ArticleScientific reports2026
Clinical impact and cost-effectiveness of rapid versus non-rapid antiretroviral therapy initiation in HIV-positive men who have sex with men in China using modelling and 96-week multicenter cohort data.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
International treatment guidelines recommend rapid initiation of antiretroviral therapy (ART) for individuals newly diagnosed with HIV-1 infection; however, robust long-term real-world evidence remains limited in China. We aimed to evaluate the clinical outcomes and cost-effectiveness of efavirenz (400 mg) plus lamivudine and tenofovir disoproxil fumarate (EFV + 3TC + TDF) versus the coformulated bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in rapid (≤ 14 days from diagnosis) versus non-rapid (> 14 days) initiation among HIV-diagnosed men who have sex with men (MSM). A real-world cohort of 301 ART-naïve HIV-positive MSM was stratified into four groups: rapid BIC (G1, n = 74), rapid EFV (G2, n = 77), non-rapid BIC (G3, n = 84), non-rapid EFV (G4, n = 66). Primary endpoint was CD4 + T-cell count change from baseline at weeks 48 and 96; secondary endpoints included viral suppression (< 50 copies/mL) and treatment persistence. Confounding was mitigated via the cloning, censoring, and weighting (CCW) method to emulate a randomized controlled trial (RCT), with cost-effectiveness analyzed using a hybrid economic evaluation model referencing China’s 2024 per capita GDP. At week 96, rapid initiation was associated with superior CD4 + T-cell recovery, particularly in the EFV-based regimen (mean difference: 144 cells/µL, p < 0.001 for rapid vs. non-rapid EFV). BIC/FTC/TAF demonstrated significantly better immunological recovery (mean difference: 151 cells/µL, p < 0.001 for non-rapid BIC vs. EFV) and higher treatment persistence (75.68%-84.52% vs. 53.25%-81.82%). Economic evaluation indicated a favorable profile for BIC/FTC/TAF. Rapid ART initiation achieved excellent virological suppression, superior long-term immunological recovery, and cost-effectiveness. Compared with EFV+3TC + TDF, BIC/FTC/TAF exhibited advantages in efficacy, economic value, and treatment persistence.
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