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

Abstract

ObjectivesRapid 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.DesignRetrospective cohort study.SettingA tertiary hospital in metropolitan Taipei, Taiwan.ParticipantsWe included 631 patients newly diagnosed as having HIV infection between March 2014 and July 2018.Main outcome measuresRapid 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.ResultsRapid 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.ConclusionsRapid 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 approvalThe study was approved by the Research Ethics Committee of National Taiwan University Hospital (Registration No. 201003112R).

Same-day antiretroviral treatment (ART) initiation and associated factors among HIV positive people in Northwest Ethiopia: baseline characteristics of prospective cohort

“…But there was increasing in the proportion of newly diagnosed HIV positive people who initiated ART within 7 days of HIV diagnosis to 65.6%. The finding was in line with a study in South Africa with overall same-day ART initiation of 40.1% and initiated within 7 days to 62.86% [ 15 ] and similar with study from Taiwan reported 68% rapid ART initiation within 7 days of HIV confirmed diagnosis in 2017 [ 8 ]. However, same-day ART initiation was lower compared to the recent finding of 54.2% in June 2018 in South Africa [ 15 ], Zimbabwe (65%) [ 55 ], 94.9% in US [ 56 ] and San Francisco (96%) [ 57 ].…”

“…In South Africa, the same-day initiation of ART was 40.1% from 2017 to 2018 in which increased from 30.3% in October 2017 to 54.2% in June 2018 [ 15 ]. In Taiwan, rapid initiation of ART was 33.8% in 2014 and increasing to 68.3% in 2017 [ 8 ]. Similarly in San Diego, 26 and 48% of newly diagnosed HIV positive individuals started ART on the same-day of diagnosis and within a week respectively [ 23 ].…”

Time to Antiretroviral Therapy Initiation and Its Predictors Among Newly Diagnosed HIV-Positive People in Nekemte Town, Western Ethiopia: Claim of Universal Test and Treat

“…Being female, urban dwellers, disclosing HIV serostatus, college and above educational level, having no baseline OIs, linked from OPD and getting tested for HIV via VCT approach were the predictors of early ART initiation. The overall incidence rate of ART initiation that was revealed in this study was 51.9/1000 person-days observation in which 67.4% [95% CI: 59.3-73.5] of them initiated the ART on the same day of confirmed 34 However, this result is higher than a study result conducted in Ethiopia, 35 and South Africa, 36 which reported the rate of the same day ART initiation among newly diagnosed HIV positive people was 40.90% and 40.4%, respectively. This inconsistency might be attributable to the study period and setting difference.…”

“…The median age of newly diagnosed HIV positive people was 35 [IQR: [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] years. The majority of the study participants (164; 31.66%) were found in age category of ≥40 years old.…”

Comparisons of Serologic Responses of Early Syphilis to Treatment with a Single-Dose Benzathine Penicillin G Between HIV-Positive and HIV-Negative Patients

“…Individuals seeking VCT services have been offered free-of-charge testing for HIV and syphilis. Those testing positive for HIV or syphilis are linked to medical care and receive treatment and further evaluation for viral hepatitis and other STDs [ 17 ].…”