OBJECTIVES: Antiretroviral therapy (ART) is the standard of care to treat human immunodeficiency (HIV). However, evidence suggests that delaying the initiation of ART increases the incidence of HIV by contributing to its transmission. The objective of this study was to assess, from a Canadian perspective, the potential epidemiological and economic impact of rapid initiation of HIV treatment with bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) compared to current initiation in clinical practice.

METHODS: A dynamic transmission model for HIV was adapted to the Canadian setting to assess the impact of rapid treatment initiation with B/F/TAF (7 days from diagnosis to treatment) compared to current clinical practice (45 days from diagnosis to treatment). A Markov tree was developed over a 20-year projection period. Three key subgroups were considered: heterosexual men and women, men who have sex with men (MSM) and people who inject drugs (PWID). The prevalent HIV population was divided by health states, each with different risks of transmission, by subgroup. Infectious individuals contribute to the incidence of new infections. Lifetime direct health care cost of HIV was applied to infected patients. Productivity costs were added in a scenario analysis.

RESULTS: Over the 20-year projection period, rapid B/F/TAF initiation is expected to prevent 415 HIV infections, resulting in savings of $139M to the Canadian healthcare system. Nearly half of new HIV infections avoided (42%) were from the MSM, while 33% were from heterosexuals and 25% from PWID. When considering productivity costs, potential savings increased to $510M. Varying the time to ART initiation by ±7 days in current clinical practice results in savings ranging from $115M to $162M over the 20-year projection period.

CONCLUSIONS: This study suggests that rapid B/F/TAF initiation represents an advantageous therapeutic strategy to reduce HIV incidence and provide substantial costs savings for the Canadian healthcare system.