The History of HIV Treatment: Antiretroviral Therapy and More

Medically Reviewed by Shruthi N, MD on September 18, 2024
Written by Stephanie Watson, Keri Wiginton
12 min read

The history of HIV in the U.S. spans more than four decades. In 1981, reports of strange illnesses began emerging in New York and California. Previously healthy young gay men were suddenly affected by Kaposi’s sarcoma, a rare, fast-growing cancer typically seen in older males or those with weakened immune systems.

By the end of 1981, 337 cases of severe immune deficiency were reported, affecting adults, teens, and children under 13 (including babies).

A year later, the CDC named the mysterious disease acquired immune deficiency syndrome, or AIDS. Once the virus took hold in your body, it attacked your immune system. If you developed AIDS (the last stage of HIV), you could no longer fight any infections. Before effective HIV treatments were available, people often faced the risk of death within a year of diagnosis.

Since mostly gay men were getting sick, health officials and the public often referred to HIV as “gay cancer.” The stigma linking HIV to the LGBTQ+ community led to poor funding for treatment and unfair treatment for those diagnosed with the virus in areas such as housing, work, and other parts of society.

Today, if you have HIV, laws protect you against discrimination. Modern antiretroviral therapy (ART) can help you live just about as long as you would without the virus. But these changes didn’t happen overnight. Learn more about the history of HIV.

HIV history timeline

Here are some of the key moments in the history of HIV: 

  • 1981: The first cases of severe immunodeficiencies were reported to the CDC.
  • 1982: The CDC used the term AIDS, or acquired immune deficiency syndrome, for the first time.
  • 1983: French scientists at the Pasteur Institute discovered the virus that causes AIDS.
  • 1986: The virus causing AIDS was officially named HIV, or human immunodeficiency virus. 
  • 1987: The FDA approved Zidovudine (AZT), the first antiretroviral drug used to treat HIV. The sale of male condoms for preventing HIV was also authorized by the FDA. Princess Diana publicly shook hands with someone living with HIV.
  • 1991: The red ribbon became the symbol of HIV/AIDS support and awareness. Basketball player Magic Johnson told the public he had HIV. 
  • 1996: Highly active antiretroviral therapy (HAART) hit the market, boosting the life expectancy of someone with HIV by 15 years. 
  • 2007: Timothy Ray Brown, known as the “Berlin patient,” got a bone marrow transplant to treat his leukemia. A few months later, doctors could no longer detect HIV in his blood despite no longer being on ART. He is the first person thought to be “cured” of cancer. (Though, there is no proven cure for HIV.)
  • 2010: A study found evidence that pre-exposure prophylaxis (PrEP) works. Researchers found that taking a daily dose of antiretrovirals not only helped those with HIV but also protected people without HIV from getting the virus. 
  • 2012: The FDA approved the first at-home HIV test and the drug Truvada, a once-daily PrEP pill.
  • 2021: The FDA approved cabotegravir and rilpivirine (Cabenuva), the first long-acting shot used as a complete HIV treatment regimen. The PrEP extended-release injectable cabotegravir suspension (Apretude) also got FDA approval.

While anyone can get HIV, the virus is more common among men or people assigned male at birth who have sex with other men. And the history of HIV is closely tied to stigma and discrimination against people in the LGBTQ+ community, including transgender women. 

During the early years of the HIV epidemic, the virus was first referred to as gay-related immune deficiency (GRID). On top of believing it was a type of cancer that only affected gay men, some labeled it the “gay plague.”

Here are some examples of discrimination throughout the history of HIV:

  • In the 1980s, many states made intimacy among same-sex couples illegal.
  • More than 35 states criminally punished sexual behaviors that might transmit HIV.
  • Family members and landlords refused to house people with HIV/AIDS.
  • People lost their jobs because they had HIV/AIDS.
  • Health professionals wouldn’t touch or treat people with HIV/AIDS.
  • Obituaries wouldn’t mention if someone died of AIDS.

Many believe negative views against gay men and people in the LGBTQ+ community played a part in the slow government response to the AIDS crisis. But strong support from advocacy groups led to action. By the 1990s, people with HIV could be treated with highly active antiretroviral therapy (HAART) and other types of antiretroviral therapy.

People with HIV and those in the LGBTQ+ community now have more rights and access to medical care. But HIV stigma still exists. Here’s what that might look like:

  • Someone who thinks only certain kinds of people can get HIV
  • Judging someone in a negative way for taking PrEP or other steps to prevent HIV
  • Thinking people deserve to get sick because they make certain lifestyle choices
  • Health professionals who judge you negatively because of your lifestyle choices
  • Doctors who won’t treat you because you have HIV
  • Feeling guilt or shame about having HIV (self-stigma or internalized stigma)

Discrimination against people with HIV is illegal. The Americans with Disabilities Act (ADA) guarantees you equal access to jobs, transportation, hospitals, or public places (restaurants, movies, hospitals, gyms, doctor offices, etc.).

HIV is hard to kill. For one thing, it attacks immune cells called T helper cells. These normally identify and clear viruses from your body. But when lots of your T cells get destroyed, your body can’t protect you against viruses very well. This leaves you open to HIV and other “opportunistic” infections, including pneumonia, tuberculosis (TB), and yeast infections.

HIV is a retrovirus, which means it’s better at invading your cells than viruses that cause things such as colds or the flu. It can bypass your immune system and take control by getting inside your DNA. If left untreated, HIV keeps making copies of itself and stays in your body permanently.

Researchers discovered that zidovudine (Retrovir), a failed cancer drug from the 1960s, could stop HIV from multiplying and help people with AIDS live longer. Also called azidothymidine (AZT), the FDA approved the medication as a treatment for HIV and AIDS in 1987. AZT blocks enzymes that the virus needs to replicate.

AZT showed that it could delay the progression of HIV to AIDS. But it wasn’t a cure and had other drawbacks. It was the most expensive drug in history (at the time) and didn’t work very well when used to treat HIV on its own. It also caused side effects such as liver problems and low bloodcell counts that could be deadly.

Over the next several years, researchers found that a lower dose of AZT could help treat HIV without the same serious side effects. The FDA also approved several other drugs that worked similarly to AZT. They belonged to a drug class called nucleoside reverse transcriptase inhibitors (NRTIs).

In the 1990s, studies revealed that combining AZT with the NRTI drug dideoxycytidine, also called zalcitabine, worked better than using AZT alone. This breakthrough led to the use of combination therapy in treating HIV and AIDS.

Reverse transcriptase is an enzyme that HIV and other viruses use to change their RNA into DNA. This lets HIV enter your cells and make more copies of itself, a process known as reverse transcription. 

AZT and other nucleoside reverse transcriptase inhibitors (NRTIs) block this enzyme, which stops the reverse transcription process and prevents HIV from multiplying.

A handful of early NRTIs are no longer available in the U.S. or only available in certain formulations or aren’t commonly recommended by doctors. Here is a list of FDA-approved nucleoside reverse transcriptase inhibitors and the year they were approved:

  • Zidovudine (AZT, Retrovir): 1987
  • Lamivudine (3TC, Epivir): 1995
  • Abacavir (Ziagen): 1998
  • Tenofovir disoproxil fumarate (Viread): 2001
  • Emtricitabine (Emtriva): 2003

Protease inhibitors 

Protease inhibitors are drugs used to treat HIV, along with viral infections such as hepatitis C and COVID-19. They block protease, an enzyme HIV and other viruses need to make copies of themselves.

Here’s a list of FDA-approved protease inhibitors used to treat HIV and the year they were approved (some formulations have been discontinued):

  • Saquinavir (Invirase): 1995
  • Ritonavir (Norvir): 1996
  • Indinavir (Crixivan): 1996
  • Nelfinavir (Viracept): 1997
  • Lopinavir/ritonavir (Kaletratra): 2000
  • Atazanavir (Reyataz): 2003
  • Fosamprenavir (Lexiva): 2003
  • Tipranavir (Aptivus): 2005
  • Darunavir (Prezista): 2006

Non-nucleoside reverse transcriptase inhibitors (NNRTIs)

NNRTIs also block HIV from using the reverse transcriptase enzyme. This prevents the virus from completing a crucial step needed to insert itself into your DNA, preventing it from making copies of itself and spreading.

Here’s a list of FDA-approved non-nucleoside reverse transcriptase inhibitors used to treat HIV and the year they were approved:

  • Nevirapine (Viramune): 1996
  • Efavirenz (Sustiva): 1998
  • Etravirine (Intelence): 2008
  • Rilpivirine (Edurant): 2011
  • Nevirapine extended-release (Viramune XR): 2011
  • Doravirine (Pifeltro): 2018
  • Rilpivirine for ages 2 and up (Edurant PED): 2024

Four NNRTIs are FDA-approved to treat people who are just starting HIV treatment. Those are doravirine, efavirenz, nevirapine, and rilpivirine. Your doctor might suggest etravirine if you’ve been on ART for a while and you need to switch to something else.

Highly active antiretroviral therapy, or HAART, is when you take a combination of three or more drugs to treat HIV. You may also hear this called combination antiretroviral therapy (cART). This method is more effective at suppressing the virus than using a single drug and became the go-to HIV treatment by 1997.

You had to take multiple pills a day when HAART first became the standard of care for people with HIV. This complex routine, along with drug side effects, made treatment hard to stick with. But in 1997, the FDA approved a pill called lamivudine/zidovudine (Combivir) that contained two HIV drugs and was easier to take.

Antiretroviral therapy typically includes two or three medicines from one of seven different drug classes. Your HIV treatment regimen may change over time.

Here is a list of FDA-approved combination HIV medicines and the year they were approved:

  • Abacavir and lamivudine (Epzicom): 2004
  • Abacavir, dolutegravir, and lamivudine (Triumeq, Trumeg PD): 2014
  • Abacavir, lamivudine, and zidovudine (Trizivir): 2000
  • Atazanavir and cobicistat (Evotaz): 2015
  • Bictegravir, emtricitabine, and tenofovir alafenamide (Biktarvy): 2018
  • Cabotegravir and rilpivirine (Cabenuva): 2021
  • Darunavir and cobicistat (2015)
  • Earunavir, cobicistat, emtricitabine, and tenofovir alafenamide (Symtuza): 2018
  • Dolutegravir and lamivudine (Dovato): 2019
  • Doravirine, lamivudine, and tenofovir disoproxil fumarate (Delstrigo): 2018
  • Efavirenz, emtricitabine, and tenofovir disoproxil fumarate (Atripla): 2006
  • Efavirenz, lamivudine, and tenofovir disoproxil fumarate (Symfi, Symfi Lo): 2018
  • Elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (Genvoya): 2015
  • Elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate (Stribild): 2012
  • Emtricitabine, rilpivirine, and tenofovir alafenamide (Odefsey): 2016
  • Emtricitabine, rilpivirine, and tenofovir disoproxil fumarate (Compiera): 2011
  • Emtricitabine and tenofovir alafenamide (Descovy): 2016
  • Emtricitabine and tenofovir disoproxil fumarate (Truvada): 2004
  • Lamivudine and tenofovir disoproxil fumarate (Cimduo): 2018
  • Lamivudine and zidovudine (Combivir): 1997
  • Lopinavir and ritonavir (Kaletra): 2000

PrEP is a medicine you take to prevent HIV. You get two shots 1 month apart, and then every 2 months after that. When you take PrEP exactly as prescribed, it can lower your risk of acquiring HIV to almost zero.

There are two FDA-approved pills you can take for PReP. When you take them exactly as prescribed — meaning every day — your chances of getting HIV through sex become almost zero. If you take drugs using needles, PrEP lowers your odds of HIV by at least 74%.

PReP drugs and the year they were approved include:

  • Emtricitabine and tenofovir disoproxil fumarate (Truvada): 2004
  • Emtricitabine and tenofovir alafenamide (Descovy): 2016
  • Cabotegravir injection (Apretude): 2021

According to the U.S. Preventive Services Task Force, anyone who tests negative for HIV but is likely to be exposed to the virus should take PReP. The odds of acquiring HIV are higher for you if you have vaginal or anal sex with someone who has HIV, you routinely have unprotected sex with multiple partners, or you inject drugs or share needles.

In 2007, the FDA approved raltegravir (Isentress), the first integrase strand transfer inhibitor (INSTI). As the name suggests, integrase inhibitors stop HIV from making integrase — an enzyme found in retroviruses.

HIV uses integrase to get inside the DNA of CD4 cells (white blood cells that help your immune system fight infections). Once it does that, HIV can make copies of itself. INSTIs block that process.

Integrase inhibitors commonly used to treat HIV and the year they were approved include: 

  • Raltegravir (Isentress, Isentress HD): 2007, 2017
  • Dolutegravir (Tivicay, Tivicay PD): 2020
  • Cabotegravir (Vocabria): 2021 

Cabotegravir is a newer INSTI. It’s approved to treat HIV in adults who’ve already been on other treatments and have achieved viral suppression.

Your body makes antibodies to find and get rid of germs. Monoclonal antibodies are antibodies made in a lab. They’re often used to treat cancer. When used to treat HIV, these drugs attach to a specific protein on the surface of the HIV cell. 

Ibalizumab (Trogarzo) was approved in 2018. It’s the only monoclonal antibody approved to treat adults with HIV. It’s used in combination with other antiretroviral drugs. Your doctor might suggest it if you’ve been on ART for a long time and your current HIV treatment regimen isn’t working anymore.

Ongoing antiretroviral therapy (ART) can suppress HIV in your body so that you’re less likely to have symptoms or transmit the virus to other people. But right now, you still need to take ART regularly for the rest of your life to keep your immune system healthy. Future treatments for HIV may change that. 

Experimental therapies for HIV may include: 

  • More long-acting drugs
  • Antibodies that help your body find and kill HIV cells
  • Therapeutic vaccines that help your immune system fight HIV
  • Genetically engineered HIV-resistant immune cells
  • Immunotherapies that may cure HIV

There’s ongoing research to find other treatments that may suppress HIV for good. Ask your doctor if a clinical trial is right for you. Find more information at ClinicalTrials.gov or Clinicalinfo.hiv.gov.

Today, there are more than 30 HIV medications available. In many cases, you can control the virus with just one pill a day. If you start antiretroviral therapy early, you may never get AIDS or related conditions, such as certain cancers. 

HIV treatment can also reduce your chances of transmitting the virus to your partner during sex. While there’s no cure for HIV, the right treatment allows you to live a healthy life, almost as if you didn’t have HIV.

When did they find a cure for HIV?

There’s no proven cure for HIV, but there’s growing evidence that stem cell transplants (like the kind used to treat cancer) may offer hope for a cure one day.

In 2007, a man diagnosed with HIV no longer tested positive for the virus 3 months after he received a stem cell transplant for leukemia (cancer of the blood). He’s known as the “Berlin Patient.” Since then, seven people have possibly been cured of HIV.

When was AIDS first reported?

In 1981, the first person with AIDS in the U.S. was admitted to the Clinical Center at the National Institutes of Health. Before that, several young gay men went to the hospital with infections caused by weakened immune systems, thought to be early cases of HIV.

Who came up with a cure for AIDS?

There’s no cure for AIDS, but researchers around the world continue to search for one.

How has HIV treatment changed?

In 1987, azidothymidine (AZT) became the first and only FDA-approved drug used to treat HIV/AIDS. AZT helped people live longer, but it couldn’t stop the virus from replicating when taken alone. Today, you can take a combination of antiretroviral drugs that will suppress your viral load so much that doctors can’t detect HIV in your blood.

What is the most successful HIV treatment?

Antiretroviral therapy (ART) is a group of medicines used to treat HIV. People usually take a combination of HIV drugs, which includes taking pills or shots every day or every couple of months. The exact medicines in your HIV treatment regimen may differ from someone else or change over time.

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