Christopher Pilcher, M.D.
San Francisco General Hospital's RAPID program, which offers antiretroviral treatment starting the same day people are diagnosed with HIV, was well received and led to more rapid viral load suppression than the standard treatment schedule, according to a study presented on Wednesday at the 8th International AIDS Society Conference in Vancouver. Participants in the RAPID program achieved undetectable viral load in a median of 56 days, compared with 119 days for those in a universal ART standard-of-care group and 283 days in people starting ART based on CD4 count. The RAPID program is now being implemented city-wide as part of the "Getting to Zero" initiative, which aims to reach zero new HIV transmission and zero AIDS-related deaths, and eliminate stigma.
Studies have shown that early antiretroviral treatment improves the health of people living with HIV and has the added public health benefit of reducing HIV transmission. But getting people into care can be challenging and some are lost at each stage of the HIV care cascade.
Christopher Pilcher, MD, presented results from a feasibility study of the UCSF/SFGH RAPID program.
In 2010 San Francisco was the first city to recommend universal antiretroviral therapy (ART) for everyone diagnosed with HIV regardless of CD4 cell count. A similar recommendation was included in U.S. treatment guidelines in 2013 and will soon be incorporated into the World Health Organization's global guidelines.
San Francisco has a well-financed HIV care system with highly experienced and culturally competent providers. Yet even with these advantages, the process of getting tested, addressing other issues that may be barriers to treatment (such as substance use or unstable housing), then figuring out how to pay for medication can take a lot of time. This delay can lead to disease progression and continued HIV transmission.
When treatment was based on CD4 count in the late 2000s, it took 128 days on average for people to get a prescription for ART and 218 days to achieve viral suppression. After the standard of care shifted to universal treatment in 2010, it took a mean of 37 days to get ART and 132 days to reach viral suppression.
The RAPID program was designed to speed up this process by collapsing some of the steps of the care continuum, Pilcher explained. Instead of HIV diagnosis, initial assessment and counseling, medical evaluation, and ART prescription being done over multiple visits, these are all consolidated into a single visit.
Pilcher's team analyzed outcomes in a demonstration project assessing this rapid approach. They looked at 39 people newly diagnosed with HIV who participated in the RAPID program between July 2013 and December 2014. This group was compared to people who historically received standard care with universal ART during 2010-2013 or CD4-guided treatment during 2006-2009.
RAPID was initially designed to offer prompt treatment for people with acute HIV infection (within the past six months), as research has shown that very early ART can limit the size of the viral reservoir. It was later expanded to include newly diagnosed people who had been infected longer, and people with indications for urgent treatment because of an opportunistic illness or CD4 count below 200. In this analysis, 70% of RAPID participants had been infected with HIV in the past six months.
This excerpt was cross-posted with the permission of BETAblog.org. Read the full article.