Strategies to Minimize Time From HIV Acquisition to ART Initiation: The Barcelona Early-cART Program.

Background: Targeted referral systems for individuals at highest risk of HIV transmission can accelerate linkage to care and antiretroviral treatment (ART) initiation, potentially reducing onward transmission.

Methods: In 2014, we established the Early-cART cohort of adults newly diagnosed with HIV who started ART within 6 months of estimated HIV acquisition (etPWH), in collaboration with community centers and via a fast-referral system to our HIV unit. Clinical data and biological samples were collected before and after initiation of ART. Total HIV-1 DNA in peripheral blood mononuclear cells was measured in a subset of participants virologically suppressed for >3 years. Link-to-care was defined as days from first positive HIV test to first appointment at the HIV unit. HIV-to-ART was defined as days from estimated acquisition to ART start.

Results: From 2014 to 2022, 340 etPWH (90% men having sex with men, mean age 34 years) were included from ∼900 new referrals. Two years after ART initiation, 48% of etPWH achieved a CD4/CD8 ratio of >1, whereas only 5% remained <0.5. In the reservoir subset, levels of HIV-1 DNA correlated with time from HIV to ART only when ART was initiated within 60 days after HIV acquisition, with 55% of participants showing <50 HIV-1 DNA copies/10⁶ peripheral blood mononuclear cells. Median link-to-care time decreased from 11 to 3 days (P = .0011), and HIV-to-ART time from 73 to 27 days (P = .0014) over the study period.

Conclusions: The Early-cART program achieved rapid linkage to care and ART initiation with robust immunovirological responses, indicating its potential to reduce HIV transmission.