Journal
AIDS
Volume 33, Issue 5, Pages 825-832Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0000000000002124
Keywords
antiretroviral therapy; early therapy; immediate therapy; Rapid Antiretroviral Therapy Program for Individuals with an HIV Diagnosis; RAPID ART; safety-net clinic; same-day therapy; virologic suppression
Categories
Funding
- NIAID NIH HHS [P30 AI027763] Funding Source: Medline
- NIGMS NIH HHS [K23 GM112526] Funding Source: Medline
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Objective: Little is known about long-term viral suppression rates for patients who start antiretroviral therapy (ART) soon after diagnosis. We describe virologic outcomes from the San Francisco-based Ward 86 Rapid ART Program for Individuals with an HIV Diagnosis (RAPID) ART program. Design: Retrospective review of clinic-based cohort. Methods: In 2013, Ward 86 adopted immediate ART at the first visit after HIV diagnosis. Patients were referred from testing sites, offered same or next-day intakes, and received multidisciplinary evaluation, support, and insurance enrollment/optimization. Patients were provided ART starter packs and close follow-up. Demographics and labs were extracted from medical records. Subsequent viral loads were obtained from public health surveillance data. Kaplan-Meier curves summarized distribution of times to first viral suppression; viral suppression rates at last viral load recorded were calculated. Results: Of 225 patients referred to RAPID ART from 2013 to 2017, 216 (96%) were started on immediate-ART: median age 30; 7.9% women; 11.6% African-American, 26.9% Hispanic, 36.6% white; 51.4% with substance use; 48.1% with mental health diagnoses; 30.6% unstably housed; baseline median CD4(+) cell count 441 cells/mu l median viral load 37 011. By 1 year after intake, 95.8% achieved viral suppression to less than 200 cells/mu l at least once. Over a median follow-up time of 1.09 years (0-3.92), 14.7% of patients had viral rebound, but most (78%) resuppressed. Viral suppression rates were 92.1% at last recorded viral load. Conclusion: In an urban clinic with high rates of mental illness, substance use and housing instability, immediate ART provided through a RAPID program resulted in viral suppression at last viral load measurement for more than 90% of patients over a median of 1.09 years. RAPID ART for vulnerable populations is acceptable, feasible, and successful with multidisciplinary care and municipal support. Copyright (C) 2019 Wolters Kluwer Health, Inc. All rights reserved.
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