Benefits and Risks of Rapid Initiation of Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Objectives: To compare the benefits and risks between Rapid ART and standard/delayed treatment for HIV. Methods: Databases of PubMed, Cochrane Library, Embase and Web of science were searched from the inception to 28 October 2021. Two investigators independently screened studies related to Rapid ART, extracted data, and evaluated the literature quality. The risk of bias was assessed by Cochrane Collaboration Risk of Bias Tool and the statistical software Stata15.0 was used for meta-analysis. Results: Ten eligible studies were included in this meta-analysis, the results showed Rapid ART was superior to standard/delayed treatment in continuing care for at least 8 months (RR = 1.13, 95%CI: 1.03~1.25, Z = 2.44, p = 0.015), and severe bacterial infection (RR = 0.42, 95%CI: 0.25~0.70, Z = 3.33, p = 0.001). At 12 months following treatment, there was no statistically significant difference in viral load < 100 copies/mL (RR = 1.05, 95%CI: 0.80~1.39, Z = 0.35, p = 0.726), mortality (RR = 0.77, 95%CI: 0.47~1.24, Z = 1.09, p = 0.277), or the incidence of adverse events (RR = 0.52, 95%CI: 0.16~1.76, Z = 1.05, p = 0.294) compared with standard/delayed treatment. Conclusion: In comparison to standard/delayed treatment, rapid ART can reduce the incidence of TB and severe bacterial infections in HIV patients. Our findings suggest that rapid ART should be utilized when clinical conditions and the patient's physical state allow.