Does the rapid initiation of antiretroviral therapy at HIV diagnosis impact virological response in a real-life setting? A single-centre experience in Northern Italy

ABSTRACT

Rapid initiation of antiretroviral therapy (ART) has been proven efficacious and safe, but more investigations are needed to define feasibility of rapid ART approach in real-life settings.We conducted a retrospective, observational study on newly HIVdiagnosed patients referred to our Infectious Diseases Department from September 1st, 2015, to July 31st, 2019. According to the timing of ART initiation, we distinguished 3 groups of patients (rapid, intermediate and late group) and represented the trend of virological response during a 400-days-period. The hazard ratios of each predictor on viral suppression were estimated through the Cox proportional hazard model.The median time from HIV diagnosis to the first medical referral was 15 days and the median time from the first care access to therapy start was 24 days. Among patients, 37.6% started ART within 7 days, 20.6% between 8 and 30 days, and 41.8% after 30 days. Longer time to ART start and higher baseline viral load were associated with a lower probability of viral suppression. After one year, all groups showed a high viral suppression rate (99%). In a high-income setting the rapid ART approach seems useful to accelerate viral suppression which is great over time regardless of ART initiation timing.

KEYWORDS:

• Antiretroviral therapy
• new HIV diagnosis
• rapid start
• viral suppression
• real-life setting

Acknowledgments

We thank the participants who contributed to this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

EQR, II and EF contributed to study design, analysis and data interpretation. SR and SC determined statistical methods and performed the statistical analysis. NG and GF contributed to data collection. NG and EF first drafted the article. EQR, EF and FC contributed to the critical reviewing of the article. All authors reviewed the article, read and approved the final version of the manuscript.

Ethics approval and consent to participate

The present study was conducted in accordance with the rules of good clinical practice (GCP-ICH) and according to the Declaration of Helsinki. The study was approved by the Ethical Board of the Brescia Province on October 1 2020 and all efforts were made to obtain the patient’s written consent.

Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.