1 / 13

Treatment as Prevention ( TasP )

Treatment as Prevention ( TasP ). Dr Michael Brady Medical Director, Terrence Higgins Trust Consultant, HIV & Sexual Health.

enye
Télécharger la présentation

Treatment as Prevention ( TasP )

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Treatment as Prevention (TasP) Dr Michael Brady Medical Director, Terrence Higgins Trust Consultant, HIV & Sexual Health

  2. Reducing onward transmission: Viral suppression among key population groups living with HIV in the United Kingdom. 19th Annual Conference of the British HIV Association (BHIVA) April 2013, Valerie Delpech, Alison Brown, Stephano Conti, VenkataPolavarapu, Zing Yin

  3. 96% (73; 99) Treatment for prevention 73% (49; 85) Tenofovir/Truvada for discordant couples Truvada for heterosexuals 63% (22; 83) Medical male circumcision 54% (38; 66) 44% (15; 63) Truvada for MSMs Tenofovir vaginal (coital) Prime boost Vaccine 39% (6; 60) 0% (-69; 41) Truvada for women 31% (1; 51) 15% (-20; 40) Tenofovir gel (daily) for women 0% 10 20 30 40 50 60 70 80 90 100% Study Effect size (95% CI) 0% (-50; 30) Truvada for women Efficacy

  4. HPTN 052 Study Design Stable, healthy, serodiscordant couples, sexually active CD4 count: 350 to 550 cells/mm3 Randomization Immediate ART CD4 350-550 Delayed ART CD4 <250 Primary Transmission Endpoint Virologically-linked transmission events Primary Clinical Endpoint WHO stage 4 clinical events, pulmonary tuberculosis, severe bacterial infection and/or death

  5. HPTN 052: HIV-1 Transmission Total HIV-1 Transmission Events: 39 96% reduction in HIV Transmission Linked Transmissions: 28 Unlinked or TBD Transmissions: 11 • 18/28 (64%) transmissions from infected participants with CD4 >350 cells/mm3 • 23/28 (82%) transmissions in sub-Saharan Africa • 18/28 (64%) transmissions from female to male partners Immediate Arm: 1 Delayed Arm: 27 p < 0.001

  6. HIV Treatment Guidelines

  7. Reducing onward transmission: Viral suppression among key population groups living with HIV in the United Kingdom. 19th Annual Conference of the British HIV Association (BHIVA) April 2013, Valerie Delpech, Alison Brown, Stephano Conti, VenkataPolavarapu, Zing Yin

  8. Distribution of viral load among gay men living with HIV in the UK in 2010 HIV treatment as prevention among men who have sex with men in the UK: is transmission controlled by universal access to HIV treatment and care? AE Brown*,ON Gill, VC Delpech, Article first published online: 28 July 2013, HIV Medicine, Volume 14, Issue 9, pages 563–570, October 2013

  9. What is the potential impact of starting treatment early? • ART started at CD4 <500 could have reduced the proportion of PLWHIV with detectable viraemia from 42% to 38% • Halving the undiagnosed population could have led to to a decrease to 28% “Unlikely early treatment will reduce HIV transmission unless undiagnosed population is substantially reduced” Brown et al AIDS 2014 Jan 14;28(2):281-3

  10. What is the potential impact of starting treatment early? • Extending ART to all diagnosed HIV infected MSM with CD4 <500 in 2010 would reduce proportion of infectious men from 35% – 29%. • Halving the proportion who are undiagnosed would further reduce this to 21% “The effectiveness of treatment as prevention will be limited unless the undiagnosed population is reduced through frequent HIV testing and consistent condom use” Brown et al AIDS 2014 Jan 14;28(2):281-3

  11. Can we afford it? • Estimated annual population treatment and care costs: • £104 million in 1997 • £483 million in 2006 • £721 million in 2013 Mandalia et al PLoS One 2010; 5:e15677

  12. Summary: TasP • The best evidence for effectiveness of an intervention to reduce transmission • Effectiveness depends on knowing HIV status and therefore interlinked with testing strategies • Cost may prohibitive

  13. With limited resources do we focus on: ART for HIV positive people? ART for HIV negative people? Reduced transmission Reduced morbidity Reduced mortality Better quality of life Low pill burden Low toxicity Reduced transmission ?cost ?adherence ?sexual behaviour ?other STIs

More Related