HAART stands for Highly Active AntiRetroviral (anti-HIV) Therapy. The first HAART treatments, in 1996, included a protease inhibitor along with two nucleoside analog drugs to fight HIV. Now HAART means any potent combination of three or more anti-HIV drugs.

HAART has been an extraordinary life-saving tool. Just a few years after HAART became widely available, studies reported 60% to 80% reductions in new AIDS illnesses, hospitalizations and deaths. Because of HAART, many people with HIV/AIDS are living longer, more productive and more normal lives. Successful HAART can change HIV disease from an illness that was almost always a death sentence into a chronic (long-term), but usually manageable condition. Benefits of HAART include driving HIV levels (viral load) below detection in blood, semen and vaginal secretions and increasing the number of CD4 cells.

Moreover, HAART contributes to fewer opportunistic infections (OIs) and HIV-associated cancers. In some cases, people taking HAART regimens have done so well that they can talk with their doctor about discontinuing OI therapy. HAART also has contributed to overall quality of life. For example, some people who were on disability are returning to work and changing their plans for the future. More HIV-positive women are considering pregnancy because the rates of mother-to-child transmission have come down to 1% to 2% for women on successful HAART regimens with undetectable viral loads.

Although there are clear benefits of HAART, it also has its shortcomings and risks. HAART does not work for everyone. Even for those who are successful and have undetectable viral loads, HAART is not a cure. The drugs only control HIV; they cannot eliminate the virus from the body. This means that HIV can still be transmitted through unsafe practices. In addition, people must stick (adhere) to a strict dosing schedule or the drugs will stop working. Drug side effects can be difficult to live with and sometimes quite serious over the long term. For these reasons, some experts recommend delaying treatment until it is necessary to prevent serious damage to the immune system. However, for many people, HAART has been a lifesaver. Thus, it is important to take into account both the benefits and potential risks of currently available treatment regimens before starting therapy.

Nancy Wongvipat, M.P.H. is Manager of Prevention Programs at AIDS Project Los Angeles.