Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 20;9(9):e033246.
doi: 10.1136/bmjopen-2019-033246.

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

Yi-Chia Huang  1 , Hsin-Yun Sun  2 , Yu-Chung Chuang  2 , Yu-Shan Huang  2 , Kuan-Yin Lin  3 , Sung-Hsi Huang  1   4 , Guan-Jhou Chen  5 , Yu-Zheng Luo  6 , Pei-Ying Wu  6 , Wen-Chun Liu  2 , Chien-Ching Hung  7   4   8   9 , Shan-Chwen Chang  2
Affiliations

Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan

Yi-Chia Huang et al. BMJ Open. .

Abstract

Objectives: Rapid initiation of antiretroviral therapy (ART) engenders faster viral suppression but with suboptimal rates of durable viral suppression and engagement in care, as reported by clinical trials in resource-limited settings. Real-world experience with rapid ART initiation remains limited in resource-rich settings.

Design: Retrospective cohort study.

Setting: A tertiary hospital in metropolitan Taipei, Taiwan.

Participants: We included 631 patients newly diagnosed as having HIV infection between March 2014 and July 2018.

Main outcome measures: Rapid ART initiation was defined as starting ART within 7 days after HIV diagnosis confirmation. HIV diagnosis, ART initiation and viral suppression dates and clinical outcome data were collected by reviewing medical records. The rates of loss to follow-up (LTFU), engagement in care and virological rebound at 12 months were compared between patients with rapid ART initiation and those with standard initiation.

Results: Rapid ART initiation increased from 33.8% in 2014 to 68.3% in 2017, and the median interval between HIV diagnosis and viral suppression (HIV RNA load <200 copies/mL) decreased from 138 to 47 days. Patients with rapid ART initiation had a significantly higher rate of engagement in care at 12 months than did those with standard initiation (88.3% vs 79.0%; p=0.002). Patients aged <30 years had a higher risk of LTFU (HR: 2.19; 95% CI 1.20 to 3.98); and rapid ART initiation was associated with a lower risk of LTFU (HR: 0.41; 95% CI 0.24 to 0.83). Patients aged <30 years were more likely to acquire incident sexually transmitted infections (STIs) before achieving viral suppression.

Conclusions: Rapid ART initiation was associated with a higher rate of engagement in care at 12 months and shortened interval from diagnosis to HIV suppression. Delayed ART initiation may increase onwards HIV transmission considering the high rates of STIs.

Ethics approval: The study was approved by the Research Ethics Committee of National Taiwan University Hospital (Registration No. 201003112R).

Keywords: engagement in care; risk compensation; sexually transmitted infection; treatment as prevention; treatment cascade.

PubMed Disclaimer

Conflict of interest statement

Competing interests: C-CH received research support from Gilead Sciences, Merck and ViiV Healthcare and speaker honoraria from Gilead Sciences and ViiV Healthcare and served on the advisory boards for Gilead Sciences and ViiV Healthcare.

Figures

Figure 1
Figure 1
Study flow. Ab, antibody; Ag, antigen; cART, combination antiretroviral therapy; RPR, rapid plasma reagin.
Figure 2
Figure 2
Intervals (in days) between confirmed HIV diagnosis and ART initiation in the four groups. ART, antiretroviral therapy.
Figure 3
Figure 3
Intervals (in days) between confirmed HIV diagnosis and PVL <200 copies/mL in the four groups. PVL, plasma HIV RNA load.
Figure 4
Figure 4
Kaplan-Meier analysis of loss to follow-up stratified by age <30 years and timing of ART initiation. ART, antiretroviral therapy.
See this image and copyright information in PMC

References

    1. WHO Guidelines Approved by the Guidelines Review Committee Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. 2015 Geneva: World Health Organization Copyright (c) World Health Organization, 2015. - PubMed
    1. Danel C, Moh R, Gabillard D, et al. . A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med 2015;373:808–22. - PubMed
    1. Lundgren JD, Babiker AG, Gordin F, et al. . Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med 2015;373:795–807. 10.1056/NEJMoa1506816 - DOI - PMC - PubMed
    1. Borges Álvaro H, Neuhaus J, Babiker AG, et al. . Immediate antiretroviral therapy reduces risk of infection-related cancer during early HIV infection. Clin Infect Dis 2016;63:1668–76. 10.1093/cid/ciw621 - DOI - PMC - PubMed
    1. O'Connor J, Vjecha MJ, Phillips AN, et al. . Effect of immediate initiation of antiretroviral therapy on risk of severe bacterial infections in HIV-positive people with CD4 cell counts of more than 500 cells per μL: secondary outcome results from a randomised controlled trial. The Lancet HIV 2017;4:e105–12. 10.1016/S2352-3018(16)30216-8 - DOI - PMC - PubMed

Substances

LinkOut - more resources