Pilcher Christopher D, Ospina-Norvell Clarissa, Dasgupta Aditi, Jones Diane, Hartogensis Wendy, Torres Sandra, Calderon Fabiola, Demicco Erin, Geng Elvin, Gandhi Monica, Havlir Diane V, Hatano Hiroyu
*Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA; and †Tulane University School of Medicine, New Orleans, LA.
J Acquir Immune Defic Syndr. 2017 Jan 1;74(1):44-51. doi: 10.1097/QAI.0000000000001134.
Antiretroviral therapy (ART) is typically begun weeks after HIV diagnosis. We assessed the acceptability, feasibility, safety, and efficacy of initiating ART on the same day as diagnosis.
We studied a clinic-based cohort consisting of consecutive patients who were referred with new HIV diagnosis between June 2013 and December 2014. A subset of patients with acute or recent infection (<6 months) or CD4 <200 were managed according to a "RAPID" care initiation protocol. An intensive, same-day appointment included social needs assessment; medical provider evaluation; and a first ART dose offered after laboratories were drawn. Patient acceptance of ART, drug toxicities, drug resistance, and time to viral suppression outcomes were compared between RAPID participants and contemporaneous patients (who were not offered the program), and with an historical cohort.
Among 86 patients, 39 were eligible and managed on the RAPID protocol. Thirty-seven (94.9%) of 39 in RAPID began ART within 24 hours. Minor toxicity with the initial regimen occurred in 2 (5.1%) of intervention patients versus none in the nonintervention group. Loss to follow-up was similar in intervention (10.3%) and nonintervention patients (14.9%) during the study. Time to virologic suppression (<200 copies HIV RNA/mL) was significantly faster (median 1.8 months) among intervention-managed patients when compared with patients treated in the same clinic under prior recommendations for universal ART (4.3 months; P = 0.0001).
Treatment for HIV infection can be started on the day of diagnosis without impacting the safety or acceptability of ART. Same-day ART may shorten the time to virologic suppression.
抗逆转录病毒疗法（ART）通常在HIV诊断数周后开始。我们评估了在诊断当天开始ART的可接受性、可行性、安全性和有效性。
我们研究了一个基于诊所的队列，该队列由2013年6月至2014年12月期间因新诊断出HIV而转诊的连续患者组成。一部分急性或近期感染（<6个月）或CD4<200的患者按照“快速”护理启动方案进行管理。密集的当日预约包括社会需求评估；医疗服务提供者评估；在采集实验室样本后提供首剂ART。比较了快速启动方案参与者与同期患者（未提供该方案）以及历史队列之间患者对ART的接受情况、药物毒性、耐药性和病毒抑制时间结果。
在86名患者中，39名符合条件并按照快速启动方案进行管理。快速启动方案组的39名患者中有37名（94.9%）在24小时内开始ART。干预组患者中有2名（5.1%）出现初始治疗方案的轻微毒性，而无干预组患者出现此类情况。在研究期间，干预组（10.3%）和无干预组患者（14.9%）的失访情况相似。与按照之前普遍ART建议在同一诊所接受治疗的患者相比，接受干预管理的患者病毒学抑制时间（<200拷贝HIV RNA/mL）明显更快（中位时间1.8个月）（4.3个月；P = 0.0001）。
HIV感染治疗可在诊断当天开始，而不影响ART的安全性或可接受性。当日ART可能会缩短病毒学抑制时间。
