Comparison of Immunological and Virological Recovery with Rapid, Early, and Late Start of Antiretroviral Treatment in Naive Plwh: Real-World Data

Background Rapid initiation of antiretroviral therapy (ART) reduces the transmission of HIV infection in the community. This study aimed to determine whether rapid ART initiation is effective compared to standard ART treatment in our country. Methods Patients were grouped based on time to treatment initiation. HIV RNA levels, CD+4 T cell count, CD4/CD8 ratio, and ART regimens were recorded at baseline and follow-up visits for 12 months. Results There were 368-ART naive adults (treatment initiated at the time of HIV diagnosis; 143 on the first day, 48 on the second-seventh day, and 177 after the seventh day). Although virological suppression rates at 12th months were higher in all groups, over 90% on average, there were no statistically significant differences in HIV-1 RNA suppression rates, CD+4 T cell count, and CD4/CD8 ratio normalization in the studied months but in multivariate logistic regression analysis; showed a significant correlation between both virological and immunological response and those with CD4+ T <350 cells/mL at 12th month in total patients. Conclusion Our findings support the broader application of recommendations for rapid ART initiation in HIV patients.

[1]  P. Volberding,et al.  Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2020 Recommendations of the International Antiviral Society-USA Panel. , 2020, JAMA.

[2]  C. Katlama,et al.  Reaching the Second and Third Joint United Nations Programme on HIV/AIDS 90-90-90 Targets Is Accompanied by a Dramatic Reduction in Primary Human Immunodeficiency Virus (HIV) Infection and in Recent HIV Infections in a Large French Nationwide HIV Cohort. , 2020, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  S. Unal,et al.  Temporal trends in the epidemiology of HIV in Turkey. , 2020, Current HIV research.

[4]  Laurent Tran,et al.  Virological and immunological impact of integrase inhibitor-based regimens initiated during primary HIV-1 infection. , 2019, AIDS.

[5]  C. Delpierre,et al.  Too fast to stay on track? Shorter time to first anti-retroviral regimen is not associated with better retention in care in the French Dat’AIDS cohort , 2019, PloS one.

[6]  Hsin-Yun Sun,et al.  Short-term outcomes of rapid initiation of antiretroviral therapy among HIV-positive patients: real-world experience from a single-centre retrospective cohort in Taiwan , 2019, BMJ Open.

[7]  G. Whitlock,et al.  Rapid initiation of antiretroviral therapy in those with newly diagnosed HIV infection in London, UK , 2019, HIV medicine.

[8]  L. Myers,et al.  A Care Continuum of Immediate ART for Newly Diagnosed Patients and Patients Presenting Later to Care at a Federally Qualified Health Center in New Orleans , 2019, Open forum infectious diseases.

[9]  J. Eron,et al.  Acute HIV Infection and CD4/CD8 Ratio Normalization After Antiretroviral Therapy Initiation , 2018, Journal of acquired immune deficiency syndromes.

[10]  E. Deeks.  Bictegravir/Emtricitabine/Tenofovir Alafenamide: A Review in HIV-1 Infection , 2018, Drugs.

[11]  Huldrych F. Günthard,et al.  Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2018 Recommendations of the International Antiviral Society–USA Panel , 2018, JAMA.

[12]  C. del Rio,et al.  Implementation of a Rapid Entry Program Decreases Time to Viral Suppression Among Vulnerable Persons Living With HIV in the Southern United States , 2018, Open forum infectious diseases.

[13]  R. Brookmeyer,et al.  Nationwide Cohort Study of Antiretroviral Therapy Timing: Treatment Dropout and Virological Failure in China, 2011–2015 , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  Anton Pozniak,et al.  The impact of HIV prevalence, conflict, corruption, and GDP/capita on treatment cascades: data from 137 countries , 2018, Journal of virus eradication.

[15]  T. Klimkait,et al.  Effect of Offering Same-Day ART vs Usual Health Facility Referral During Home-Based HIV Testing on Linkage to Care and Viral Suppression Among Adults With HIV in Lesotho: The CASCADE Randomized Clinical Trial , 2018, JAMA.

[16]  S. Buchbinder,et al.  Trends in the San Francisco Human Immunodeficiency Virus Epidemic in the “Getting to Zero” Era , 2018, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  L. Myers,et al.  Linkage and Antiretroviral Therapy Within 72 Hours at a Federally Qualified Health Center in New Orleans , 2018, AIDS patient care and STDs.

[18]  N. Ford,et al.  Benefits and risks of rapid initiation of antiretroviral therapy , 2017, AIDS.

[19]  J. Sterne,et al.  CD4:CD8 Ratio and CD8 Count as Prognostic Markers for Mortality in Human Immunodeficiency Virus–Infected Patients on Antiretroviral Therapy: The Antiretroviral Therapy Cohort Collaboration (ART-CC) , 2017, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  J. Pape,et al.  Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial , 2017, PLoS medicine.

[21]  J. Elliott,et al.  Time from HIV diagnosis to commencement of antiretroviral therapy as an indicator to supplement the HIV cascade: Dramatic fall from 2011 to 2015 , 2017, PloS one.

[22]  N. Funderburg,et al.  Inflammation, Immune Activation, and Antiretroviral Therapy in HIV , 2017, Current HIV/AIDS Reports.

[23]  A. Pharris,et al.  HIV continuum of care in Europe and Central Asia , 2017, HIV medicine.

[24]  D. Glidden,et al.  Effects of a multicomponent intervention to streamline initiation of antiretroviral therapy in Africa: a stepped-wedge cluster-randomised trial. , 2016, The lancet. HIV.

[25]  M. Fox,et al.  Initiating Antiretroviral Therapy for HIV at a Patient’s First Clinic Visit: The RapIT Randomized Controlled Trial , 2016, PLoS medicine.

[26]  J. Singer,et al.  Early Initiation Rather Than Prolonged Duration of Antiretroviral Therapy in HIV Infection Contributes to the Normalization of CD8 T-Cell Counts. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[27]  H. Lane,et al.  Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection. , 2015, The New England journal of medicine.

[28]  R. Salamon,et al.  A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa. , 2015, The New England journal of medicine.

[29]  R. Baggaley,et al.  Young key populations and HIV: a special emphasis and consideration in the new WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations , 2015, Journal of the International AIDS Society.

[30]  A. Pozniak,et al.  Large disparities in HIV treatment cascades between eight European and high-income countries – analysis of break points , 2014, Journal of the International AIDS Society.

[31]  M. Prosperi,et al.  Factors influencing the normalization of CD4+ T-cell count, percentage and CD4+/CD8+ T-cell ratio in HIV-infected patients on long-term suppressive antiretroviral therapy. , 2012, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[32]  Andrew N. Phillips,et al.  Projected life expectancy of people with HIV according to timing of diagnosis , 2012, AIDS.

[33]  D. Hosmer,et al.  Model‐Building Strategies and Methods for Logistic Regression , 2005 .

[34]  H. Fleury,et al.  Predictors of long-term increase in CD4(+) cell counts in human immunodeficiency virus-infected patients receiving a protease inhibitor-containing antiretroviral regimen. , 2002, The Journal of infectious diseases.

[35]  Mark Payne,et al.  Health and Human Services , 2020, Congress and the Nation 2013-2016, Volume XIV: Politics and Policy in the 113th and 114th Congresses.

[36]  D. Havlir,et al.  RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. , 2019, AIDS.

[37]  H. Hatano,et al.  The Effect of Same-Day Observed Initiation of Antiretroviral Therapy on HIV Viral Load and Treatment Outcomes in a US Public Health Setting , 2017, Journal of acquired immune deficiency syndromes.

[38]  K. Yoshimura.  Current status of HIV/AIDS in the ART era. , 2017, Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy.

[39]  B. Walker,et al.  Antiretroviral therapy in early HIV infection. , 2013, The New England journal of medicine.