Clinical benefits of rapid initiation of antiretroviral therapy within 14 days for newly diagnosed late-presentation people living with human immunodeficiency virus (PLWH)

Abstract

This study evaluated the impact of initiating antiretroviral therapy (ART) within 14 days compared to starting after 14 days in newly diagnosed, late-presenting people living with human immunodeficiency virus (PLWH). A total of 1,538 PLWH with a baseline CD4⁺ T-cell count < 350 cells/μL who attended our outpatient clinic from January 2017 to June 2022 were included. Participants were divided into two groups based on ART initiation timing: rapid initiation (ART within 14 days) and delayed initiation (ART after 14 days). Rapid initiation led to significantly higher virologic suppression rates at 6 months (62.5% vs. 52.7%, P < 0.05) and 1 year (81.6% vs. 72.1%, P < 0.01) compared to delayed initiation. While overall treatment retention rates were comparable, rapid initiation improved retention at 6 months for those with baseline CD4⁺ < 200 cells/μL and at 1 year for those with baseline CD4⁺ between 200 and 350 cells/μL. No significant differences in CD4⁺ T-cell counts or CD4/CD8 ratio were observed. A positive correlation was found between baseline viral load and time to virologic suppression, with rapid initiation of ART leading to faster suppression, especially in those with higher baseline viral loads. Multivariate analysis confirmed that ART initiation timing and baseline viral load were key determinants of virologic suppression. In conclusion, rapid ART initiation within 14 days was associated with higher virologic suppression at 6 months and 1 year. Rapid initiation of ART and lower baseline viral load were critical for virologic suppression, with improved retention for specific subgroups.