HIV and ID Observations

I think we all have pet peeves, and so I’ll confess one of mine: I hate the term “HAART.” (I work with someone, by the way, who hates the term “viral load,” preferring “virus load.” Go figure.) Standing for “highly active antiretroviral therapy,” HAART first surfaced in the mid-1990s in order to distinguish potent anti-HIV treatment from the older, not-so-active form of antiretroviral therapy that preceded it. Writers often will use the phrases “era of HAART” or “advent of HAART,” both of which sound to me like essays on Dutch history.

But HAART has never been very precise — what exactly does it mean? 

The vagueness is illustrated by a quick Google search of “define: HAART,” which gives no fewer than 9 definitions, including:

• “A term for aggressive anti-HIV treatment” (Really? Isn’t it standard-of-care treatment? It’s not “aggressive” if everyone is doing it.)
• “Combination anti-HIV therapy, usually involving a protease inhibitor …” (Nope, not quite — EFV or NVP + 2 NRTIs is the most common initial treatment worldwide, so, in fact, HIV therapy does not “usually” involve a PI.)
• “Treatment [of HIV] with a very potent drug cocktail” (Uh-oh, another pet peeve alert — that never-to-die use of “cocktail” to describe HIV treatment, something the lay press still adores. Even worse, “potent cocktail”? A Mai Tai at Trader Vic’s, anyone?)
• “A combination of protease inhibitors taken with reverse transcriptase inhibitors” (Again, just wrong, though I suppose ritonavir-boosted PIs are a “combination of protease inhibitors,” so partial credit.)

Several years ago, when the imprecision of HAART first started to get under my skin, I suggested to one of our fellows that she do a review of published HIV clinical studies to collect the various definitions in common use at the time. She looked at me like I was out of my mind — okay, more like “get a life.” I still think it would be an interesting paper, but how would one do such a review — searching PubMed for HAART yields a mere 11, 937 results. 

The problem is that I don’t have a ready alternative. The D:A:D folks tried “cART” several years ago, standing for combination antiretroviral therapy (kind of liked that one), but I don’t see the abbreviation in their latest paper; I confess to using “ART” (antiretroviral therapy) when abbreviating HIV treatment; in AIDS Clinical Care, our Executive Editor prefers “potent combination antiretroviral therapy,” all 15 syllables worth. None of these terms gets it quite right, I’m afraid.

Any ideas? Or should I just give up? Help!