The Benefits of Immediate ART

Abstract

The benefits of "early" antiretroviral therapy (ART; ie, initiation when CD4 ≥500 cells/mm³) are now well accepted as reflected in the removal of the CD4-based eligibility from new ART guidelines by the World Health Organization (WHO). However, neither the "treat-all" strategy recommendations presented in the guidelines nor the HIV care cascade goals in the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets adequately address the issue of ART timing. Our recent study on "immediate" ART (ie, ≤30 days after HIV diagnosis) adds important evidence demonstrating the real and meaningful benefits of rapid ART initiation even among those who have CD4 ≥500 cells/mm³. We call on WHO and UNAIDS to consider this research and encourage a shift from the treat-all strategy to an "immediately-treat-all" strategy, and from a slow, fragmented, complicated, multistep HIV care cascade to a fast, easy, and simple cascade with effectiveness measures that incorporate the important aspect of time.

Keywords: China; HIV; antiretroviral therapy; early; immediate.

Figure 1.

Graphical representation of a portion of China’s HIV care continuum highlighting the treatment gap caused by lengthy pre-ART periods (ie, the time between diagnosis and treatment initiation). For example, in 2013, there were nearly 200 000 PLWH who were diagnosed with HIV infection but still not on ART, a treatment gap of 44%. Adapted with permission from Ma and colleagues. ART, antiretroviral therapy; PLWH, people living with HIV.