What Is cART?

Combination Antiretroviral Therapy

The acronym cART stands 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 and the terminology has further evolved to simply ART for antiretroviral therapy.

Two people sorting medication into day-of-the-week containers
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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.

Why Did ART and cART Replace HAART?

The term HAART (highly active antiretroviral therapy) was used for many years. It can be confusing to see the term cART or ART being used instead. Why did certain scientists start moving away from the term HAART? 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.

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. You are more likely to see cART used in literature after 2009.

The next step was to switch to ART as the typical acronym, even though it still implies using three or more antiretroviral drugs, which may be taken individually or in a combination formulation.

Monotherapies vs. Combination Therapies

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

You may continue to see all three terms in the literature and online. While it may be confusing for a few years, the term ART is more inclusive of different types of effective therapy for HIV. You will see ART in use on U.S. government and World Health Organization sites and publications.

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