Comparable clinical outcomes with same-day versus rapid initiation of antiretroviral therapy in Taiwan

Yi-Chia Huang; Chia-Jui Yang; Hsin-Yun Sun; Chen-Hsiang Lee; Po-Liang Lu; Hung-Jen Tang; Chun-Eng Liu; Yuan-Ti Lee; Chin-Shiang Tsai; Nan-Yao Lee; Bo-Huang Liou; Tung-Che Hung; Mei-Hui Lee; Miao-Hui Huang; Ning-Chi Wang; Chi-Ying Lin; Yi-Chien Lee; Shu-Hsing Cheng; Chien-Ching Hung; Taiwan HIV Study Group

doi:10.1016/j.ijid.2023.12.012

Comparable clinical outcomes with same-day versus rapid initiation of antiretroviral therapy in Taiwan

Int J Infect Dis. 2024 Mar:140:1-8. doi: 10.1016/j.ijid.2023.12.012. Epub 2023 Dec 30.

Authors

Yi-Chia Huang¹, Chia-Jui Yang², Hsin-Yun Sun³, Chen-Hsiang Lee⁴, Po-Liang Lu⁵, Hung-Jen Tang⁶, Chun-Eng Liu⁷, Yuan-Ti Lee⁸, Chin-Shiang Tsai⁹, Nan-Yao Lee⁹, Bo-Huang Liou¹⁰, Tung-Che Hung¹¹, Mei-Hui Lee¹², Miao-Hui Huang¹³, Ning-Chi Wang¹⁴, Chi-Ying Lin¹⁵, Yi-Chien Lee¹⁶, Shu-Hsing Cheng¹⁷, Chien-Ching Hung¹⁸; Taiwan HIV Study Group

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
² Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
⁴ Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan; Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan.
⁵ Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁶ Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁷ Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
⁸ Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
⁹ Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹⁰ Department of Internal Medicine, Hsinchu Mackay Memorial Hospital, Hsin-Chu, Taiwan.
¹¹ Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.
¹² Department of Internal Medicine, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
¹³ Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan.
¹⁴ Department of Internal Medicine, Tri-Service General Hospital, Taipei, Taiwan.
¹⁵ Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
¹⁶ Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.
¹⁷ School of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Infectious Diseases, Taoyuan General Hospital, Taoyuan, Taiwan.
¹⁸ Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hcc0401@ntu.edu.tw.

PMID: 38163618
DOI: 10.1016/j.ijid.2023.12.012

Abstract

Objectives: WHO has recommended same-day antiretroviral therapy (SDART) initiation since 2017; however, higher attrition rates were noted in developing countries.

Methods: We included newly diagnosed people with HIV (PWH) from 2018 to 2022 at 18 hospitals around Taiwan. SDART initiation was defined as starting ART on the same day of HIV diagnosis and rapid initiation as starting ART within 14 days of diagnosis. A composite unfavorable outcome was defined as death after 30 days of diagnosis, loss to follow-up (LTFU), or virologic failure or rebound at 12 months.

Results: At 12 months, PWH on SDART initiation and those on rapid ART initiation showed similar rates of engagement in care with plasma HIV-1 RNA <50 copies/mL (87.5% vs 87.7%) and composite unfavorable outcome (7.7% vs 7.7%). PWH aged >30 years were less likely to have LTFU (aHR 0.44, 95% CI 0.28-0.70). PWH aged >30 years (aHR 0.59, 95% CI 0.41-0.85) and gay, bisexual, and men who have sex with men (GBMSM) (aHR 0.50, 95% CI 0.32-0.79) were less likely to have composite unfavorable outcomes.

Conclusions: SDART and rapid ART initiation resulted in comparable clinical outcomes and viral suppression rates. PWH aged >30 years and GBMSM were less likely to have unfavorable outcomes.

Keywords: Care continuum; Engagement in care; Test-and-treat; Virologic response.

MeSH terms

Anti-HIV Agents* / therapeutic use
CD4 Lymphocyte Count
HIV Infections* / drug therapy
Homosexuality, Male
Humans
Male
Sexual and Gender Minorities*
Taiwan / epidemiology

Substances

Anti-HIV Agents