Rapid Initiation of Antiretroviral Therapy after HIV Diagnosis

Roughly, 38 million people are living with HIV worldwide. Despite the success of antiretroviral therapy (ART) for suppressing virus replication and restore immunity in infected persons, the HIV epidemics are not controlled globally. Each year 1.8 million new HIV infections occur. This rate has declined only slightly during the past decade, despite huge efforts for expanding ART coverage, pre- and post-exposure prophylaxis, and stopping vertical transmission. To achieve the United Nations Programme on HIV/AIDS goals of 95-95-95 by 2030, renewed efforts and innovative strategies must be undertaken. The source of most new HIV infections is people unaware of their HIV-positive status and/or not linked to care. Thus, efforts for unveiling HIV positives and, especially, rapid initiation of ART and retention in care would be the most effective interventions for halting HIV spreading globally. In certain settings, access to point-of-care diagnostic tests and immediate start of ART (even the same day) must be implemented at large scale. Selection of the most convenient ART to be prescribed empirically is an important caveat to minimize the risks of treatment failure. Ideally, it must be easy to take, coformulated as single-tablet regimen (STR), well tolerated, with no requests for prior human leukocyte antigen testing, depict few drug interactions, keep activity against transmitted drug-resistant viruses, remain efficacious in patients with elevated HIV-RNA, and/or low CD4 counts, and when present, suppress hepatitis B coinfection. At this time, the coformulation of darunavir, cobicistat, emtricitabine, and tenofovir alafenamide (Symtuza®) is the only regimen that has been evaluated in a Phase 3 trial as "test-and-treat" strategy. Results at 48 weeks in the DIAMOND study are reassuring, as more than 90% of individuals achieve undetectable viremia.