From the Guidelines
HAART therapy, or Highly Active Antiretroviral Therapy, is the standard treatment approach for HIV infection, combining at least three antiretroviral medications from at least two different drug classes to effectively suppress HIV replication in the body. The goal of HAART is to achieve maximal and durable suppression of viral load, restoration and preservation of immunologic function, improvement of quality of life, and reduction of HIV-related morbidity and mortality 1. A typical HAART regimen includes:
- Two nucleoside reverse transcriptase inhibitors (NRTIs) such as tenofovir and emtricitabine (often combined as Truvada)
- Plus either an integrase strand transfer inhibitor (INSTI) like dolutegravir, a non-nucleoside reverse transcriptase inhibitor (NNRTI) like efavirenz, or a protease inhibitor (PI) like darunavir boosted with ritonavir. Key points to consider when initiating HAART include:
- The primary goals of antiretroviral therapy are maximal and durable suppression of viral load, restoration and preservation of immunologic function, improvement of quality of life, and reduction of HIV-related morbidity and mortality 1.
- Adherence to the prescribed regimen is crucial for treatment success and preventing drug resistance 1.
- HAART has been associated with a marked decline in morbidity and mortality of HIV-infected patients in the United States 1.
- The use of antibiotic medication to prevent opportunistic infections is effective in persons with advanced disease 1. Some potential side effects and considerations of HAART therapy include:
- Lactic acidosis and hepatic steatosis, particularly with the use of NRTIs 1
- Drug interactions and toxicity, particularly with the use of PIs and NNRTIs 1
- The potential for drug resistance and the need for regular monitoring and adherence to the prescribed regimen 1.
From the Research
Definition of HAART Therapy
- HAART (Highly Active Antiretroviral Therapy) involves combination treatment with three or more antiretroviral agents 2.
- The goal of HAART is to reduce plasma virus levels below the limits of detection in previously untreated HIV-1-infected patients 3.
Components of HAART Regimens
- Most HAART regimens include drugs from at least two of the three classes of antiretroviral therapy:
- Nucleoside analog reverse transcriptase (RT) inhibitors
- Non-nucleoside analog RT inhibitors
- Protease inhibitors 3
- Other classes of antivirals, such as fusion inhibitors (FIs) and integrase strand transfer inhibitors (INSTIs), may also be used in HAART regimens 4.
Benefits and Effectiveness of HAART
- HAART has been shown to dramatically change the course of HIV infection and improve survival among HIV-infected individuals 4, 5.
- The use of HAART has been associated with a reduced risk of HIV transmission 6.
- Long-term follow-up studies have demonstrated the effectiveness of HAART in reducing mortality and improving outcomes among children and adolescents with HIV infection 5.
Considerations for HAART Use
- The decision to initiate HAART should balance the virological and immunological benefits of early treatment with the costs of drug therapy, the risk of drug side effects, and the risk of drug resistance if adherence is suboptimal 3.
- HAART regimens should be individualized based on factors such as viral load, CD4 cell count, and resistance testing 4.