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The Effect of Same-Day Observed Initiation of Antiretroviral Therapy on HIV Viral Load and Treatment Outcomes in a US Public Health Setting

Pilcher, Christopher D. MD; Ospina-Norvell, Clarissa FN-P; Dasgupta, Aditi BS; Jones, Diane RN; Hartogensis, Wendy PhD; Torres, Sandra MSW; Calderon, Fabiola MSW; Demicco, Erin MPH; Geng, Elvin MD; Gandhi, Monica MD; Havlir, Diane V. MD; Hatano, Hiroyu MD

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 January 2017 - Volume 74 - Issue 1 - p 44–51
doi: 10.1097/QAI.0000000000001134
Clinical Science

Background: Antiretroviral therapy (ART) is typically begun weeks after HIV diagnosis. We assessed the acceptability, feasibility, safety, and efficacy of initiating ART on the same day as diagnosis.

Methods: We studied a clinic-based cohort consisting of consecutive patients who were referred with new HIV diagnosis between June 2013 and December 2014. A subset of patients with acute or recent infection (<6 months) or CD4 <200 were managed according to a “RAPID” care initiation protocol. An intensive, same-day appointment included social needs assessment; medical provider evaluation; and a first ART dose offered after laboratories were drawn. Patient acceptance of ART, drug toxicities, drug resistance, and time to viral suppression outcomes were compared between RAPID participants and contemporaneous patients (who were not offered the program), and with an historical cohort.

Results: Among 86 patients, 39 were eligible and managed on the RAPID protocol. Thirty-seven (94.9%) of 39 in RAPID began ART within 24 hours. Minor toxicity with the initial regimen occurred in 2 (5.1%) of intervention patients versus none in the nonintervention group. Loss to follow-up was similar in intervention (10.3%) and nonintervention patients (14.9%) during the study. Time to virologic suppression (<200 copies HIV RNA/mL) was significantly faster (median 1.8 months) among intervention-managed patients when compared with patients treated in the same clinic under prior recommendations for universal ART (4.3 months; P = 0.0001).

Conclusions: Treatment for HIV infection can be started on the day of diagnosis without impacting the safety or acceptability of ART. Same-day ART may shorten the time to virologic suppression.

*Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA; and

Tulane University School of Medicine, New Orleans, LA.

Correspondence to: Christopher D. Pilcher, MD, Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, Box 0874 San Francisco General Hospital Ward 84, 995 Potrero Avenue, San Francisco, CA 94110-0874 (e-mail: cpilcher@php.ucsf.edu).

Supported by a grant from the NIH/NIMH R34MH096606 (C.P.D.). The remaining authors have no funding or conflicts of interest to disclose.

Partial results previously presented at: C.D.P. et al. Providing same day, observed ART to newly diagnosed HIV+ outpatients is associated with improved virologic suppression. Eighth International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention (IAS 2015), July 19–22, 2015, Vancouver, Canada (abstract WEAD0105LB).

Received May 05, 2016

Accepted June 17, 2016

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