Rapid initiation of antiretroviral therapy for people living with HIV

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Alberto Mateo‐Urdiales1, Samuel Johnson1, Rhodine Smith2, Jean B Nachega3, Ingrid Eshun‐Wilson2

1.  Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
2. Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
3. Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, USA, Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa

Mateo‐Urdiales  A, Johnson  S, Smith  R, Nachega  JB, Eshun‐Wilson  I. Rapid initiation of antiretroviral therapy for people living with HIV. Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD012962. DOI: 10.1002/14651858.CD012962.pub2

Access the full text article here: DOI: 10.1002/14651858.CD012962.pub2

Effects of starting antiretroviral therapy within one week of diagnosis on people living with HIV

What is the aim of this review?

The aim was to determine whether starting antiretroviral therapy (ART) within one week of HIV diagnosis (rapid ART) resulted in a lower risk of dying or better suppression of the virus in people's blood than standard care; as well as studying the effect of this intervention on whether people start taking ART and continue to be engaged in care after 12 months.

Key messages

Offering ART to people living with HIV (PLWH) within one week of diagnosis probably increases the number of people initiating the therapy at 12 months and the number of PLWH whose virus has been suppressed in the blood at 12 months. It may also improve the number of people who are still in contact with healthcare services at 12 months. We don't know the effect this has on people dying. We found that several other changes need to be made alongside rapid ART for services to achieve these outcomes.

What was studied in the review?

HIV is a leading cause of death worldwide. Although more people are taking ART than ever before, there is a large percentage of PLWH who are not being treated. One of the reasons identified is the long period between being diagnosed with HIV and starting ART. Rapid ART has been proposed as a way to increase the number of PLWH being started on ART and improve HIV‐related outcomes.

What are the main results of the review?

We found seven studies that met the inclusion criteria of the review and assessed the effect of rapid ART on PLWH. Rapid ART probably increases the number of people being initiated on ART at 12 months and the number of PLWH with no detectable virus in their blood at 12 months (moderate‐certainty evidence). Based on low‐certainty evidence, rapid ART may increase the number of PLWH being retained in care. We don't know whether rapid ART has an effect on the number of deaths (very low‐certainty evidence).

We found that if healthcare services aim to offer ART within a week of diagnosis, changes to how these systems operate will need to be made.

How up to date is the review?

We searched for relevant trials up to 14 August 2018.