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British Columbia Centre for Excellence in HIV/AIDS

British Columbia Centre for Excellence in HIV/AIDS . Treatment as Prevention: HAART Expansion - A Powerful Strategy to Reduce AIDS Morbidity and Mortality and HIV Incidence. Julio Montaner MD, FRCPC, FCCP, FRSC Director, BC-Centre for Excellence on HIV/AIDS, Providence Health Care

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British Columbia Centre for Excellence in HIV/AIDS

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  1. British Columbia Centre for Excellence in HIV/AIDS Treatment as Prevention: HAART Expansion - A Powerful Strategy to Reduce AIDS Morbidity and Mortality and HIV Incidence Julio Montaner MD, FRCPC, FCCP, FRSC Director, BC-Centre for Excellence on HIV/AIDS, Providence Health Care Professor of Medicine and Head, Division of AIDS, University of British Columbia President, International AIDS Society IAC, 2010, Vienna

  2. HAART Can Reduce HIV Transmission HAART stops HIV replication  HIV levels fall to undetectable in blood as well as in sexual fluids  Sharp reduction in HIV transmission

  3. Prevention Strategies - Education - Change in behavoir - Harm reduction - New strategies/technology - Vaccines Existing strategies have failed to contain the global HIV pandemic

  4. Impact of HAART on IDUs Morbidity and Mortality Incidence

  5. Wood et al, BMJ, 2009

  6. Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.

  7. Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.

  8. Wood et al, BMJ, May 16, 2009

  9. Cost Effectiveness of HAART Revisited

  10. Unique Study Features: • Population Based • Free Access to HAART and Medical Monitoring • Centralized Data Capture / Single Source • Access to Blood Borne Dxs – BCCDC • Retrospective & Prospective Phases

  11. January 2004 Summer of 1996 Summer of 1996 Phase I Phase II Phase III Year Montaner et al, Lancet, June 18th 2010

  12. Incidence/yr Acquired resistance falling 90 80 70 60 Plasma viral load suppression rising Viral load < 50/mL (%)

  13. Highest HIV-1- Plasma Viral load per Year Non IDU IDU Ever on Treatment & Censoring at the time of Death or Move The proportion of HIV infected IDUs engaged in care in BC with plasma viral load >1500 c/mL, as a surrogate for “high” community HIV-1-viral load, decreased from ~50% in 2000-04 to ~20% in 2009 (p<0.001) Montaner et al, Lancet 2010

  14. “Provincial Viral Load” All Patients Ever Tested for Plasma HIV-1-Viral Load in BC Censoring at the time of Death or Move

  15. Number of HIV tests per Year in BC 1994 2000 2008 BC-CDC Report, 2009

  16. Hepatitis C, 1999-2008 Infectious Syphilis, 1999-2008 2004 • BC • BC 2004 x Canada x Canada Genital Chlamydia, 1999-2008 Gonorrhea, 1999-2008 x Canada • BC x Canada • BC 2004 2004

  17. Key Findings: Overall correlation between the number of pts on HAART and the number of new HIV cases diagnosed per year was -0.89 (p<0.0001) For every 100 additional patients on HAART, the number of new HIV cases decreased by a factor of 0.97 (95% CI 0.96-0.98) • ie: new HIV diagnoses fell by 3%. For every 1 log10 decrease in viral load, the number of new HIV cases decrease by a factor of 0.86 (95% CI 0.75-0.98)

  18. Incremental net benefit (Millions of CDN $) over 30 years K Johnston et al, AIDS, 2010

  19. Combination prevention HIV testing, linkage to care and expanded HAART coverage HIV Prevention Community Interventions Biomedical Interventions Structural Interventions Individual and small group behavioral interventions Modified from T. Coates

  20. British Columbia Centre for Excellence in HIV/AIDS Thank You Supported by the Province of British Columbia; the Canadian Institutes of Health Research (CIHR); and the National Institute on Drug Abuse, US-NIH. Additional support has been provided by Merck, Gilead and ViiV Healthcare

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