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RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population
Published by François RAFFI
Updated: 25 August, 2019
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 CD4þ cell count 441 cells/ml median viral load 37 011. By 1 year after intake, 95.8% achieved viral suppression to
less than 200 cells/ml 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.