April 10th, 2008

Needed: Something Better than “HAART”

dutch springI 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 are the most common initial treatments 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!

6 Responses to “Needed: Something Better than “HAART””

  1. Martin says:

    I like your cART but I think HAART will stay as everybody who thinks about this subject will see the mass (mess?) of 11,937 PubMed hits…

  2. Paul Sax says:

    I’m still hopeful “HAART” will go away eventually — after all, we don’t refer to penicillin for syphilis as “HAST” (highly-active syphilis treatment)!

  3. rachna says:

    HAART sounds complicated and confusing. Simple,”ART”‘ is better. Even patients can follow it very well

  4. Paul Sax says:

    Rachna, I totally agree with you. I prefer “ART” to “HAART”!


  5. Neil Ampel says:

    As a Journal Watch associate, I quickly learned from our editors to use the term “potent antiretroviral therapy.” Over time, I’ve come to think that this expresses things about right and can be shortened to pART. However, I am now preparing a manuscript on this topic in association with opportunistic infections and I can’t escape from the term HAART. In fact, I found your blog in trying to sort this out. I confess that I’m about to give up just to to conform (like using arithmetic values for HIV RNA). I am reminded that John Mellors was not enthused with the term and once mused during a lecture that there are patients who only partially respond to HAART. He felt that they were only receiving “fairly active antiretroviral therapy” or FAART.

  6. Paul Sax says:

    Neil, thanks for your comment (and humorous reminder — Marty Hirsch used to say the same thing about “fairly active …”). Seems to me that once we’ve had a few more years of “potent” therapy, then we’ll basically call it all ART and kind of ignore pre-1995/6.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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