Growing evidence suggests that rapid initiation of antiretroviral therapy for HIV improves care continuum outcomes. We evaluated process and clinical outcomes for rapid initiation in acute HIV infection within a multisite health care–based HIV testing and linkage to care program in Chicago. Through retrospective analysis of HIV testing data (2016-2017), we assessed linkage to care, initiation of antiretroviral therapy, and viral suppression. Of 334 new HIV diagnoses, 33 (9.9%) individuals had acute HIV infection. Median time to linkage was 11 (interquartile range [IQR]: 5-19.5) days, with 15 days (IQR 5-27) to initiation of antiretroviral therapy. Clients achieved viral suppression at a median of 131 (IQR: 54-188) days. Of all, 69.7% were retained in care, all of whom were virally suppressed. Sites required few additional resources to incorporate rapid initiation into existing processes. Integration of rapid initiation of antiretroviral therapy into existing HIV screening programs is a promising strategy for scaling up this important intervention.

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BackgroundPersons with acute HIV infection have high viral loads and are highly infectious compared with those with chronic infection. Rapid linkage to care and initiation of therapy, facilitated by new testing algorithms, allows for immunologic preservation and rapid virologic control, which benefits the individual and decreases transmission events.MethodsWe analyzed testing data (2016–2017) from the xTLC Program, a collaborative effort between 13 healthcare centers on the South and West sides of Chicago. For acute HIV infections, we assessed linkage to care, initiation of antiretroviral therapy (ART) and viral suppression across sites.ResultsOf 334 new HIV diagnoses in xTLC, 33 (9.9%) had acute infection across six sites (five acute care hospitals/emergency departments, one clinic). Baseline viral load (VL) was 2.19 million copies/mL (IQR 0.47–5.00) and baseline CD4 count was 440.5/µL (IQR 287.5–568.5). Table 1 shows care continuum outcomes for patients with acute HIV infection.Table 1: Care Continuum Outcomes for Acute HIV Infections Diagnosed Through X-TLC Site (N) Days to Linkage* (IQR) Days to ART* (IQR) Days to ≥2 Log Reduction in VL* (IQR) Days to VL ≤ 200* (IQR) Retained in Care** (%) Virally Suppressed (%)A (1)27 (27–27)9 (9–9)55 (55–55)55 (55–55)1 (100.0)1 (100.0)B (6)11 (6–58)21.5 (7–58)48 (34–62)132.5 (48–321)4 (66.7)4 (100.0)C (2)39 (39–39)53 (53–53)95 (95–95)162 (162–162)1 (50.0)1 (100.0)D (4)3.5 (1.5–4.5)4 (3–6)31 (29–33)31 (29–33)3 (75.0)3 (100.0)E (14)8.5 (4–18)5.5 (4–21)55 (47–131)124 (55–162)10 (71.4)10 (100.0)F (6)14 (13–21)25.5 (23–34)92.5 (62–471)329.5 (186–643)4 (66.7)4 (100.0)Total (33)11 (5–19.5)15 (5–27)58.5 (42–117)131 (54–188)23 (69.7)23 (100.0)*Median.**Currently in care.ConclusionPatients with acute HIV infection can be successfully managed in existing programs for HIV screening and linkage to care. The xTLC program had a high linkage to care rate, timely initiation of ART, and relatively quick reduction in viral loads. Our outcomes approach those seen for intensive immediate therapy programs, but without additional costs beyond those of the xTLC program. This will likely create similar public health benefits as dedicated programs for rapid initiation of therapy.Disclosures B. Hunt, Gilead: supported by Gilead FOCUS grant, Salary. A. Tobin, Gilead: supported by Gilead FOCUS grant, Salary. A. B. Maheswaran, Gilead: supported by Gilead FOCUS grant, Salary. J. Lin, Gilead: Grant Investigator, Grant recipient. R. Novak, Gilead: Scientific Advisor, Consulting fee. Viiv: Scientific Advisor, Consulting fee. Theratech: Scientific Advisor, Consulting fee. B. Sha, Gilead Sciences: Grant Investigator and Investigator, Grant recipient and Research grant. Viiv Healthcare: Investigator, Research grant. D. Pitrak, Gilead: Grant Investigator, Grant recipient and Research grant. N. Glick, Gilead: Grant Investigator and Scientific Advisor, Grant recipient