiv/hiv-treatment-and-drug-drug-interactions [Accessed: March 2025]
  11. Clinical Guidelines Program. Resource: ART Drug-Drug Interactions. 2024. Available from: https://www.hivguidelines.org/guideline/hiv-art-drug-interactions/ [Accessed: March 2025]
  12. HIV.gov. Overview: Recommendations for Antiretroviral Drugs Use During Pregnancy. 2024. Available from: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/recommendations-arv-drugs-pregnancy-overview [Accessed: March 2025]
  13. BHIVA. British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 (2020 third interim update). 2020. Available from: https://bhiva.org/wp-content/uploads/2024/10/BHIVA-Pregnancy-guidelines-2020-3rd-interim-update.pdf
  14. AIDSMAP. Stanford A. Food requirements for anti-HIV medications. 2023. Available from: https://www.aidsmap.com/about-hiv/food-requirements-anti-hiv-medications
  15. Kalichman SC, Katner H, Banas E, Hill M, Kalichman MO. HIV-related stigma and non-adherence to antiretroviral medications among people living with HIV in a rural setting. Soc Sci Med. 2020;258(113092):113092. Available from: http://dx.doi.org/10.1016/j.socscimed.2020.113092
  16. Buscher A, Hartman C, Kallen MA, Giordano TP. Impact of antiretroviral dosing frequency and pill burden on adherence among newly diagnosed, antiretroviral-naïve HIV patients. Int J STD AIDS. 2012;23(5):351–5. Available from: https://journals.sagepub.com/doi/10.1258/ijsa.2011.011292
  17. AIDSMAP. Redzheb Z. Changing HIV treatment. 2024. Available from: https://www.aidsmap.com/about-hiv/changing-hiv-treatment [Accessed: March 2025]

NP-GBL-HVX-COCO-250013 July 2025

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the GSK Reporting Tool link https://gsk.public.reportum.com/. By reporting side effects, you can help provide more information on the safety of this medicine.

If you are from outside the UK, you can report adverse events to GSK/ ViiV by selecting your region and market, here.