The now-familiar acronym "HAART" stands for highly active antiretroviral therapy. It is a strategy for treating HIV/AIDS built on the use of 3 or more anti-HIV drugs in the hope of halting disease progression by hindering viral replication. The approval of protease inhibitors (PIs) in the mid-1990s made such an approach possible. Usually one PI is combined with 2 nucleoside reverse transcriptase inhibitors (NRTIs), the first class of approved antiretroviral drugs. This strategy has proved to prolong lives; indeed, many people with AIDS have been brought back from the brink of death. However, for all its glitter, HAART is not the golden cure for which we had hoped.

Roughly 5 years since its inception, HAART can no longer be considered a long-term strategy for the treatment of HIV. Despite having reduced greatly the number of AIDS-related deaths and having lowered the incidence of opportunistic infections, HAART has had some unforeseen and undesirable consequences. In addition to the common side effects of the drugs, there are complications like fat accumulation and atrophy, bone mineral loss and insulin resistance that may also be therapy related. For some, the long-term use of these drugs is resulting in liver toxicity and increased risk of cardiovascular disease. Also, cases of some HIV-related cancers are on the rise (see this issue's article on lymphoma). Although obituary columns in the newspapers of developed nations now list far fewer deaths from AIDS, there is a slow and unsettling increase in the number of deaths from liver failure, cancer, etc. Increased viral suppression and survival time have come with a price.

So what now? If HAART cannot eradicate HIV, how do we cure this disease? There is a growing consensus that viral suppression is only a piece of the puzzle. The immune system will likely play an important role as well. In simplest terms, since the immune system cannot completely control HIV, we must induce it to control the virus and establish an equilibrium. Fortunately, as faith in HAART as a cure has dwindled, researchers have focused once again on the basic science of the immune system and immune-based therapies.

References to "the HAART era" in the history of HIV/AIDS are already appearing in the literature, even though this period certainly is not over. We still have little idea of what will happen as a result of long-term aggressive drug therapy for HIV. After all the hope -- and all the hype -- we are still far from a cure. HAART undoubtedly changed the way we view AIDS. Can we now change the way we view HAART?

On a final note, this issue of RITA! debuts a new section, For the Clinician, which contains review articles written by clinical researchers and physicians and intended for a clinical audience. Articles in this section are supplemented with a glossary to assist readers who may not be entirely familiar with the terminology used. Clinicians are welcomed to submit short (3-5 page) review articles on HIV/AIDS-related treatments and conditions for possible inclusion in future issues. Contact information is given on the inside cover of this issue.

Very truly yours,

The Center for AIDS: Hope & Remembrance Project
Thomas Gegeny, M.S., E.L.S.
Editor

Back to the RITA! September 2000 contents page.