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Deep Dive #61  ·  Treatment

HIV Medications:
A Plain-Language Guide

Last reviewed: September 2026

Educational information only — not medical advice. Talk to your healthcare provider about your specific situation.

What you're taking, why it works, how the drug classes differ, and what treatment resistance means — in language that makes sense at your kitchen table, not just in a clinic chart.

💊 Once-Daily Pills 💉 Injectables 🧬 Drug Classes 🔬 Resistance 🖨️ Printable Reference
Not medical advice. This guide is for education and community reference. Your HIV provider determines the right regimen for you based on your full health history, resistance testing, and current status. If you have questions about your medications, ask your provider.
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⚙️ How ART Works 💊 Once-Daily Pills 💉 Injectables 🧬 Drug Classes 🔬 Resistance 🌴 Florida Access 🖨️ Printable Card 📚 References
The Foundation

How Antiretroviral Therapy Works

HIV replicates by using cells to make more copies of itself. Antiretroviral therapy (ART) does not cure HIV, but it interrupts that replication process at multiple points and can suppress the virus to undetectable levels.[4]

Modern ART commonly uses two or three medicines from different classes, each blocking HIV at a different point in its life cycle. That combination helps keep treatment effective and gives HIV fewer opportunities to develop resistance.[5]

When ART works as it should, your viral load can become undetectable, often within several months of starting treatment. Undetectable means the virus is suppressed, not eliminated. If treatment stops, the virus can rebound, so taking medication as prescribed matters.[6]

01
Block entry into cells
Entry inhibitors and fusion inhibitors prevent HIV from attaching to and entering CD4 cells in the first place.
02
Block reverse transcription
NRTIs and NNRTIs block the enzyme HIV uses to convert its RNA into DNA — a critical step in the replication cycle.
03
Block integration
Integrase inhibitors (INSTIs) — the most prescribed class today — prevent HIV's DNA from inserting itself into your cell's DNA.
04
Block assembly
Protease inhibitors and capsid inhibitors block HIV from assembling into mature, infectious particles that can infect new cells.

✅ U=U: The Most Important Thing ART Does

When you are on treatment and maintain an undetectable viral load, you do not sexually transmit HIV. This is U=U — Undetectable = Untransmittable. Read the full science →[7]

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Current Regimens

Once-Daily Pills

All of the medications below are taken once daily as a single pill. Some contain two active ingredients, some three or four — but the pill count is one. They are organized from most commonly prescribed to alternative regimens.

A note on "two-drug" vs. "three-drug": You may hear your provider mention Dovato or Juluca as "two-drug regimens." This means two active ingredients inside one pill — not two pills. The distinction matters clinically because two-drug regimens spare certain drug classes (particularly tenofovir), which can reduce long-term kidney and bone effects for some patients.

B
Biktarvy
bictegravir / emtricitabine / tenofovir alafenamide (TAF)
INSTI NRTI × 2
💊 Dosing 1 pill, once daily. Can be taken with or without food.
⭐ First-line? Recommended by federal guidelines as an initial regimen for many people starting ART.[8]
🧬 Why it works Bictegravir is an integrase inhibitor with a high barrier to resistance when used as part of a fully suppressive regimen.[9]
⚠️ Watch for Not recommended if creatinine clearance is below 30 mL/min. Monitor kidney function.
🚨 FL ADAP Restored July 1, 2026, for direct-dispense ADAP enrollees. CVS Caremark retail-dispense enrollees can receive co-pay and deductible assistance; confirm your dispensing route with ADAP or your Ryan White clinic.[10]
✓ Restored to FL ADAP — July 1, 2026 Gilead PAP available
D
Dovato
dolutegravir / lamivudine (3TC)
INSTI NRTI
💊 Dosing 1 pill, once daily. Two active ingredients — a "two-drug regimen" in one pill.
⭐ First-line? A recommended two-drug initial regimen for some people. It is not recommended with hepatitis B coinfection or when HIV RNA is above 500,000 copies/mL.[11]
🧬 Why it works Dolutegravir has a high resistance barrier. Lamivudine is well-tolerated with decades of safety data.
⚠️ Watch for Your clinician will review hepatitis B status, viral load, and treatment history before choosing this option.[12]
✓ Florida ADAP Covered ViiV PAP available
J
Juluca
dolutegravir / rilpivirine
INSTI NNRTI
💊 Dosing 1 pill, once daily with a meal. Two active ingredients — spares both tenofovir and emtricitabine.
⭐ First-line? Switch regimen for virally suppressed adults. Not used in treatment-naive patients.
🧬 Why it works The most "drug-sparing" oral regimen available — two classes, two drugs, zero tenofovir or emtricitabine.
⚠️ Watch for Must be taken with food. Rilpivirine requires stomach acid to absorb — avoid antacids and PPIs.
✓ Florida ADAP Covered ViiV PAP available
G
Genvoya
elvitegravir / cobicistat / emtricitabine / TAF
INSTI NRTI × 2
💊 Dosing 1 pill, once daily with food. Four active ingredients including a pharmacokinetic booster (cobicistat).
⭐ First-line? Alternative regimen. Many people switched from Stribild to Genvoya when TAF replaced TDF.
⚠️ Watch for Cobicistat has many drug interactions — review all medications carefully with your provider.
🌴 FL ADAP Do not rely on the old Descovy restriction as a blanket rule. Ask ADAP or your Ryan White clinic to confirm the current formulary and your dispensing route before a refill.[13]
⚠ Verify current ADAP coverage Gilead PAP available
O
Odefsey
rilpivirine / emtricitabine / TAF
NNRTI NRTI × 2
💊 Dosing 1 pill, once daily with a meal. TAF-based version of Complera with improved kidney/bone profile.
⭐ First-line? Alternative regimen for treatment-naive patients with viral load under 100,000 copies/mL.
⚠️ Watch for Must be taken with food. Avoid antacids and PPIs — rilpivirine needs stomach acid to absorb.
🌴 FL ADAP The July 2026 restoration changed the prior Descovy restriction. Confirm the current formulary and dispensing route with ADAP or your Ryan White clinic before a refill.[14]
⚠ Verify current ADAP coverage Gilead PAP available
S
Symtuza
darunavir / cobicistat / emtricitabine / TAF
PI NRTI × 2
💊 Dosing 1 pill, once daily with food. A protease inhibitor-based single tablet — important for certain resistance profiles.
⭐ First-line? Alternative regimen. Often used when INSTI resistance is present or suspected.
⚠️ Watch for Cobicistat increases drug interactions. Sulfa allergy possible (darunavir has a sulfonamide component).
🌴 FL ADAP The prior Descovy restriction is no longer the current statewide framing. Confirm this distinct product's current ADAP coverage and dispensing route with your clinic.[15]
⚠ Verify current ADAP coverage Janssen PAP available
T
Triumeq
dolutegravir / abacavir / lamivudine (3TC)
INSTI NRTI × 2
💊 Dosing 1 pill, once daily with or without food. Tenofovir-free — useful for patients with kidney concerns.
⭐ First-line? An alternative regimen. HLA-B*5701 screening is required before starting because abacavir can cause a serious hypersensitivity reaction.[16]
⚠️ Watch for HLA-B*5701 positive patients must not take abacavir. Possible cardiovascular risk — discuss history with provider.
✓ Florida ADAP Covered ViiV PAP available
D
Delstrigo
doravirine / lamivudine / tenofovir disoproxil fumarate (TDF)
NNRTI NRTI × 2
💊 Dosing 1 pill, once daily with or without food. Uses TDF (older tenofovir) rather than TAF.
⭐ First-line? Alternative regimen. Doravirine is a newer NNRTI with a better resistance profile than efavirenz.
⚠️ Watch for TDF carries higher kidney and bone risk than TAF over time — monitoring recommended.
⚠ Verify ADAP coverage Merck PAP available
Still in use today

Many people are doing well on regimens that are no longer first-line — including Truvada + Isentress (raltegravir), Truvada + Tivicay (dolutegravir), Atripla, Complera, and older boosted protease inhibitor combinations. If you are undetectable and tolerating your medication, that matters. Your provider may discuss switching for a specific clinical reason, such as kidney concerns, drug interactions, resistance, or simplification. Being on an older regimen does not automatically mean you are receiving inferior care.[17]

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Long-Acting Treatment

Injectable & Long-Acting Options

For people who are virally suppressed on oral ART, long-acting injectable regimens can offer an alternative to a daily pill. These treatments are administered by a clinician, not self-injected at home.[18]

💉
Cabenuva
cabotegravir + rilpivirine (two injections)
INSTI NNRTI
📅 Schedule Two intramuscular injections at a clinic, given monthly or every two months after the appropriate start-up schedule.[19]
✅ Who it's for Adults with sustained viral suppression and no known or suspected resistance to cabotegravir or rilpivirine; your clinician will review the full eligibility criteria.
🧬 Why it's different It replaces daily pills with scheduled clinic visits. Reliable appointment planning matters because late doses need a clinical plan.
⚠️ Watch for Injection site reactions are common. Missing appointments creates risk — build in reminder systems.
✓ Florida ADAP Covered ViiV PAP available
💉
Sunlenca / Yeztugo
lenacapavir
Capsid Inhibitor
📅 Schedule Two subcutaneous injections every 26 weeks, used with other HIV medicines for treatment-experienced adults with multidrug-resistant HIV.[20]
✅ Who it's for Sunlenca: treatment-experienced adults with multidrug-resistant HIV, used with other ART. Yeztugo: lenacapavir for HIV prevention, approved in June 2025; it is not HIV treatment.[21]
🧬 Why it's different First-in-class capsid inhibitor — a completely new mechanism that works even when other drug classes have failed.
⚠️ Watch for Injection site nodules can persist for months — not harmful but noticeable. Access is still expanding.
⚠ Verify ADAP coverage Gilead PAP available

What's coming next in HIV treatment?

From broadly neutralizing antibodies to once-yearly injectables to functional cure research — the pipeline has never been more promising.

Read the Deep Dive →
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How They Work

HIV Drug Classes Explained

Every HIV medication belongs to a class defined by its mechanism — where and how it blocks the virus. Understanding classes helps you understand why your regimen is built the way it is, and why combination therapy is so effective.

Integrase Strand Transfer Inhibitors
INSTIs
Block the integrase enzyme, preventing HIV's DNA from inserting into your cell's DNA. These medicines are central to many current initial regimens and have a high barrier to resistance.
[22]
Key drugs: bictegravir (Biktarvy), dolutegravir (Dovato, Juluca, Triumeq), cabotegravir (Cabenuva), elvitegravir (Genvoya), raltegravir (Isentress)
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
NRTIs
The backbone of most regimens. Block the reverse transcriptase enzyme, preventing HIV from converting its RNA into DNA. Decades of safety data.
Key drugs: tenofovir alafenamide/TAF, tenofovir/TDF, emtricitabine/FTC, lamivudine/3TC, abacavir/ABC
Non-Nucleoside Reverse Transcriptase Inhibitors
NNRTIs
Also block reverse transcriptase, but at a different binding site than NRTIs. Lower resistance barrier than INSTIs — one mutation can cause resistance to older NNRTIs.
Key drugs: rilpivirine (Odefsey, Juluca, Cabenuva), doravirine (Delstrigo), efavirenz (Atripla — older), etravirine
Protease Inhibitors
PIs
Block the protease enzyme, preventing HIV from assembling mature infectious copies of itself. Often require a pharmacokinetic booster (ritonavir or cobicistat) to reach effective levels.
Key drugs: darunavir (Symtuza, Prezista), atazanavir, lopinavir — boosted with ritonavir or cobicistat
Capsid Inhibitors
CIs — Newest Class
Block the HIV capsid protein, disrupting multiple stages of the virus's replication cycle. Lenacapavir is the approved capsid inhibitor used in treatment for adults with multidrug-resistant HIV.
Key drug: lenacapavir (Sunlenca for treatment, Yeztugo for PrEP)
Entry & Fusion Inhibitors
Entry Inhibitors
Prevent HIV from attaching to and entering CD4 cells. Used primarily in treatment-experienced patients with resistance to other classes.
Key drugs: maraviroc (CCR5 antagonist — requires tropism testing), ibalizumab (IV infusion), fostemsavir, enfuvirtide (older, injectable)
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When Treatment Gets Complicated

Treatment Resistance — What It Means & What Your Options Are

HIV resistance sounds frightening. It isn't the end of options — not even close. Here's what it actually means and what happens next.

What is HIV drug resistance?

HIV mutates constantly as it replicates. Most mutations are dead ends — they weaken the virus. But occasionally a mutation helps the virus escape a drug. When that mutation survives and replicates, you have a resistant strain.

Resistance can develop when:

  • Doses are missed consistently — giving the virus room to replicate in the presence of low drug levels
  • A regimen isn't strong enough to fully suppress the virus (more common with older drugs)
  • Resistance is transmitted at the time of infection — your virus was already resistant before you started treatment
  • An older drug class with a low "genetic barrier" was used — one mutation can be enough

This is why modern first-line drugs such as bictegravir and dolutegravir have high barriers to resistance: resistance is less likely when treatment remains fully suppressive, although it is never something to diagnose or manage alone.[23]

The most important thing: People with extensive resistance histories may still have treatment options. Lenacapavir (Sunlenca), a capsid inhibitor, was developed for treatment-experienced adults with multidrug-resistant HIV and is used with an optimized background regimen.

Resistance Testing

If your viral load is detectable on treatment, your provider will order resistance testing before changing your regimen. There are two types:

Genotypic testing — sequences the virus's genetic code to identify known resistance mutations. Faster, less expensive, most commonly used.

Phenotypic testing — directly tests how well drugs suppress your actual virus in the lab. More comprehensive but slower and more expensive. Used when genotypic results are complex or ambiguous.

Salvage Regimens & Switching

For people with resistance to multiple drug classes, salvage regimens combine drugs that still work based on resistance test results, sometimes including entry inhibitors, older classes, or lenacapavir. An HIV specialist — not just a general practitioner — should manage complex resistance cases.

For people who are virally suppressed but want to switch for other reasons (simplification, side effects, kidney concerns, pregnancy, or moving to injectable), switching is routine and safe when done carefully under provider guidance.

🔬 Talk to your provider — not the internet

Resistance is highly individual. Two people with "the same" resistance mutations may have very different options depending on their full history. The only way to know your options is through a full resistance panel reviewed by your HIV provider or specialist. Find an HIV provider in Florida →

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Getting Your Medications

Florida Access & ADAP

HIV medications are expensive, but Florida has several access pathways through ADAP, Ryan White providers, insurance assistance, and manufacturer programs. The March 2026 ADAP disruption was serious; the current situation is different from the early drafts of this guide.

Florida ADAP Formulary — Updated August 2026

What Changed — and What to Confirm Before Your Refill

March 2026 — Historical Context
Biktarvy was removed
Florida DOH removed Biktarvy from the ADAP formulary in March 2026. A joint public comment reported that about 60% of Florida ADAP clients were taking Biktarvy at the time, helping explain why the change caused immediate concern.[24]
March–June 2026 — Legislative Response
Eligibility funding was restored
On March 24, 2026, Governor DeSantis signed HB 697 after the Legislature appropriated $30.9 million to restore ADAP eligibility to 400% of the federal poverty level through June 30, 2026.[25] [26]
July 1, 2026 — Current Status
Biktarvy and Descovy were restored
Florida DOH restored Biktarvy and Descovy to the ADAP formulary for direct-dispense enrollees. CVS Caremark retail-dispense enrollees can receive co-pay and deductible assistance for these medicines.[27]

Updated August 2026: This article no longer treats Biktarvy and Descovy as still removed. Your access can depend on enrollment and dispensing route, so verify your current benefits before a refill rather than relying on old formulary screenshots or social posts.

If you are having trouble getting Biktarvy or Descovy through ADAP: Call Florida ADAP client services at 1-844-381-2327 and contact your Ryan White clinic right away. Gilead Advancing Access may also help eligible people with out-of-pocket costs or medication access. See all manufacturer programs →

Ryan White HIV Program — If you lose coverage or are uninsured, your Ryan White clinic is an important place to start. Local programs can help connect people to HIV medical care, medications, and support services. Learn more about Ryan White →

340B pricing — Many Ryan White clinics and federally qualified health centers participate in the federal 340B drug-pricing program. That can help clinics stretch resources and support access to medications and care.

📋 Read the full ADAP crisis coverage

What changed, who's affected, what the advocacy response looks like, and what to do now — all documented. What happened to Florida ADAP →  |  Special Enrollment guide →

🌴 Find HIV Care in Florida

195+ Florida HIV organizations — Ryan White clinics, ADAP enrollment sites, telehealth providers, and support services. Search by ZIP code. Open the Florida HIV Care Locator →

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Take It With You

HIV Medication Reference Card

Save it to your phone, share it with a caregiver, or print it for your next appointment. Switch between views using the buttons below.

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A note from the founder — RiseUpToHIV

I've been living with HIV for 16 years. When I was diagnosed, the conversation about medications was overwhelming — acronyms, drug classes, side effects I couldn't pronounce. I wish someone had handed me a guide like this.

The single most important thing I can tell you: get into care, start treatment, and stay on it. Everything else — which pill, which class, which regimen — is a conversation between you and your provider. What matters is that you show up for that conversation.

If you need help finding care in Florida, the locator is right here. You don't have to figure this out alone.

Related articles
Treatment Hub Long-Acting Treatment Understanding Your Labs U=U Explained All Deep Dives →

References & Sources

  1. HIV/AIDS Management, including Florida ADAP information — Florida Department of Health. https://www.floridahealth.gov/individual-family-health/injury-prevention-wellness/hiv-aids/hiv-aids-management/. ↩
  2. Advancing Access patient-support program — Gilead Sciences. https://www.gileadadvancingaccess.com/. ↩
  3. Ryan White HIV/AIDS Program — Health Resources and Services Administration. https://ryanwhite.hrsa.gov/. ↩
  4. Drug Characteristics Tables — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-characteristics-tables. ↩
  5. What to Start: Initial Combination Antiretroviral Regimens — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/what-start-initial-combination-regimens. ↩
  6. What to Start: Initial Combination Antiretroviral Regimens — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/what-start-initial-combination-regimens. ↩
  7. Undetectable = Untransmittable — Centers for Disease Control and Prevention. https://www.cdc.gov/global-hiv-tb/php/our-approach/undetectable-untransmittable.html. ↩
  8. What to Start: Initial Combination Antiretroviral Regimens — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/what-start-initial-combination-regimens. ↩
  9. Drug Characteristics Tables — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-characteristics-tables. ↩
  10. HIV/AIDS Management, including current Florida ADAP information — Florida Department of Health. https://www.floridahealth.gov/individual-family-health/injury-prevention-wellness/hiv-aids/hiv-aids-management/. ↩
  11. What to Start: Initial Combination Antiretroviral Regimens — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/what-start-initial-combination-regimens. ↩
  12. Drug Characteristics Tables — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-characteristics-tables. ↩
  13. HIV/AIDS Management, including current Florida ADAP information — Florida Department of Health. https://www.floridahealth.gov/individual-family-health/injury-prevention-wellness/hiv-aids/hiv-aids-management/. ↩
  14. HIV/AIDS Management, including current Florida ADAP information — Florida Department of Health. https://www.floridahealth.gov/individual-family-health/injury-prevention-wellness/hiv-aids/hiv-aids-management/. ↩
  15. HIV/AIDS Management, including current Florida ADAP information — Florida Department of Health. https://www.floridahealth.gov/individual-family-health/injury-prevention-wellness/hiv-aids/hiv-aids-management/. ↩
  16. Drug Characteristics Tables — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-characteristics-tables. ↩
  17. What to Start: Initial Combination Antiretroviral Regimens — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/what-start-initial-combination-regimens. ↩
  18. FDA approval of Cabenuva for every-two-month dosing — ViiV Healthcare. https://viivhealthcare.com/hiv-news-and-media/news/press-releases/2022/january/viiv-healthcare-announces-fda-approval-of-cabenuva-for-use-every-two-months/. ↩
  19. Cabenuva prescribing information — U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/212888s005s006lbl.pdf. ↩
  20. Sunlenca FDA approval history — Drugs.com. https://www.drugs.com/history/sunlenca.html. ↩
  21. Yeztugo (lenacapavir) FDA approval for HIV prevention — Gilead Sciences. https://www.gilead.com/news/news-details/2025/yeztugo-lenacapavir-is-now-the-first-and-only-fda-approved-hiv-prevention-option-offering-6-months-of-protection. ↩
  22. Drug Characteristics Tables — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-characteristics-tables. ↩
  23. Drug Characteristics Tables — NIH ClinicalInfo. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/drug-characteristics-tables. ↩
  24. Joint public comment on Florida ADAP formulary changes — HealthHIV. https://healthhiv.org/wp-content/uploads/2026/03/2026_ADAP_Public_Comment_Florida_DOH_ADAP_03.02.26-Joint-Statement-HealthHIV.pdf. ↩
  25. Remarks on HB 697 and Florida ADAP funding — Florida Senate. https://www.flsenate.gov/PublishedContent/Offices/President/3_10_26_ADAP_Release_and_Remarks_as_Prepared_Combined.pdf. ↩
  26. Governor DeSantis signs HB 697 — AIDS Healthcare Foundation. https://www.aidshealth.org/2026/03/gov-desantis-signs-emergency-bill-restoring-hiv-drug-access-for-over-12000-floridians/. ↩
  27. HIV/AIDS Management, including the July 2026 ADAP restoration — Florida Department of Health. https://www.floridahealth.gov/individual-family-health/injury-prevention-wellness/hiv-aids/hiv-aids-management/. ↩