Editor's Note: The 11th Asia-Pacific AIDS & Co-Infections Conference (APACC 2026) was successfully convened in Tokyo, Japan. Bringing together HIV prevention and control experts from across the region, the conference focused on core regional challenges including standardized antiretroviral therapy (ART) and whole-course management for people living with HIV, serving as an exchange platform to advance the optimization of HIV diagnosis and treatment in the Asia-Pacific. Infectious Disease Frontier conducted an exclusive on-site interview with Researcher Johanna Beulah Sornillo from the Research Institute for Tropical Medicine of the Philippines. Currently, loss to follow-up after diagnosis remains a prominent pain point in HIV response across the Asia-Pacific, and the “Treat All” strategy coupled with rapid ART initiation has emerged as a key solution to this dilemma.
This in-depth conversation revolved around the value of the two core treatment strategies, real-world study data from Asian populations, as well as obstacles and solutions for regional rollout and implementation. By sharing findings from cutting-edge observational studies tailored to the clinical characteristics of Asian populations, the interview provides reference insights for regional countries to improve one-stop diagnosis and treatment services and expand treatment coverage.
Infectious Disease Frontier: Could you please explain the significance of “Treat All” and “Rapid ART Initiation”?
Researcher Sornillo: Loss to follow-up is prevalent among people living with HIV (PLHIV) after diagnosis, which is an urgent challenge to address in HIV prevention and control. To date, numerous experts in the field have formulated relevant clinical guidelines to explore targeted strategies to curb this issue.
The “Treat All” strategy stipulates that PLHIV are not required to meet any preconditions or specific eligibility criteria prior to initiating antiretroviral therapy (ART), and all confirmed cases qualify for treatment. By contrast, “Rapid ART Initiation” prioritizes the earliest possible start of treatment, with same-day initiation at diagnosis when feasible.
The core value of these two strategies is to expand treatment coverage for PLHIV. Ample clinical evidence has fully validated the potent and reliable viral suppression efficacy of ART. Promoting early access to standardized treatment regimens for PLHIV enables them to achieve virological suppression more rapidly.
Infectious Disease Frontier: In the study you’re presenting at this congress, what impact did rapid ART initiation have on clinical outcomes among Asian patients?
Researcher Sornillo: Admittedly, this study has certain limitations. As an observational study, relevant data were submitted by various medical institutions in accordance with variables predefined in the study’s data dictionary, and all analyses were conducted exclusively based on available data.
Despite these limitations, study findings indicate that rapid ART initiation can reduce patient mortality and loss to follow-up to a certain extent, yet no fundamental improvement in viral suppression rate has been observed. Overall, early and rapid treatment initiation delivers measurable clinical benefits for PLHIV: patients are not required to wait for weeks or even months, and can start treatment immediately at the point of diagnosis when conditions allow.
Infectious Disease Frontier: What do you see as the key challenges to scaling up rapid ART initiation across Asia, and how should they be addressed?
Researcher Sornillo: The rollout of rapid ART initiation faces multiple practical challenges. While the strategy may appear straightforward to implement, it is hindered by considerable administrative and logistical barriers in practice. Immediate treatment prescription for all HIV-positive patients presenting to clinics cannot be achieved automatically, as there are multiple procedural bottlenecks to be resolved. Additionally, the severity of patients’ illness must be assessed to confirm their physical suitability for treatment initiation.
To tackle these challenges, clinical guidelines should be issued at both the institutional and governmental levels, supported by the establishment of a centralized care model and the adoption of a one-stop service framework. All required diagnostic assessments can be completed in a single setting, enabling comprehensive evaluation of whether PLHIV are eligible for on-site, rapid, or same-day treatment initiation, thus ensuring the effective implementation of the rapid ART initiation strategy.
