Effect of rapid antiretroviral therapy initiation on loss to follow-up, mortality, and virologic failure among people with human immunodeficiency virus under the treat-all policy in China: analysis of routine data

TL;DR

Starting HIV treatment within 7 days of diagnosis in China reduces mortality and virologic failure without increasing loss to follow-up.

Contribution

This study demonstrates the benefits of rapid ART initiation under China's treat-all policy using real-world data.

Findings

Rapid ART initiation showed lower mortality compared to delayed ART.

Rapid ART was associated with reduced odds of virologic failure.

Loss to follow-up rates were similar across rapid and delayed ART groups.

Abstract

Since 2016, China has provided timely HIV antiretroviral therapy (ART) under the treat-all policy. This study aimed to evaluate the impact of rapid ART initiation (≤7 days post-HIV diagnosis) on loss to follow-up (LTFU), mortality, and virologic failure compared with that of delayed ART.

This study included adults with ART-naive HIV infection in Xi’an, China, between 2016 and 2022. Kaplan–Meier analysis was used to examine LTFU and death time for rapid and delayed ART initiation. Moreover, multivariate Cox regression was employed to evaluate the correlation between rapid ART initiation and LTFU/mortality, while logistic regression was utilized to assess the association between rapid ART and 12-month virologic failure.

Of the 6992 participants, 770 (11.0%) initiated ART ≤7 days postdiagnosis. The percent of ART initiations in the first week postdiagnosis quadrupled from 4.2% in 2016 to 19.7% in 2022. The LTFU rate for rapid ART initiators was comparable to that in the 8–29- (P = 0.132) and ≥30-day groups (P = 0.432). Mortality was notably decreased in the rapid ART group (0.0%) than in the 8–29- (1.5%) and ≥30-day groups (2.2%). The rapid ART initiators demonstrated lower odds of developing virologic failure compared with delayed ART initiators (aOR: 0.50; 95% CI: 0.26–0.89; P = 0.028; ≤7 days versus ≥30 days).

Under China’s treat-all policy, rapid ART initiation showed equivalent LTFU but lower mortality and virologic failure. Chinese HIV patients may benefit from rapidly ART, but they require more intensive, tailored counseling to remain in treatment.

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