Rapid Start can help achieve long-term success with HIV treatment1
The importance of Rapid Start to help achieve viral suppression with HIV treatment
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Consider treatments that can be immediately initiated before test results are available for CD4 count, viral load, or resistance1
Guidelines have changed in recent years to reflect the importance of Rapid Start, which has allowed some patients to start treatment at the time of diagnosis.
The many benefits of Rapid Start:
Baseline testing and Rapid Start1
The following testing is recommended by DHHS guidelines, prior to ART initiation:
- HIV infection should be confirmed
- HIV RNA and CD4 count also should be obtained, but results need not be available before starting ART. CD4 count will determine the need for prophylaxis for certain opportunistic infections
- If available, results of safety testing—such as complete blood count, renal function tests, and liver enzymes—should be reviewed. If safety test results are not available, ART can still be started, but a clinician should review the results as soon as possible
- Genotypic resistance testing for reverse transcriptase and protease genes (and INSTI resistance testing if patient has a history of long-acting INSTI-based PrEP use or if INSTI transmission is suspected) should be obtained before ART initiation. It is not necessary to delay ART until results are available, but results should be reviewed as soon as possible in order to make adjustments to the regimen, if needed
- Screening for viral hepatitis should be done before starting ART, and if ART initiation occurs before results are available, a regimen that has activity against hepatitis B virus should be selected
- In patients who do not have reliable methods of contact, rapid ART may be initiated with a plan for a return clinic visit soon after ART initiation to review test results
- Screening for sexually transmitted infections should, ideally, occur at the initial visit, but results do not need to be available before starting ART
Baseline laboratory testing for PWH recommended by DHHS guidelines includes1:
- HIV antigen/antibody test
- CD4 count
- HIV viral load
- Genotypic resistance testing
- Hepatitis B serology (HBsAb, HBsAg, HBcAb)
- Hepatitis C screening
- Basic metabolic panel
- ALT, AST, total bilirubin
- CBC with differential
- Lipid profile
- Random or fasting glucose
- Urinalysis
- Pregnancy test (for persons of childbearing potential)
Ag, antigen; ALT, alanine aminotransferase; ART, antiretroviral therapy; AST, aspartate aminotransferase; CBC, complete blood count; CD4, cluster of differentiation 4; DHHS, US Department of Health and Human Services; HBcAb, hepatitis B core antibody; HBsAb, hepatitis B surface antibody; HBsAg, hepatitis B surface antigen; INSTI, integrase strand transfer inhibitor; PrEP, pre-exposure prophylaxis; PWH, people with HIV; RNA, ribonucleic acid.
References:
- Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. US Department of Health and Human Services. Updated September 12, 2024. Accessed January 8, 2025. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf
- Drug resistance. HIVinfo.NIH.gov. Updated March 31, 2025. Accessed April 1, 2025. https://hivinfo.nih.gov/understanding-hiv/fact-sheets/drug-resistance