Rapid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps

M. A. Boyd, M. Boffito, A. Castagna, V. Estrada

Research output: Contribution to journalReview articlepeer-review

Abstract

Initiating antiretroviral therapy (ART) as early as the day of HIV diagnosis is a strategy of increasing global interest to control the HIV epidemic and optimize the health of people living with HIV (PLWH). No detrimental effects of rapid-start ART have been identified in randomized controlled trials undertaken in low- or middle-income countries, or in cohort studies performed in high-income countries. Rapid-start ART may be a key approach in reaching the 2020 Joint United Nations Programme on HIV/AIDS goal of 90% of all PLWH knowing their status, 90% of those diagnosed receiving sustained ART, and 90% of those receiving ART achieving viral suppression; it may also be important for achieving the suggested fourth “90%” goal: improving health-related quality-of-life in PLWH. Presently there is insufficient broad evidence for guidelines to recommend universal test-and-treat strategies for all people, in all settings, at HIV diagnosis; consequently, there is a pressing need to conduct high-quality studies that investigate immediate ART initiation. This article evaluates global evidence regarding rapid-start ART, including same-day start, with particular focus on the implementation of this strategy in high-income countries.

Original languageEnglish
Pages (from-to)3-11
Number of pages9
JournalHIV Medicine
Volume20
DOIs
Publication statusPublished - Mar 2019

Keywords

  • antiretroviral therapy
  • HIV diagnosis
  • initiation
  • rapid start
  • treatment guidelines

ASJC Scopus subject areas

  • Health Policy
  • Infectious Diseases
  • Pharmacology (medical)

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