Strategies to Minimize Time From HIV Acquisition to ART Initiation: The Barcelona Early-cART Program

Targeted referral systems for individuals at highest risk of HIV transmission can accelerate linkage to care and antiretroviral treatment (ART) initiation, potentially reducing onward transmission.

In 2014, we established the Early-cART cohort of adults newly diagnosed with HIV who started ART within 6 months of estimated HIV acquisition (etPWH), in collaboration with community centers and via a fast-referral system to our HIV unit. Clinical data and biological samples were collected before and after initiation of ART. Total HIV-1 DNA in peripheral blood mononuclear cells was measured in a subset of participants virologically suppressed for >3 years. Link-to-care was defined as days from first positive HIV test to first appointment at the HIV unit. HIV-to-ART was defined as days from estimated acquisition to ART start.

From 2014 to 2022, 340 etPWH (90% men having sex with men, mean age 34 years) were included from ∼900 new referrals. Two years after ART initiation, 48% of etPWH achieved a CD4/CD8 ratio of >1, whereas only 5% remained <0.5. In the reservoir subset, levels of HIV-1 DNA correlated with time from HIV to ART only when ART was initiated within 60 days after HIV acquisition, with 55% of participants showing <50 HIV-1 DNA copies/10⁶ peripheral blood mononuclear cells. Median link-to-care time decreased from 11 to 3 days (P = .0011), and HIV-to-ART time from 73 to 27 days (P = .0014) over the study period.

The Early-cART program achieved rapid linkage to care and ART initiation with robust immunovirological responses, indicating its potential to reduce HIV transmission.