What benefits can HIV-infected people bring to the rapid start-up treatment strategy emphasized by the World Health Organization?

Only for medical professionals to read for reference, the earlier the antiretroviral treatment of AIDS is started, the greater the benefit
.

AIDS is an important public health problem that seriously affects human health.
So far, it has caused nearly 33 million deaths
.

However, as more and more people obtain effective AIDS prevention, diagnosis, treatment and care measures, AIDS has become a preventable and controllable chronic disease, and the life expectancy of people infected with human immunodeficiency virus (HIV) is also increasing.
The closer it is to a normal person [1]
.

At present, the most effective way to suppress the virus in HIV-infected patients is still lifelong anti-retroviral therapy (ART) [2], and how to quickly suppress the virus in HIV-infected patients and delay disease progression is a clinician and AIDS-related researcher Questions that have been considered
.

Rapid start of treatment has obvious benefits and helps promote AIDS prevention and treatment.
In 2017, the World Health Organization (WHO) formally put forward the concept of "rapid start" (RAPID ART), clearly recommending that all HIV-infected patients start ART within 7 days of diagnosis; Infected patients who are prepared for treatment and have no clinical contraindications or other special circumstances should consider starting treatment on the day of diagnosis [3,4]
.

At present, the rapid-start ART treatment model has been widely recognized worldwide.
In recent years, more and more guidelines have emphasized the concept of rapid-start treatment in anti-HIV treatment [5]
.

The rapid start of treatment has two important effects[4,5]: In the absence of an effective HIV vaccine or cure strategy, controlling the viral load in the plasma of an infected person below the detection limit through ART can effectively control the virus.
Transmission, that is, (U=U), so as to effectively control the HIV epidemic; quick-starting ART can significantly improve the clinical results of HIV-infected patients, increase the treatment rate of the infected, reduce the mortality rate, and improve the quality of life and health of the infected
.

With the accumulation of clinical evidence, there is now more and more evidence showing the benefits of the strategy of rapid initiation of treatment
.

A clinical cohort study included 86 newly diagnosed HIV-infected patients, of which 39 received rapid-start therapy.
The results showed that the infected patients in the rapid-start group were referred to virologically suppressed (HIV RNA <200 copies/mL) Compared with the non-rapid start group, the median time of the group was shortened by 23 days (56 days vs.
79 days, P=0.
009) [6]
.

In addition, the proportion of rapid-start infections who obtain virological suppression is also higher
.

An open, randomized CASCADE study published in the journal "JAMA" showed that the virological inhibition rate of the rapid-start group was 50.
4% at 12 months of treatment, while that of the standard procedure group was only 34.
3% (P=0.
007) [7]
.

In terms of fatality rate, the South African cohort study model predicts that the fatality rates within 52 weeks of infected persons who start antiviral treatment immediately after seeing a doctor and those who start antiretroviral treatment after 10 weeks will be 11.
1% and 14.
7%, suggesting that the sooner HIV-infected patients receive treatment, The lower the risk of death [8]
.

In the past ten years, many countries and regions around the world have launched antiviral therapy rapid-start pilot projects.
Their specific implementation plans and experience have reference value for China to promote the rapid-start treatment model.
The implementation of this strategy will also help Improve the late treatment and non-treatment of HIV-infected people in our country, shorten the time for infected people to obtain virological suppression, and reduce the mortality rate [4]
.

Figure 1: Reference to the experience of international rapid-start treatment programs.
This program does not require genetic testing.
It is a rapid-start program recognized by the guidelines.
In a rapid-start treatment strategy, choosing the right drug program is also an important part
.

At present, the global anti-HIV treatment has entered the era of Integrase Inhibitors (INSTI).
Among them, bicampano tablets (B/F/TAF) are the first choice for quick-start programs recommended by the latest U.
S.
Department of Health and Human Services (DHHS) guidelines.
First, the programs containing non-nucleoside reverse transcriptase inhibitors (NNRTI), abacavir (ABC), etc.
, require drug resistance or hypersensitivity testing before treatment, and are not suitable for rapid start-up treatment [9]
.

Figure 2: 2021 DHHS guidelines for quick start ART program recommendations (BIC: bictegravir; FTC: emtricitabine; TAF: tenofovir propofol; TDF: tenofovir disoproxil fumarate; DTG: Dolutegravir; 3TC: Lamivudine) B/F/TAF has several advantages over existing INSTI-based antiviral treatment programs
.

First of all, DTG and ABC in the DTG/ABC/3TC protocol are related to hypersensitivity, and the hepatitis B surface antigen and HIV RNA test must be carried out before the use of DTG/3TC, and the HLA-B*5701 gene screening must be carried out before the use of ABC.
/F/TAF has no hypersensitivity, no need for HLA-B*5701 gene and baseline virus genotype screening, HIV-infected patients can start treatment quickly
.

Secondly, B/F/TAF only needs to take one tablet per day, not affected by the time of eating, and is the smallest in the existing INSTI compound tablets, which helps to improve the compliance of the infected patients [9,10]
.

A pooled analysis of research data from 1489 & 1490 shows that among newly-treated adult infected persons, B/F/TAF can achieve rapid virological response in a short period of time, and the average HIV-1 RNA decline at the fourth week reached 3.
3 log10, which is a long-term virus.
The learning inhibition rate is as high as 99.
8%[11-13]
.

Figure 3: B/F/TAF can achieve rapid virological response in a short period of time.
In addition, among newly-treated adult infected persons, whether it is at baseline CD4 <200 cells/μL or HIV-1 RNA>105c/mL, even at baseline The worst situation: among infected persons with CD4<200 and HIV RNA >105c/mL, the virus inhibition rate of B/F/TAF treatment at 96 weeks was 100% [11]
.

Figure 4: The efficacy of B/F/TAF in suppressing the virus is not affected by baseline viral load and CD4 level.
It is particularly worth mentioning that B/F/TAF has a higher resistance barrier.
In the newly treated population, B/F The incidence of drug resistance at 144 weeks of /TAF treatment was 0[14]
.

In addition, regardless of whether there is transmissible resistance, B/F/TAF treatment for 144 weeks can achieve a high level of sustained virological suppression [15]
.

Figure 5: Regardless of whether there is transmissible resistance, B/F/TAF treatment can achieve a high level of sustained virological suppression (transmissible resistance refers to the direct transmission of HIV resistance-related mutations from drug-resistant strain carriers to never Newly infected people who have received antiretroviral therapy[16]) Conclusion that rapid initiation of treatment can effectively control the spread of HIV and improve the health and quality of life of HIV-infected people.
It is currently receiving widespread attention
.

Bikampinol tablets have no hypersensitivity reactions and no need for genotype screening at baseline.
It is a fast-start treatment plan recommended by the latest guidelines, which can quickly and strongly inhibit the virus, and the incidence of long-term treatment resistance is 0
.

I look forward to the widespread promotion and application of the rapid-start treatment concept in China to promote my country's AIDS prevention and control work and achieve the goal of AIDS prevention and control as soon as possible! References: [1] World Health Organization.
HIV/AIDS.
https:// [2] Wei Lai, Zhao Yan.
Factors influencing the speed of viral suppression in AIDS antiretroviral therapy[J].
International Journal of Epidemiology and Infectious Diseases.
2020; 47(2): 77-82.
[3]World Health Organization.
Guidelines for managing advanced HIV disease and rapid initiation of antiretroviral therapy [M].
Geneva, 2017.
[4]Kang Wen, Sun Yongtao.
Benefits, challenges and model exploration of rapid initiation of antiretroviral therapy for HIV infection in China[J].
China AIDS & STD.
2020; 26(9): 1025-1029 .
[5]Jiao Jie, Dai Lili, Chen Xiaohong.
Research progress on AIDS rapid antiviral treatment strategies[J].
China AIDS and STD.
2020; 26(6): 660-663.
[6]Pilcher CD, Ospina-Norvell C, Dasgupta A, et al.
The effect of sameday observed initiation of antiretroviral therapy on HIV viral load and treatment outcomes in a US public health setting [J].
J Acquir Immune Defic Syndr.
2017; 74(1): 44-51 .
[7]Labhardt ND, Ringera I, Lejone TI, et al.