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In conclusion, there are solid data demonstrating that it is safe and effective to start ART on the day of diagnosis or at the time of linkage—ART should preferably be started within 48-72 hours of diagnosis, even before laboratory results are obtained. Evidence from the DIAMOND trial and from observational studies in real-world settings demonstrate that immediate ART initiation leads to earlier viral suppression and increased retention in care with sustained virologic response.
High efficacy rates were demonstrated in the United States from clinical experience with DTG-based and BIC-based regimens and with DRV/COBI/FTC/TAF in the first phase III trial for the rapid care model (DIAMOND trial). There are limited data to support that these regimens are as effective in patients with PrEP failure and baseline M184V/I mutations. Of importance, there have been no reported cases to date of INSTI or DRV resistance or regimen modifications needed from the clinics in San Francisco, New Orleans, and Chicago or from the DIAMOND trial.