Rapid ART start in early HIV infection: Time to viral load suppression and retention in care in a London cohort

• Published in: HIV medicine Vol. 21; no. 9; pp. 613 - 615
• Main Authors: Girometti, Nicolò, Lander, Frances, McOwan, Alan, Nwokolo, Nneka, Boffito, Marta, Whitlock, Gary, Suchak, Tara, Patel, Sheel, Gedela, Keerti, McCormack, Sheena, Tittle, Victoria, Nugent, Diarmuid
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-10-2020
• Subjects: Adult; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; CD4 Lymphocyte Count; Darunavir - therapeutic use; Female; HIV; HIV Infections - drug therapy; HIV Infections - immunology; HIV Infections - virology; HIV Integrase Inhibitors - therapeutic use; HIV-1 - drug effects; HIV-1 - physiology; Homosexuality, Male - statistics & numerical data; Human immunodeficiency virus; Humans; Immunology; Infections; integrase inhibitors; London; Male; Patients; Protease inhibitors; Proteinase inhibitors; rapid ART; Retention; Retention in Care - statistics & numerical data; Ribonucleic acid; RNA; RNA, Viral - drug effects; RNA, Viral - genetics; seroconversion; Tenofovir; Tenofovir - therapeutic use; test and treat; Time Factors; treatment as prevention; Treatment Outcome; Viral Load - drug effects; London; integrase inhibitors; seroconversion; treatment as prevention; rapid ART; test and treat
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/hiv.12900

Objectives
Rapid antiretroviral therapy (ART) initiation is recommended in early HIV infection (EHI), even in the absence of baseline viral resistance test result. We analysed time to viral suppression according to ART regimen started in a cohort of patients diagnosed with EHI.
Methods
Clinical records of individuals consecutively diagnosed with EHI between July 2016‐June 2018 were reviewed. The distribution of clinical, virological and immunological factors was compared in treatment groups using the Mann–Whitney U‐test.
Results
262 individuals (97% MSM) were diagnosed with EHI. 58% of patients agreed to start ART within 14 days of diagnosis. Tenofovir‐based combinations were prescribed to all patients. DRV/b was the most commonly prescribed third agent (78%), when genotypic resistance testing was not available at time of ART choice. Switching to INSTI was encouraged once VRT became available and 27% switched from DRV/b to INSTI (mainly RAL) within 28 days from ART start. Those receiving INSTI were more likely to have a baseline viral load exceeding 1 million HIV‐1 RNA copies/mL compared with those starting with DRV/b. Rapid start with INSTI regimens resulted in quicker viral suppression than when DRV/b was chosen in EHI, even when that was subsequently switched to INSTI. Retention in care following rapid ART start was achieved by all patients at 24 weeks.
Conclusions
Starting an INSTI‐based ART combination was associated with quicker viral suppression than when a protease inhibitor‐based combination was chosen. No differences in the achievement of viral suppression or in retention in care were observed.