"HAART Era" Now Longer Than "Pre-HAART Era" -- Can We Officially Retire "HAART"?

July 1, 2012

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

As I've shared before, I'm no fan of the term "HAART" and do everything I can to stop people from using it.

(I'm a fun guy to have at parties.)

I'm returning to this pet peeve of mine because I realized recently that we've passed a milestone of sorts:

  • Period of no effective HIV treatment, 15 years (1981-1996)
  • Period of effective HIV treatment, 16 years (1996-2012)

I came to this realization while reviewing a manuscript on an HIV-related complication. The author repeatedly (and at great length) described how this complication had changed with the "advent of HAART" (cringe) -- incidence down, prognosis better, management altered. There were many comparisons between the "pre-HAART era" and the "post-HAART era," even a separate table on the differences.

Of historical interest, yes, but hardly earth-shattering news at this point , and not of much practical use to the reader -- pretty much everything changed with effective HIV treatment.

The bottom line is that HIV-related complications should be considered now only in the context of patients who are receiving, or who are about to receive, antiretroviral therapy. In other words, describing how to manage HIV-related complications without HIV treatment would be like an endocrinologist describing management of Type 1 diabetes complications without insulin.

So since HIV treatment is now the new normal -- becoming more so with each passing year -- let's just call it antiretroviral therapy, and assume that it's standard of care to give the highly active kind.

And if you want to abbreviate it, "ART" will do just fine.

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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This article was provided by NEJM Journal Watch. NEJM Journal Watch is a publication of the Massachusetts Medical Society.


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