Duong Khanh N C, Schmutz Howard Weston, Ben-Umeh Kenechukwu C, Duru Emeka E, Rose Natalie, Trom Cassidy, Chaiyakunapruk Nathorn, Willis Connor
Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT.
Gilead Sciences, Foster City, CA.
AIDS. 2025 Mar 1;39(3):241-252. doi: 10.1097/QAD.0000000000004046. Epub 2024 Oct 24.
We aimed to synthesize clinical and economic outcomes of rapid start versus nonrapid antiretroviral therapy (ART) in people with HIV (PWH) in real-world settings.
A search was conducted in PubMed, Embase, Web of Science, and ProQuest from January 2017 to January 2023, supplementing a previous search by Ford et al . in 2018. Observational studies investigating clinical or economic outcomes of rapid start ART versus nonrapid ART in PWH were included. Clinical outcomes were mortality, loss-to-follow-up (LTFU), and viral suppression. Economic outcomes were incremental cost-effectiveness ratio (ICER) values and per patient per month (PPPM) costs. Meta-analyses using random-effects models were performed for clinical outcomes, whereas qualitative syntheses were conducted for economic outcomes. The quality of clinical and economic studies was assessed.
Sixty-two studies were included. The pooled adjusted risk ratio (aRR) for mortality demonstrated a significant reduction in risk of mortality among participants who received rapid start ART compared with nonrapid ART [0.80, 95% confidence interval (CI), 0.65-0.98]. For LTFU at 6 and 12 months, the pooled aRR showed increased LTFU for rapid start ART (1.33, 95% CI, 1.15-1.55 and 1.18, 95% CI, 0.74-1.89 respectively). All cost-effectiveness studies reported cost-saving or cost-effective findings. The PPPM costs of rapid start ART across the first 36 months of treatment were consistently lower than nonrapid ART.
Rapid ART is associated with reduced mortality and is cost-effective compared with nonrapid ART in real-world settings. Clinicians and policymakers should consider these findings to facilitate rapid start of ART in PWH. Further research on LTFU in PWH is needed.
我们旨在综合现实环境中HIV感染者（PWH）接受快速启动抗逆转录病毒治疗（ART）与非快速启动ART的临床和经济结果。
于2017年1月至2023年1月在PubMed、Embase、Web of Science和ProQuest中进行检索，补充了Ford等人在2018年的先前检索。纳入了调查PWH中快速启动ART与非快速启动ART的临床或经济结果的观察性研究。临床结果为死亡率、失访（LTFU）和病毒抑制。经济结果为增量成本效益比（ICER）值和每位患者每月（PPPM）成本。对临床结果进行随机效应模型的Meta分析，而对经济结果进行定性综合分析。评估临床和经济研究的质量。
纳入62项研究。与非快速启动ART相比，接受快速启动ART的参与者的合并调整风险比（aRR）显示死亡率风险显著降低[0.80，95%置信区间（CI），0.65 - 0.98]。对于6个月和12个月时的LTFU，合并aRR显示快速启动ART的LTFU增加（分别为1.33，95%CI，1.15 - 1.55和1.18，95%CI，0.74 - 1.89）。所有成本效益研究均报告了成本节约或成本效益结果。快速启动ART在治疗的前36个月的PPPM成本始终低于非快速启动ART。
在现实环境中，快速启动ART与死亡率降低相关，且与非快速启动ART相比具有成本效益。临床医生和政策制定者应考虑这些结果，以促进PWH快速启动ART。需要对PWH中的LTFU进行进一步研究。
