Rapid Start vs. Standard Start Antiretroviral Therapy (ART) in HIV

Inclusion Criteria:

• Men and women 15 years and older in Colorado and 19 years and older in Nebraska. Awaiver of parental consent is planned for individuals 15-17 in accordance withColorado law which allows minors to consent for treatment for sexually transmittedinfections, including HIV.
• Reactive HIV-1 on an approved fourth generation HIV-1 antibody/antigen test within 72hours
• Any primary language with access to an interpreter by phone is included.

Exclusion Criteria:

• Pregnancy or intention to become pregnant in the next two years after enrollment
• Symptomatic acute HIV (with fever, rash, influenza-like symptoms)
• Creatinine clearance <30 mL/min by Cockcroft-Gault equation. (Therapy initiated willbe terminated promptly in individuals who are found to have creatinine clearance <30mL/min)
• Prior history of known HIV diagnosis
• Negative confirmatory HIV differentiation assays (therapy initiated will be terminatedin individuals with negative tests and excluded from the primary analysis)
• Allergy to bictegravir, emtricitabine or tenofovir alafenamide
• Signs or symptoms of opportunistic infection with cryptococcal meningitis,tuberculosis or other infection that requires delay of initiation of antiretroviraltherapy (up to the discretion of the site PI)
• Vulnerable populations including prisoners and individuals without decision makingcapacity
• Concommitant use of medications that are contraindicated with bictegravir,emtricitabine and tenofovir alafenamide including adefovir, carbamazepine, cladribine,dofetilide, fosphenytoin-phenytoin, oxcarbazepine, phenobarbital, primidone, rifampin,rifabutin, rifapentine, St. John's Wort, tipranavir