Empower your patients to initiate treatment ASAP
- Shortens the time between diagnosis and viral suppression
- Lowers the risk of transmission sooner
- Improves retention in care
Starting ART and achieving viral suppression earlier in the course of disease may also1,5:
- Reduce inflammation and immune activation1
- Restore and preserve normal immune function (immune system damage may occur early)1,5
- Decrease future risk of AIDS events and non-AIDS-related health complications1
Are you considering treatment regimens that allow for early initiation?
The importance of laboratory monitoring
IAS-USA recommends laboratory monitoring in order to characterize6:
- The stage of HIV (using HIV RNA level and CD4 count)
- Overall health (kidney and liver function, lipid levels, complete blood cell count, blood glucose level, and pregnancy)
- Any co-infections, including viral hepatitis A, hepatitis B, hepatitis C, tuberculosis, and STIs
- These tests should not delay the start of ART unless preexisting kidney or liver damage is present or there is a high likelihood of drug resistance
- Quickly perform follow-up tests for all measures to ensure proper safety
- ART should be initiated as soon as possible in all people living with HIV, regardless of CD4 count
- In people with acute or recent (early) HIV infection, in pregnant people with HIV, or in people who will initiate ART on the day of or soon after HIV diagnosis, ART initiation should not be delayed while awaiting resistance testing results; the regimen can be modified once results are reported
- When initiating treatment, it is important to educate patients on the benefits and considerations of ART and adherence
- ART should be initiated as soon as possible after diagnosis, including immediately after diagnosis, unless patient is not ready to commit to starting therapy
- Studies demonstrate that implementing rapid treatment protocols can lead to increased retention and population-level viral suppression
- Rapid ART initiation, defined as within seven days of diagnosis, should be offered to all patients with HIV following confirmed diagnosis and clinical assessment
- Consider the overarching principles of providing people-centered care with a focus on the health needs and preferences of patients. People should be supported in making informed decisions regarding when to start treatment
Experts agree that early initiation of ART can provide a multitude of benefits for PLWH.
ART, antiretroviral therapy; CD4, cluster of differentiation 4; DHHS, US Department of Human and Health Services; IAS-USA, International Antiviral Society–USA; RNA, ribonucleic acid; STD, sexually transmitted disease; STI, sexually transmitted infection; WHO, World Health Organization.
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Updated January 20, 2022. Accessed January 31, 2022 https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/guidelines-adult-adolescent-arv.pdf
- Pilcher CD, Ospina-Norvell C, Dasgupta A, et al. The effect of same-day observed initiation of antiretroviral therapy on HIV viral load and treatment outcomes in a US public health setting. J Acquir Immune Defic Syndr. 2017;74(1):44-51.
- Rosen S, Maskew M, Fox MP, et al. Initiating antiretroviral therapy for HIV at a patient’s first clinic visit: the RapIT randomized controlled trial. PLoS Med. 2016;13(5):e1002015.
- Hoenigl M, Chaillon A, Moore DJ, et al. Rapid HIV viral load suppression in those initiating antiretroviral therapy at first visit after HIV diagnosis. Sci Rep. 2016;6:32947.
- Sereti I, Krebs SJ, Phanuphak N, et al. Persistent, albeit reduced, chronic inflammation in persons starting antiretroviral therapy in acute HIV infection. Clin Infect Dis. 2017;64(2):124-131.
- Saag MS, Benson CA, Gandhi RT, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2020 recommendations of the International Antiviral Society–USA Panel. JAMA. 2020;320(4):379-396.
- Lundgren JD, Babiker AG, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. N Engl J Med. 2015;373(9):795-807.
- Danel C, Moh R, Gabillard D, et al. A trial of early antiretrovirals and isoniazid preventive therapy in Africa. N Engl J Med. 2015;373:808-822.
- Heisler S, Cohn J, Lukomski D, Tuinier K. Ending the HIV epidemic: rapid ART start at the Detroit STD Clinic. Oral presentation at: International AIDS Society Conference on HIV Science 2020. July 6 –10, 2020. Oral abstract PEB0341.
- Coffey S, Bacchetti P, Sachdev D, et al. RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population. AIDS. 2019;33(5):825-832.
- World Health Organization. Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy. Published July 2017. Accessed July 5, 2021. https://www.who.int/publications/i/item/9789241550062