Objective To evaluate the effects of rapid initiation of antiretroviral therapy (ART) on virological suppression and immune recovery in treatment-naïve patients infected with human immunodeficiency virus type 1 (HIV-1) in Sichuan province. Methods A prospective study was conducted on treatment-naïve HIV-1-infected patients who were diagnosed and received first-time ART at Department of Infectious Disease, the Public Health Clinical Center of Chengdu, from March 2020 to May 2024. Participants were divided into two groups according to the time from diagnosis to ART initiation: a rapid initiation group (≤7 d after diagnosis) and a control group (8–30 d after diagnosis). The primary outcome measures were virological suppression rate and immune recovery (changes in CD4⁺ T lymphocyte count). Clinical outcomes were compared between the two groups at week 4, 24 and 48 of treatment. Results A total of 306 patients were enrolled, including 134 in the rapid initiation group and 172 in the control group. In the rapid initiation group, the virological suppression rates at week 4, 24 and 48 were 64.7%, 87.9% and 89.7%, respectively. Compared with the control group, the rapid initiation group demonstrated significantly better virological suppression at all follow-up time points (P<0.001). Regarding immune recovery, CD4⁺ T lymphocyte counts in the rapid initiation group showed a sustained increase from a baseline of 239.5 cells/μL to 390 cells/μL at week 48, along with a continuous improvement in the CD4/CD8 ratio (P<0.001). No significant differences were observed in biochemical parameters between the two groups, and no serious adverse events occurred. Conclusions Rapid initiation of ART significantly improves virological suppression rates and accelerates early immune recovery in treatment-naïve HIV-1-infected patients in Sichuan province. This strategy provides strong evidence for enhancing treatment outcomes of HIV-1 infection and reducing viral transmission.