Rapid ART Initiation in the Asia-Pacific Region

Accelerating U=U: The Impact of Rapid ART Initiation in the Asia-Pacific Region

Released: December 06, 2024

Expiration: December 05, 2025

Nittaya Phanuphak, MD, PhD

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Key Takeaways

To efficiently achieve Undetectable equals Untransmittable status, healthcare services and providers must offer easily accessible HIV testing and ensure immediate linkage to rapid antiretroviral treatment initiation.
In real-world national programs in the Asia-Pacific region, rapid antiretroviral initiation has been shown to reduce the risks of loss to follow-up and virologic failure.

At IDWeek and HIV Glasgow 2024, several studies from the Asia-Pacific region emphasized the importance of Undetectable equals Untransmittable and demonstrated how the rapid initiation of antiretroviral therapy plays a crucial role in achieving this status.

The First U of U=U
People living with HIV who are on antiretroviral therapy (ART) can reach Undetectable equals Untransmittable (U=U) status, meaning they have effectively no risk of transmitting HIV to their sexual partners. To efficiently achieve the first U—an undetectable viral load—individuals with HIV must know their HIV status through testing and begin ART as soon as possible. To maintain an undetectable viral load, it is crucial to ensure that individuals with HIV feel supported in their care, are provided with user-friendly ART regimens, and have access to consistent and sustainable supply of antiretroviral medications.

Implementing ART Early
In the Asia-Pacific region, rapid ART initiation has slowly gained momentum:

A real-world cohort of 4688 participants from China, presented at IDWeek 2024, showed that the rate of rapid ART initiation increased from 7.5% in 2016 to 33.3% by 2022.
Similarly, data from Thailand’s national HIV program presented at HIV Glasgow 2024 revealed that 39.7% of participants initiated ART rapidly, with 26.4% starting that same day and 13.3% starting within 2 to 7 days.
At a regional level, data from the TREAT Asia HIV Observational Database Continuum of Care cohort from 2013 to 2023 showed a shorter time from HIV diagnosis to ART initiation over time. The median time decreased from 2.12 years in 2013-2015, to 0.19 years in 2016-2019, and to 0.15 years in 2020-2023. Also, ART initiation was shorter in the upper to middle- and high-income countries than low-income counties in the region.

These data proved that rapid ART initiation is feasible and can be scaled to a regional level. However, it has been more than 7 years since the World Health Organization recommended that rapid ART initiation should be offered to people living with HIV following confirmed diagnosis and clinical assessment. Translating guideline recommendations into effective implementation must occur more rapidly. Countries in the Asia-Pacific region need to invest not only in education and training to enhance the capacity and skills of healthcare professionals but also in significant logistical adjustments within healthcare facilities to ensure they can offer same-day and rapid ART initiation.

Achieving and Maintaining an Undetectable Viral Load
Findings from the same cohort in China from IDWeek 2024 confirmed the benefits of rapid ART initiation in reducing the risks of virologic failure (adjusted OR: 0.35; 95% CI: 0.12-0.80) and loss to follow-up (adjusted HR: 0.65; 95% CI: 0.44-0.96).

Simple ART regimens could also optimize virologic outcomes. In Thailand, the fixed-dose combination of dolutegravir/lamivudine/tenofovir disoproxil fumarate (DTG/3TC/TDF) has been scaled up as a first-line ART regimen since 2020. From 2020 to 2023, 9472 of 10,475 (90.4%) ART-naive individuals with HIV in the national HIV program started DTG/3TC/TDF. During a median follow-up of 8.7 months (IQR 6.8-12.4), excellent viral suppression was found, with 96.9%, 95.3%, and 84.5% achieving HIV-1 RNA ≤1000, <200 and <50 copies/mL, respectively.

The Second U of U=U
Knowing that an undetectable viral load status means individuals with HIV cannot transmit the virus to their sexual partners can empower them to live a full, healthy life without fear of transmission. A recent qualitative study in Thailand highlighted how people with HIV and their partners felt that U=U communication would enable them to love, be loved, and to enjoy intimacy again. To fully realize the benefits of the second U in U=U, healthcare professionals in the Asia-Pacific region must be sensitized and trained to effectively communicate about sexual life, sexual health, and relationships with their clients.

Your Thoughts?
How do the findings from the IDWeek and HIV Glasgow 2024 studies in the Asia-Pacific region influence the treatment and care of your patients living with HIV? Get involved by posting a comment below!

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