"HAART Era" Now Longer Than "Pre-HAART Era" -- Can We Officially Retire "HAART"?
July 1, 2012
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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Comment by: harleymc
Sun., Dec. 23, 2012 at 6:38 am EST
the HAART acronym probably should be consigned to the dustbin of history for an entirely different reason. Combination therapies can and do fail especially on heavily pretreated patients many of whom have never had a fresh three drug combination.
The Highly Active part of the acronym lulls both doctors and patients into a false sense of security. Combination antiretroviral therapy (CART) certainly fills the same role in differentiateing from the early monotherapy days, but without the false sense of security.
Comment by: ALex
Wed., Jul. 18, 2012 at 7:18 pm EDT
I agree 110% with u... the term "HAART" is somewhat stigmatizing us hiv+.. I don't know another field that uses the suffix "highly active" .. it put emphasis on the fact that this are potent meds with potent side effects... and they remind you this every month..stop use the term "HAART"
Comment by: James John
Mon., Jul. 16, 2012 at 9:55 pm EDT
This assumes that all patients can afford these drugs. Many cannot and if Mitt Romney and his Republican mob get elected, you can expect to see a lot more people unable to afford HIV meds with no place to turn to.
Comment by: Scott
Fri., Jul. 13, 2012 at 1:39 am EDT
As a person that went from HIV to AIDS while being treated with HAART -it's now time to research the past studies suggesting HIV as co-factor and not play political games.AIDS is still terminal to some of us!HAART is still toxic therapy.Much of HIV as the cause of AIDS research was discredited.
Lets go back and prove or disprove facts with documentation by independent labs.
Comment by: Julianna K.
Wed., Jul. 11, 2012 at 3:33 pm EDT
My only concern with this proposal is that in many low-resource countries, HAART is not necessarily the norm--particularly for prevention of mother-to-child transmission. Given that the majority of infections (and the majority of treatment) now occurs outside of the US and Europe (with plenty of people researching and publishing related to these environments), I would say there's still room for the phrase.
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