title: The Effect of Same-Day Observed Initiation of Antiretroviral Therapy on HIV Viral Load and Treatment Outcomes in a US Public Health Setting.
abstract: BACKGROUND
  Antiretroviral therapy (ART) is typically begun weeks after HIV diagnosis. We assessed the acceptability, feasibility, safety, and efficacy of initiating ART on the same day as diagnosis.
  
  
  METHODS
  We studied a clinic-based cohort consisting of consecutive patients who were referred with new HIV diagnosis between June 2013 and December 2014. A subset of patients with acute or recent infection (<6 months) or CD4 <200 were managed according to a "RAPID" care initiation protocol. An intensive, same-day appointment included social needs assessment; medical provider evaluation; and a first ART dose offered after laboratories were drawn. Patient acceptance of ART, drug toxicities, drug resistance, and time to viral suppression outcomes were compared between RAPID participants and contemporaneous patients (who were not offered the program), and with an historical cohort.
  
  
  RESULTS
  Among 86 patients, 39 were eligible and managed on the RAPID protocol. Thirty-seven (94.9%) of 39 in RAPID began ART within 24 hours. Minor toxicity with the initial regimen occurred in 2 (5.1%) of intervention patients versus none in the nonintervention group. Loss to follow-up was similar in intervention (10.3%) and nonintervention patients (14.9%) during the study. Time to virologic suppression (<200 copies HIV RNA/mL) was significantly faster (median 1.8 months) among intervention-managed patients when compared with patients treated in the same clinic under prior recommendations for universal ART (4.3 months; P = 0.0001).
  
  
  CONCLUSIONS
  Treatment for HIV infection can be started on the day of diagnosis without impacting the safety or acceptability of ART. Same-day ART may shorten the time to virologic suppression.
authors.affiliation: *Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA; and †Tulane University School of Medicine, New Orleans, LA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Pilcher
authors.forename: Clarissa
authors.initials: C
authors.lastname: Ospina-Norvell
authors.forename: Aditi
authors.initials: A
authors.lastname: Dasgupta
authors.forename: Diane
authors.initials: D
authors.lastname: Jones
authors.forename: Wendy
authors.initials: W
authors.lastname: Hartogensis
authors.forename: Sandra
authors.initials: S
authors.lastname: Torres
authors.forename: Fabiola
authors.initials: F
authors.lastname: Calderon
authors.forename: Erin
authors.initials: E
authors.lastname: Demicco
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.forename: Diane V
authors.initials: DV
authors.lastname: Havlir
authors.forename: Hiroyu
authors.initials: H
authors.lastname: Hatano
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D019468:Disease Management; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D011635:Public Health Administration; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents