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HIV Spotlight on Center on Caring for the Newly Diagnosed Patient

News

HIV Diagnosis Followed by Initiation of Treatment on the Same Day

December 8, 2016

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Changing Clinics and Other Issues

Similar proportions of participants in RAPID (21%) and non-RAPID care (23%) subsequently chose to receive care at a different clinic.

Clinic staff lost contact with a broadly similar proportion of participants in RAPID (10%) and non-RAPID care (15%).


Viral Load

For the purposes of this analysis, the research team chose to use a viral load level of 200 copies/mL as a goal of therapy in the short term. They found that, on average, participants in RAPID achieved a target viral load of 200 copies/mL faster (58 days) after their first clinic visit than non-RAPID participants who took nearly 80 days after their first clinic visit to reach the same level.


A Combined Effort

The research team noted that "starting ART immediately [after diagnosis] required additional time from all members of our multidisciplinary team." This issue arose because the researchers found that "our new patients lacked health insurance and often had immediate housing, substance use or mental health treatment needs. The addition of same-day ART into the first clinic visit therefore increased the urgency of arranging health insurance and also compressed the time available for social workers to begin the process of psychological and social stabilization."


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Summing It Up

Based on their results, the researchers made the following statement:

"We found that a health system intervention to initiate ART on the same day as an HIV diagnosis was highly feasible in a real-world public health clinic in San Francisco. Same-day, observed initiation of ART was well accepted, was well tolerated by patients and did not appear to interfere with subsequent engagement in care."

It is likely that in the future more cities, regions and countries will prioritize programs such as RAPID to help improve the health of HIV-positive people and stem the spread of new infections.


Not Just in San Francisco

Researchers in Vancouver have also published their preliminary results with HIV diagnosis followed by the offer of initiating ART on the same day. Also, researchers in London, England, have reported their experience with a relatively early initiation of ART in people with very early HIV infection.


Resources

Negligible Risk: Updated results from two studies continue to show that antiretroviral treatment and an undetectable viral load is a highly effective HIV prevention strategy -- CATIE News

Starting ART on the same day as an HIV diagnosis in British Columbia -- TreatmentUpdate 210

Study heralds an important shift in care and treatment -- TreatmentUpdate 210

Detailed results from the START study -- TreatmentUpdate 210

CATIE statement on the use of antiretroviral treatment (ART) and an undetectable viral load to prevent the sexual transmission of HIV


References

  1. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. Jul 12;316(2):171-81.
  2. Daar ES, Corado K. Condomless sex with virologically suppressed HIV-infected individuals: How safe is it? JAMA. 2016 Jul 12;316(2):149-51.
  3. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. New England Journal of Medicine. 2016 Sep 1;375(9):830-9.
  4. Mayer KH, Krakower DS. Antiretrovirals for HIV treatment and prevention: The challenges of success. JAMA. 2016 Jul 12;316(2):151-3.
  5. 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 U.S. public health setting. Journal of Acquired Immune Deficiency Syndromes. 2017; in press.
  6. Ryom L, Boesecke C, Gisler V, et al. Essentials from the 2015 European AIDS Clinical Society (EACS) guidelines for the treatment of adult HIV-positive persons. HIV Medicine. 2016 Feb;17(2):83-8.
  7. INSIGHT START Study Group, Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine. 2015 Aug 27;373(9):795-807.
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