HIV TREATMENT

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People living with HIV may consider changing HIV medication over time for a variety of reasons, including reducing pill burden, managing side effects, or finding a treatment that better fits their lifestyle. Any decision to switch HIV treatment should be made in partnership with a healthcare provider to ensure the regimen remains safe, effective and appropriate for individual needs.

REASONS FOR SWITCHING 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. 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. 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]

  • Managing 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:[8,9]

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

    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. 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 living with HIV can continue using the same ARV drugs they used before pregnancy. However, in some cases, changing the treatment regimen may be recommended during pregnancy. 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.[14] 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.

  • Pill burden and adherence

    For some people living with HIV, their ART regimen may be challenging to follow or inconvenient. 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.[1,2,15] For example, certain ARVs need to be taken with food, while others must be taken on an empty stomach.[15] 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.[16]

    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.[17]

  • 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. 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.[18] Generic medications match brand-name drugs in effectiveness, safety, potency, and quality.[18] 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]

HOW TO TALK 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. Being honest about why you want to change your HIV treatment will also help your doctor to suggest the best alternative treatment options.[19]

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 switching HIV treatment, there will be a monitoring period of approximately three months. 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]

FAQS ABOUT CHANGING HIV MEDICATION

  • What is pill burden?

    The number of tablets, capsules or other medicines a person needs to take regularly. A higher pill burden can make it more difficult for some people to take their HIV treatment as prescribed.[20]

  • Are there any myths about switching HIV treatment?

    • Myth 1: Switching means your current treatment is failing
      The Reality: This is not always the case, since a change in ART may be appropriate for some people, even if their HIV viral load has remained consistently suppressed. Reasons to switch ART despite virologic suppression include the following:[1]

    This is different from switching ART after virologic failure, when drug resistance testing may be needed to help choose a new treatment regimen.[1]

    • Myth 2: You will eventually run out of drug options
      The Reality: While it is possible to run out of HIV treatment options, this is much less common today thanks to advances in HIV medicines.[21] Most people can achieve long-term viral suppression by taking their treatment as prescribed.[22]

    In one large study of people who had been taking ART for at least five years, around 1 in 10 had limited or exhausted treatment options. The most common reason for needing a different HIV treatment was difficulty tolerating previous medicines, rather than the treatment no longer working.[23]

    • Myth 3: New medications will always cause worse side effects
      The Reality: In fact, newer ART regimens generally feature significantly improved safety profiles, milder short-term reactions, and lower risks of long-term toxicity compared to older treatments.[1,24,25]
    • Myth 4: If you switch, you can never go back to your old medication.
      The Reality: Not necessarily. Whether you can switch back depends on why your treatment was changed and whether HIV drug resistance is a factor.[26]

    If your HIV remains undetectable and you switch to another effective treatment, you may be able to return to your previous medication if the new one isn't suitable, such as if it causes side effects. Your healthcare provider will help determine the safest and most effective option for you.[26]

  • What is viral rebound?

    Viral rebound is when HIV becomes detectable in the blood again after it has previously been kept at undetectable levels with ART. It can happen if HIV treatment is not taken as prescribed or if the virus develops resistance to the medication.[27]

    A temporary viral blip may not require changes to your HIV medication. However, if the viral load remains above 200 copies/mL, your healthcare provider may recommend drug resistance testing to help determine whether a change in treatment is needed.[28]

  • Can I change my HIV medication?

    Yes, but only after speaking with your healthcare provider. If your current HIV treatment is working well, keeping your viral load undetectable, and not causing troublesome side effects, there may be no need to switch.[29]

    Your healthcare provider can help decide whether changing treatment is appropriate based on your individual needs. Switching without medical advice may increase the risk of HIV drug resistance, which could limit future treatment options.[29]

  • What does polypharmacy mean?

    Polypharmacy means taking multiple medications at the same time. In people living with HIV, it is commonly defined as taking five or more medications, including both HIV treatment and medicines for other health conditions.[30]

    As people with HIV are living longer, many also take medicines for conditions such as high blood pressure, diabetes, or high cholesterol.[31] Taking several medications can increase the risk of drug interactions, side effects, and make treatment more difficult to manage.[30] If you're taking multiple medicines, it's important to review them regularly with your healthcare provider to make sure your treatment remains safe and effective.

Abbreviations:

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

References:

  1. National HIV Curriculum. Switching or Simplifying Antiretroviral Therapy. 2026. Accessed September 2026. Available at: https://www.hiv.uw.edu/go/antiretroviral-therapy/switching-antiretroviral-therapy/core-concept/all#page-title
  2. POZ.com. Switching HIV Treatment. 2026. Accessed September 2026. Available at: https://www.poz.com/basics/hiv-basics/switching-hiv-treatment
  3. Foka FET, Mufhandu HT. Current ARTs, virologic failure, and implications for AIDS management: A systematic review. Viruses. 2023;15(8):1732.
  4. NIAID. 10 Things to Know About HIV Suppression. 2025. Accessed September 2026. Available at: https://www.niaid.nih.gov/diseases-conditions/10-things-know-about-hiv-suppression
  5. NIH.gov. HIV Drug Resistance. 2026. Accessed September 2026. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/drug-resistance
  6. AIDSMAP. What happens to HIV drugs in the body, and do missed doses matter? 2023. Accessed September 2026. Available at: 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. 2026. Accessed September 2026. Available at: https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/taking-your-hiv-medications-every-day
  8. HIV.gov. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. 2024. Accessed September 2026. Available at: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/what-start-initial-combination-regimens
  9. AIDSMAP. Side-effects of HIV treatment. 2025. Accessed September 2026. Available at: https://www.aidsmap.com/about-hiv/side-effects-hiv-treatment
  10. AIDSMAP. HIV treatment and drug-drug interactions. 2024. Accessed September 2026. Available at: https://www.aidsmap.com/about-hiv/hiv-treatment-and-drug-drug-interactions
  11. Johns Hopkins University Clinical Guidelines Program. Resource: ART Drug-Drug Interactions. 2025. Accessed September 2026. Available at: https://www.hivguidelines.org/guideline/hiv-art-drug-interactions/
  12. HIV.gov. Recommendations for Antiretroviral Drugs Use During Pregnancy. 2026. Accessed September 2026. Available at: https://clinicalinfo.hiv.gov/en/guidelines/perinatal/recommendations-arv-drugs-pregnancy-overview
  13. BHIVA. BHIVA guidelines on the management of HIV in pregnancy and the postpartum period 2025. Accessed September 2026. Available at: https://bhiva.org/wp-content/uploads/2025/06/BHIVA-guidelines-on-the-management-of-HIV-in-pregnancy-and-the-postpartum-period.pdf 
  14. Eke AC, Lockman S, Mofenson LM. Antiretroviral treatment of HIV/AIDS during pregnancy. JAMA. 2023;329(15):1308-1309.
  15. Wiesner A, Skrońska M, Gawlik G, Marcinkowska M, Zagrodzki P, Paśko P. Interactions of antiretroviral drugs with food, beverages, dietary supplements, and alcohol: A systematic review and meta-analyses. AIDS Behav. 2023;27(5):1441-1468.
  16. Magura J, Nhari SR, Nzimakwe TI. Barriers to ART adherence in sub-Saharan Africa: a scoping review toward achieving UNAIDS 95-95-95 targets. Front Public Health. 2025;13:1609743.
  17. NIH.gov. FDA-Approved HIV Medicines. 2026. Accessed September 2026. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/fda-approved-hiv-medicines
  18. Oosterhof P, Van Luin M, Vanhommerig JW, Brinkman K, Burger DM. Impact of generic antiretroviral drugs introduction on pharmaceutical expenditure patterns in the Netherlands: a six-year retrospective database analysis from 2016 to 2022. BMC Health Serv Res. 2025;25(1):643.
  19. BHIVA. BHIVA Guidelines on Antiretroviral Treatment for Adults Living with HIV-1 2022 (2025 Interim Update). 2025. Accessed September 2026. Available at: https://bhiva.org/wp-content/uploads/2025/10/BHIVA-guidelines-on-antiretroviral-treatment-for-adults-living-with-HIV-1-2025-interim-update.pdf
  20. HIV.gov. Pill Burden. Accessed September 2026. Available at: https://clinicalinfo.hiv.gov/en/glossary/pill-burden
  21. Łupina K, Nowak K, Lorek D, et al. Pharmacological advances in HIV treatment: from ART to long-acting injectable therapies. Arch Virol. 2025;170(9):195.
  22. HIV.gov. Viral Suppression and an Undetectable Viral Load. 2026. Accessed September 2026. Available at: https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/viral-suppression
  23. Mocroft A, Pelchen-Matthews A, Hoy J, et al. Heavy antiretroviral exposure and exhausted/limited antiretroviral options: predictors and clinical outcomes. AIDS. 2024;38(4):497-508.
  24. Iheagwara C, Ezulike S, Anja M, Okobi OE. The latest trends and evolution of HIV medication management: A systematic review. Cureus. 2025;17(9):e91933.
  25. Chawla A, Wang C, Patton C, et al. A review of long-term toxicity of antiretroviral treatment regimens and implications for an aging population. Infect Dis Ther. 2018;7(2):183-195.
  26. U.S. Department of Veterans Affairs: HIV FAQs. 2019 Accessed September 2026. https://www.hiv.va.gov/patient/faqs/returning-to-old-meds.asp
  27. HIV.gov. Viral Rebound. Accessed September 2026. Available at: https://clinicalinfo.hiv.gov/en/glossary/viral-rebound
  28. BHIVA HIV Guidelines 2015: Summary for HIV Positive People. 2015. Accessed September 2026. Available at: https://bhiva.org/wp-content/uploads/2025/01/Changing-ART.pdf
  29. NIH.gov. Long-Acting HIV Medicine. 2026. Accessed September 2026. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/long-acting-hiv-medicine#
  30. Danjuma MIM, Khan S, Wahbeh F, Naseralallah LM, Jumbo UE, Elzouki A. What is polypharmacy in people living with HIV/AIDS? A systematic review. AIDS Res Ther. 2022;19(1):37.
  31. Danjuma MI, Adegboye OA, Aboughalia A, et al. Prevalence and global trends of polypharmacy among people living with HIV: a systematic review and meta-analysis. Ther Adv Drug Saf. 2022;13:20420986221080795.

NP-GBL-HVX-COCO-250013 September 2026

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.