TOPLINE

Among individuals newly diagnosed with HIV, rapid antiretroviral therapy (ART) initiation was associated with higher retention in care at 3 to 4 months and a shorter time to viral suppression compared with delayed initiation; however, neither the retention advantage nor the overall likelihood of achieving viral suppression remained statistically significant at 1 year.

METHODOLOGY

• Researchers conducted a prospective cohort study to evaluate whether initiation of rapid ART improved retention in care and time to viral suppression among individuals newly diagnosed with HIV.
• They enrolled 168 treatment-naive adults (median age, 32 years; 82% men) newly diagnosed with HIV between 2021 and 2023 at an outpatient HIV clinic in Louisville, Kentucky.
• Of the 168 participants, 64% presented within 1 week of diagnosis and started ART on the same day, forming the rapid group; the remaining 36% presented more than 1 week after diagnosis and followed the clinic’s standard intake procedures.
• The primary outcome was retention in HIV care during the first year after diagnosis. Secondary outcomes included the proportion achieving viral suppression, defined as HIV-1 RNA < 200 copies/mL within 1 year of diagnosis, and time to viral suppression.

TAKEAWAY

• Short-term retention at 3-4 months was significantly higher in the rapid ART group than in the non-rapid group (50% vs 27%; P = .006), but retention at 1 year did not differ significantly between the groups.
• Rapid ART was associated with a shorter time to viral suppression, with a median time to suppression of 78 days vs 196 days in the non-rapid group (P < .001).
• However, rapid ART was not associated with higher odds of viral suppression within a year.
• The benefit of rapid ART on viral suppression was concentrated in the first 90 days after diagnosis, when rapid initiation was associated with a higher rate of achieving suppression (adjusted hazard ratio, 8.85; 95% CI, 2.41-32.51); this effect was no longer statistically significant beyond 90 days.

IN PRACTICE

"Integrating rapid ART initiation with ongoing supportive services may further strengthen continuity of care, improve long-term health outcomes, and reduce HIV transmission at the population level," the authors wrote.

SOURCE

The study was led by Forest W. Arnold, Department of Medicine, Division of Infectious Diseases, School of Medicine, University of Louisville, Louisville, Kentucky. It was published online on August 27 in AIDS Care.

LIMITATIONS

The study was conducted at a single clinic, which may limit the generalizability of findings to other healthcare settings. The modest sample size and observational design limit the ability to account for all differences between the groups. Injection drug use was more common in the non-rapid ART group and may have introduced confounding that the analysis could not fully address.

DISCLOSURES

The study was supported in part by a grant from Gilead Sciences. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.