The Early-cART programme achieves HIV treatment initiation within 48 hours of diagnosis

A new study, led by Dr Lucía Bailón from the HIV team at the Fight Against Infections Foundation and physician at Germans Trias Hospital, together with IrsiCaixa and BCN Checkpoint, has analysed one of the key challenges in the HIV field: reducing the time between infection and the start of treatment.

The research, published in Open Forum Infectious Diseases, has shown that the earlier antiretroviral therapy (ART) begins after HIV infection, the better the outcomes, both for the individual and for public health. Rapid treatment initiation reduces virus transmission and limits damage to the immune system.

However, diagnosing HIV in very early stages remains difficult, as there are often no clear symptoms and access to testing may be hindered by stigma or lack of information.

The Early-cART programme: an innovative response

Since 2014, the three institutions have promoted the Early-cART programme, aimed at identifying and treating people who have contracted HIV in the Barcelona metropolitan area as quickly as possible.

The programme is based on three pillars:

• Specific training for healthcare and community professionals to recognise early signs of infection.
• Rapid diagnosis using fourth-generation tests and, in suspected cases, molecular techniques (NAT) that can detect the virus just days after acquisition.
• Fast-track referral: when a case is detected, the Early-cART team is immediately notified, offering an appointment with a specialist within 48 hours and recommending treatment initiation on the same day.

What were the study results?

The study, covering 2014 to 2022, included 340 people who started treatment in the acute/recent phase. The results were:

• The average time between infection and treatment initiation dropped from 73 days in 2014 to just 27 in 2022.
• The time between a positive test and specialist visit fell from 11 to 3 days.
• Almost half (48%) showed good immune system recovery two years after starting treatment.
• The viral reservoir was significantly lower in those who began treatment within 60 days of infection.
• The programme achieved an 85% retention rate at two years.

The Early-cART model has proven that diagnosing and treating HIV very early is possible, with clear benefits for individual health and for preventing new transmissions. Collaboration between community centres and hospitals, training, and fast referral are the keys to success.

Moreover, this pathway has enabled the creation of a group of people treated very early, which is essential for advancing research towards an HIV cure and for participation in innovative clinical trials.