What is cART?

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Question: What is cART?

cART is the acronym for combination antiretroviral therapy. This refers to the combinations of drugs that are used to keep HIV infections under control. These are also commonly referred to as HAART regimens.

Drug combinations used in cART consist of a minimum of two active drugs from two classes. Usually they contain three or more different drugs. Using a combination of different drugs makes treatment more effective.

It also reduces the risk that a patient might develop drug resistance. 

The major classes of medications commonly included in cART regimens include:

  • nucleotide reverse transcriptase inhibitors (NRTIs)
  • non-nucleotide reverse transcriptase inhibitors (NNRTIs)
  • protease inhibitors (PIs)
  • integrase inhibitors

Each type of drug interferes with different stages of the HIV infection and replication process.

Answer:

When I first stumbled across the term cART -- combination antiretroviral therapy -- in the literature, I was confused. Why were certain scientists moving away from the term HAART -- highly active antiretroviral therapy? As it turns out, there is actually a good reason for the change. The term cART is a way for doctors to specify the use of combinations of antiretroviral medication in an age where there is growing interest in monotherapies. Monotherapies are single drug therapies for HIV/AIDS.

Interest in monotherapies springs from a desire to reduce barriers to HIV/AIDS treatment. These barriers include drug cost and difficulties with taking medicine as prescribed. Single drug therapies may also be used to lower the risks of long-term treatment with various HIV drugs. For example, they might be used to address side effects such as premature aging and metabolic dysfunction.

Arguments against the use of monotherapies include concerns that using a single therapy greatly increases the risk of encouraging the formation of drug-resistant strains of the virus. There are also worries that single drug regimens may simply be not as effective as combination regimens. However, even those who acknowledge that monotherapy may not be useful in all HIV patients are often willing to acknowledge that it might be suitable in certain subpopulations. For example, monotherapy may be helpful for people who have had good, long-term suppression of their HIV using more traditional combination therapies.They have shown they can take their medication consistently. They may also need less medication to keep their viral load under control. 

A Word from Verywell

It can be hard to pick the best terminology to use when discussing STDs and sexual health. In truth, cART is a more technically accurate term than HAART. Unlike it's predecessor, it specifies that a combination of antiretroviral drugs are being used.

Although HAART therapy is generally formulated as a combination, the term could theoretically also be used to refer to a highly active monotherapy. Referring specifically to cART allows doctors to clearly distinguish between drug cocktails and single medications. In contrast, using the term HAART only addresses theoretical levels of medication activity.

For reasons similar to the ones I used when deciding to call myself the expert on sexually transmitted diseases instead of the expert  on sexually transmitted infections, I don't foresee switching from writing about HAART to writing about cART any time soon.. The term STIs was also more medically accurate than STDs. Still, as with cART, it's less recognized and understood. When writing for the general public, that's a problem. However, being able to debate the terminology problem is great. It's a tool for education.

When someone comes up and asks me why I haven't switched from STDs to STIs, I love having a chance to explain. Answering gives me the chance to start a great discussion about the importance of asymptomatic sexually transmitted infections in sexual health. I suspect that a similar thing will happen if there is a widespread professional shift from HAART to cART. We'll start talking about the various types of drug regimens. We'll also have better discussions about when it is appropriate to use them in different situations.

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