by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
November 7, 2023
Dalal A, Clark E, Samiezade-Yazd Z, et al. Outcomes and predictors of rapid antiretroviral therapy initiation for people with newly diagnosed HIV in an integrated health care system. Open Forum Inf Dis. 2023 Oct 26. Online available: https://doi.org/10.1093
Authors conducted an observational longitudinal cohort study involving 1,409 newly diagnosed patient members of Kaiser Permanente Northern California (KPNC), an integrated health system spanning six service areas across urban, suburban, and rural communities. All patients received dedicated clinician support, case management, and benefits coordination. Overall, 34.1% started on rapid ART, defined as an ART prescription fill from a KPNC pharmacy within 7 days of diagnosis. Compared to the standard ART group, patients in the rapid ART group had a slightly higher mean age (38.3 years vs. 36.8 years) and fewer cases of viral hepatitis co-infection (0.8% vs. 2.6%). There were no differences in median baseline HIV viral load and CD4 count. Within one year, most patients had achieved virologic suppression (89.8% in the rapid ART group vs. 91.6% in the standard ART group, p=0.09) and average length of time to virologic suppression was shorter in the rapid ART group (48 vs. 77 days, p<0.001). Over the follow-up period, viral suppression in the standard ART group remained above 80% while viral suppression decreased below 80% for the rapid ART group at years 3 and 4 of follow-up. Multivariate analyses identified lower odds of rapid ART initiation among patients with a higher Charlson comorbidity index (adjusted odds ratio = 0.65).
Similar to other rapid ART studies, people in this cohort who initiated rapid ART achieved viral suppression in fewer days and experienced reduced cumulative viral exposure. However, longer term outcomes were mixed, with no significant improvement in long-term viral suppression, medication adherence, and care retention over 5 years of follow-up. Authors offer potential explanations for this such as lack of time to address HIV stigma, unmet needs with regard to social determinants of health, and medical mistrust. These observations underscore the critical recognition that HIV care is about more than viral suppression – approaches to support engagement in care, improve quality of life, and help patients achieve health goals require ongoing attention and collaboration.
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