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 Since 2014, we established the Early-cART cohort of adults newly diagnosed with HIV who started ART within six months of estimated HIV acquisition (etPWH), in collaboration with community centers and via 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 PBMCs was measured in a subset of participants virologicallysuppressed 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 2014-2022, 340 etPWH (90% MSM, mean age 34y) were included from ∼900 new referrals. Two years after ART initiation, 48% of etPWH achieved a CD4/CD8 ratio of >1, while 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 PBMCs. Median link-to-care time decreased from 11 to 3 days (p=0.0011), and HIV-to-ART from 73 to 27 days (p=0.0014) 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.