Determinants of rapid antiretroviral therapy initiation and its longitudinal clinical outcomes among people living with HIV in China: a single-center retrospective cohort study

Rapid initiation of antiretroviral therapy (Rapid ART, R-ART) is a cornerstone of the WHO/UNAIDS strategy to end the HIV/AIDS epidemic by 2030. However, evidence on the determinants and longitudinal clinical impact of R-ART in Chinese real-world populations remained poorly understood. This study included 550 patients. Multivariate logistic regression was used to assess factors for R-ART initiation. Generalized estimating equations (GEE) examined longitudinal changes in CD4 count, CD4/CD8 ratio, viral load, BMI, and biochemical markers. Within each initiation stratum, we estimated drug‑class effects (INSTIs vs. EFV/3TC/TDF) at baseline, as mean over follow‑up, and as time interaction. False discovery rate (Benjamini–Hochberg) correction was applied across 12 biochemical indices, and a propensity‑score weighted sensitivity analysis was performed. Of 550 patients, higher education level (adjusted OR 2.35, 95% CI 1.12–4.92, P = 0.024) and heterosexual transmission (vs. MSM; adjusted OR 2.24, 95% CI 1.02–4.91, P = 0.044) were independently associated with R-ART initiation. Over a median follow-up of 36 months, R-ART produced faster initial viral-load decline, but the medication regimen × time interaction terms for VL and CD4 trajectory were not statistically significant after FDR correction, indicating comparable long-term immunological and virological trajectories between initiation strategies. INSTIs regimens showed superior hepatic safety (ALT, AST), but produced mild elevations in creatinine and bilirubin and modestly higher TC and TG levels than EFV/3TC/TDF; these patterns were consistent across both R-ART and standard ART (S-ART) strata, with no significant medication regimen × time interaction. R-ART was associated with more rapid early viral suppression but no statistically significant divergence in long-term clinical trajectories. INSTI-based regimens offered hepatic advantages with modest renal and metabolic trade-offs regardless of initiation timing. These findings support the use of R-ART with INSTI-based backbone in Chinese HIV care while underscoring the need for proactive renal and metabolic monitoring. Not applicable.