Comparable Clinical Outcomes with Same-Day Versus Rapid Initiation of Antiretroviral Therapy: A Real-World Retrospective Cohort Study in a Developed Country

Background: Same-day antiretroviral therapy (SDART) initiation is recommended for newly diagnosed people with HIV (PWH) by the WHO; however, higher attrition rates were noted after SDART initiation in developing countries.Methods: To compare the clinical outcomes with SDART versus rapid ART initiation, we included newly diagnosed PWH from 2018 to 2022 in Taiwan, where the program of rapid ART initiation was implemented in 2018. SDART initiation was defined as starting ART on the same day of HIV diagnosis and rapid ART initiation as starting ART within 14 days of diagnosis. A composite unfavorable clinical outcome was assessed, defined as any deaths after 30 days of diagnosis, loss to follow-up (LTFU), or virologic failures or rebounds at 12 months.Findings: The rate of SDART initiation increased from 15·8% in 2018 to 34·1% in 2021-2022. At 12 months, PWH on SDART initiation and those on rapid ART initiation showed similar rates of engagement in care with viral suppression (87·5% vs 87·7%) and the composite unfavorable outcome (7·7% vs 7·7%). Age >30 years (adjusted hazard ratio [aHR] 0·44, 95% CI 0·28-0·70) was the only independent factor associated with LTFU. PWH aged >30 years (aHR 0·59, 95% CI 0·41-0·85) and GBMSM (aHR 0·50, 95% CI 0·32-0·79) were less likely to have composite unfavorable outcomes.Interpretation: Programs of SDART and rapid ART initiation demonstrated comparable clinical outcomes and viral suppression rates for newly diagnosed PWH. Strategies are needed for PWH 30 years or younger and those other than GBMSM to improve the post-engaging care continuum.Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.Declaration of Interest: C.-C. H has received honoraria and research funding from Gilead Sciences. Other authors have no conflict of interest to declare.Ethical Approval: This study was reviewed and approved by the Research Ethics Committee of the National Taiwan University Hospital (202101016RIND). Due to the retrospective study design, patients were not involved in research development, recruitment, study conduction, or outcome measurement.