Treat All, Treat Fast: Time From HIV Diagnosis to Treatment Initiation in Switzerland, 1996-2025.
10 affiliations
- 1Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- 2Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
- 3Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.
- 4HIV Unit, Division of Infectious Diseases, University Hospital Geneva, University of Geneva, Geneva, Switzerland.
- 5Division of Infectious Diseases, University Hospital Lausanne, University of Lausanne, Lausanne, Switzerland.
- 6Division of Infectious Diseases, Ente Ospedaliero Cantonale di Bellinzona e Valli, Bellinzona, University of Basel, Basel, Switzerland.
- 7HOCH Health Ostschweiz, St Gallen, Division of Infectious Diseases, Infection Prevention and Travel Medicine, Department General Internal Medicine, St Gallen, Switzerland.
- 8Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
- 9Arud Centre for Addiction Medicine, Zurich, Switzerland.
- 10School of Social Sciences, Education and Social Work, Queen's University, Belfast, UK.
Abstract
Immediate antiretroviral therapy (ART) initiation after HIV diagnosis is a clinical and public health priority. The "treat all" strategy-ART initiation irrespective of CD4+ cell count-improves health outcomes and curtails further transmissions. Using data from the Swiss HIV Cohort Study, we assessed time from HIV diagnosis to ART initiation and associated sociodemographic and clinical characteristics to evaluate how rapidly and equitably it was adopted at a national level. We analyzed participants diagnosed in 1996-2025. Time from HIV diagnosis to ART initiation was assessed by Kaplan-Meier estimates, and associated characteristics were evaluated by fitting time-updated Cox proportional hazards models. Among 7525 participants diagnosed between 1996 and 2025, 93.1% initiated ART. Median time to ART initiation declined steeply from 983 days (2005) to 63 days (2010), reaching 12 days by 2025; 42.2% initiated ART within 1 week in 2025. CD4+-based differences disappeared, with median ART initiation times falling below 3 weeks across all strata by 2025. Higher viral load remained associated with faster ART initiation, although absolute differences in ART timing among viral load strata were small. Participants from Africa and the Americas showed significantly lower initiation hazards than Europeans in 2017-2025, with absolute differences of at most 1 week by 2025. By transmission mode, people who inject drugs consistently showed the lowest ART initiation hazard. Universal treatment was rapidly implemented in Switzerland, with a shift toward rapid and equitable ART initiation. Residual differences for viral load, region of origin, and people who inject drugs warrant continued monitoring.
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BibTeX
@article{bot2026treat,
title = {{Treat All, Treat Fast: Time From HIV Diagnosis to Treatment Initiation in Switzerland, 1996-2025.}},
author = {Anna Bot and Nanina Anderegg and Marcel Stöckle and Gilles Wandeler and Alexandra Calmy and Matthias Cavassini and Luigia Elzi and Patrick Schmid and Irene A Abela and Philip Bruggmann and David Jackson-Perry and Sandra E Chaudron and Huldrych F Günthard and Roger D Kouyos and Andri Rauch and Katharina Kusejko},
journal = {Open forum infectious diseases},
year = {2026},
month = oct,
doi = {10.1093/ofid/ofag642},
url = {https://europepmc.org/article/MED/42953077},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Treat All, Treat Fast: Time From HIV Diagnosis to Treatment Initiation in Switzerland, 1996-2025.
AU - Anna Bot
AU - Nanina Anderegg
AU - Marcel Stöckle
AU - Gilles Wandeler
AU - Alexandra Calmy
AU - Matthias Cavassini
AU - Luigia Elzi
AU - Patrick Schmid
AU - Irene A Abela
AU - Philip Bruggmann
AU - David Jackson-Perry
AU - Sandra E Chaudron
AU - Huldrych F Günthard
AU - Roger D Kouyos
AU - Andri Rauch
AU - Katharina Kusejko
PY - 2026
DA - 2026/10/08
JO - Open forum infectious diseases
DO - 10.1093/ofid/ofag642
UR - https://europepmc.org/article/MED/42953077
AB - Immediate antiretroviral therapy (ART) initiation after HIV diagnosis is a clinical and public health priority. The "treat all" strategy-ART initiation irrespective of CD4+ cell count-improves health outcomes and curtails further transmissions. Using data from the Swiss HIV Cohort Study, we assessed time from HIV diagnosis to ART initiation and associated sociodemographic and clinical characteristics to evaluate how rapidly and equitably it was adopted at a national level. We analyzed participants diagnosed in 1996-2025. Time from HIV diagnosis to ART initiation was assessed by Kaplan-Meier estimates, and associated characteristics were evaluated by fitting time-updated Cox proportional hazards models. Among 7525 participants diagnosed between 1996 and 2025, 93.1% initiated ART. Median time to ART initiation declined steeply from 983 days (2005) to 63 days (2010), reaching 12 days by 2025; 42.2% initiated ART within 1 week in 2025. CD4+-based differences disappeared, with median ART initiation times falling below 3 weeks across all strata by 2025. Higher viral load remained associated with faster ART initiation, although absolute differences in ART timing among viral load strata were small. Participants from Africa and the Americas showed significantly lower initiation hazards than Europeans in 2017-2025, with absolute differences of at most 1 week by 2025. By transmission mode, people who inject drugs consistently showed the lowest ART initiation hazard. Universal treatment was rapidly implemented in Switzerland, with a shift toward rapid and equitable ART initiation. Residual differences for viral load, region of origin, and people who inject drugs warrant continued monitoring.
SN - 2328-8957
ER -