{"id":15,"date":"2008-04-10T21:38:50","date_gmt":"2008-04-11T02:38:50","guid":{"rendered":"http:\/\/blogs.nejm.org\/pov\/hiv-id-observations\/index.php\/2008\/04\/10\/needed-something-better-than-haart\/"},"modified":"2019-11-19T13:14:30","modified_gmt":"2019-11-19T18:14:30","slug":"needed-something-better-than-haart","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/needed-something-better-than-haart\/2008\/04\/10\/","title":{"rendered":"Needed:  Something Better than &#8220;HAART&#8221;"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-thumbnail wp-image-799\" title=\"dutch spring\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2008\/04\/dutch-spring-150x1501.jpg\" alt=\"dutch spring\" width=\"150\" height=\"150\" \/>I think we all have pet peeves,\u00a0and so I&#8217;ll confess one of mine:\u00a0I hate the term &#8220;HAART.&#8221;<\/p>\n<p>(I work with someone, by the way, who hates the term &#8220;viral load,&#8221; preferring &#8220;virus load.&#8221;\u00a0Go figure.)<\/p>\n<p>Standing for &#8220;highly active antiretroviral therapy,&#8221; HAART first surfaced in the mid-1990s in order to distinguish <span style=\"color: #0000ff\"><span style=\"color: #333333\">potent anti-HIV\u00a0treatment<\/span> <\/span>from the older, not-so-active form of antiretroviral therapy that preceded it. Writers often will use the phrases &#8220;era of HAART&#8221; or &#8220;advent of HAART,&#8221; both of which\u00a0sound to me like essays on Dutch history.<\/p>\n<p>But HAART has never been very precise &#8212; what exactly does it mean?\u00a0<!--more--><\/p>\n<p>The\u00a0vagueness is illustrated by<span style=\"color: #333333\"> a quick Google search of &#8220;<a href=\"http:\/\/www.google.com\/search?hl=en&amp;q=define%3A+HAART\">define: HAART<\/a><\/span><span style=\"color: #333333\">,&#8221;<\/span> which gives no fewer than 9 definitions, including:<\/p>\n<ul>\n<li><strong>&#8220;A term for aggressive anti-HIV treatment &#8230;&#8221;<\/strong> Really? Isn&#8217;t it standard-of-care treatment? It&#8217;s not &#8220;aggressive&#8221; if everyone is doing it.)<\/li>\n<li><strong>&#8220;Combination anti-HIV therapy, usually involving a protease inhibitor &#8230;&#8221;<\/strong> Nope, not quite &#8212; EFV<span style=\"color: #0000ff\"> <span style=\"color: #333333\">or<\/span> <\/span>NVP + 2 NRTIs are the most common initial treatments worldwide, so, in fact, <span style=\"color: #333333\">HIV therapy<\/span> does not &#8220;usually&#8221; involve a PI.<\/li>\n<li><strong>&#8220;Treatment [of HIV] with a very potent drug cocktail &#8230;&#8221;<\/strong> Uh-oh, another pet peeve alert &#8212; that never-to-die use of &#8220;cocktail&#8221; to describe HIV treatment, something the lay press still adores. Even worse, &#8220;potent cocktail&#8221;? A Mai Tai at Trader Vic&#8217;s, anyone?<\/li>\n<li><strong>&#8220;A combination of protease inhibitors taken with reverse transcriptase inhibitors &#8230;&#8221;<\/strong> Again, just wrong, though I suppose ritonavir-boosted PIs are a &#8220;combination of protease inhibitors,&#8221; so partial credit.<\/li>\n<\/ul>\n<p>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.<\/p>\n<p>She looked at me like I was out of my mind &#8212; <span style=\"color: #0000ff\"><span style=\"color: #333333\">okay, more like<\/span> <\/span>&#8220;get a life.&#8221; I still think it would be an interesting paper, but how would one do such a review &#8212; searching <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/sites\/entrez?linkbar=jsmenu2\">PubMed<\/a> for HAART yields a mere 11, 937 results.<\/p>\n<p>The problem is that I don&#8217;t have a ready alternative.\u00a0The D:A:D folks tried &#8220;cART&#8221; several years ago, standing for combination antiretroviral therapy (kind of liked that one), but I don&#8217;t see the abbreviation in their latest\u00a0paper;\u00a0I confess\u00a0to using\u00a0&#8220;ART&#8221; (antiretroviral therapy)\u00a0when abbreviating HIV treatment; in <em><a href=\"http:\/\/aids-clinical-care.jwatch.org\/\">AIDS Clinical Care<\/a><\/em>, our Executive Editor prefers &#8220;potent combination antiretroviral therapy,&#8221; all 15 syllables worth.<\/p>\n<p>None of these terms\u00a0gets it quite right, I&#8217;m afraid.<\/p>\n<p>Any ideas?\u00a0Or should I just give up?\u00a0Help!<\/p>\n","protected":false},"excerpt":{"rendered":"<p>I think we all have pet peeves,\u00a0and so I&#8217;ll confess one of mine:\u00a0I hate the term &#8220;HAART.&#8221; (I work with someone, by the way, who hates the term &#8220;viral load,&#8221; preferring &#8220;virus load.&#8221;\u00a0Go figure.) Standing for &#8220;highly active antiretroviral therapy,&#8221; HAART first surfaced in the mid-1990s in order to distinguish potent anti-HIV\u00a0treatment from the older, [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,5],"tags":[77,399,423,910],"class_list":["post-15","post","type-post","status-publish","format-standard","hentry","category-hiv","category-infectious-diseases","tag-antiretroviral-therapy","tag-haart","tag-hiv","tag-terminology"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/15","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=15"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/15\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=15"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=15"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=15"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}