by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer
August 25, 2020
Martin TCS et al. Rapid antiretroviral therapy among individuals with acute and early HIV. Clin Infect Dis. 2020 Aug 10: ciaa1174. doi: 10.1093/cid/ciaa1174. PMID: 32777035
Numerous studies have demonstrated that rapid-ART is acceptable to many patients with HIV and is associated with improved linkage to care and a shorter time to viral suppression. This strategy has not been evaluated in persons with acute and early HIV (AEH) infection. A study from San Diego, CA enrolled 84 persons with AEH who were offered rapid ART (ART initiation < 7 days from diagnosis). The enrollment period was 2014 through 2018. The majority were men (95.2%) with substance use reported in 46%, homelessness in 6%, and 25% having a median monthly income of < $1000.00. Thirty-nine percent were diagnosed with acute HIV infection and 61% with early infection. Primary outcomes were assessed on an intention-to-treat basis and included number of participants that started rapid-ART, the median duration to viral suppression and proportion with viral suppression by 12, 24- and 48-weeks. Approximately 69% initiated ART after a median duration of four days and by 60 days from diagnosis 81 (96%) of subjects were on treatment. By ITT analysis, the median duration to viral suppression was 15 weeks. The proportion of participants that achieved viral suppression by 48 weeks was 88%. The authors believe these data support rapid initiation of ART which was feasible in this difficult to treat population mainly due to medication availability and intensive case management.
Rapid treatment of persons with HIV has progressively become standard of care and has been recommended by the DHHS guidelines since December 2019. The population in this study was unique in that most were newly infected, and thus more contagious due to having higher baseline viral loads (which was assessed in the study). Many of these patients were homeless and had a history of substance abuse making the results more impressive. To do rapid ART successfully, adequate infrastructure at clinical sites is essential, including access to medication, adherence counseling, and close follow-up.
The author has no conflicts of interest to disclose.
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