1 st International Treatment as Prevention (TasP) Workshop Overview British Columbia Centre for Excellence in HIV/AIDS Julio Montaner MD, DSc(hon), FRCPC, FCCP, FRSC, OBC Director, BC-Centre for Excellence on HIV/AIDS, Providence Health Care Professor of Medicine and Head, Division of AIDS, University of British Columbia Past-President, International AIDS Society
Additional Industry Support: British Columbia Centre for Excellence in HIV/AIDS
Treatment as Prevention vs ARV Chemoprophylaxis
Integrating HIV prevention and treatment: From slogans to impact Salomon JA, Hogan DR, Stover J, Stanecki KA, Walker N, et al. (2005). PLoS Med 2(1): e16 Sub Saharan Africa
Treatment as Prevention Heterosexual Couples
HIV Incidence (per 100-person-years) 2.24 ( ) 0.37 ( ) HIV Partner Had Started HAART NoYes 92% Reduction Donnell D, et al. Lancet. 2010;375:
HPTN 052 ( HR = 0.37 or 96.3% reduction in transmission No difference whether index pt was M or F Deferred Immediate M Cohen et al, NIH Press Conference May 12 th To be presented at IAS-Rome, July 2011 %
HPTN 052 ( Extra-Pulmonary TB Deferred : 17 cases Immediate : 3 cases 84% Reduction Deferred Immediate M Cohen et al, NIH Press Conference May 12 th To be presented at IAS-Rome, July 2011 %
Treatment as Prevention MSM
Determinants of HIV-1 Transmission in MSM: A Combined Clinical, Epidemiological and Phylogenetic Approach
Treatment as Prevention IDUs
Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.
Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.
HAART Reduces HIV incidence in IDUs G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011 HIV Incidence Community pVL % Injecting % on HAART
HAART Reduces HIV incidence in IDUs G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011 From 1997, HIV incidence decreased by 74% (IRR 0.26, ) for each log decline in community pVL In a separate model, HIV incidence decreased by 5% (3-8%) for each 1% increase in the proportion of HAART treated patients For the entire follow up period, for each 1% decline in the proportion of HIV+ patients actively injecting, there was a 3% decline in HIV incidence. - However, this effect was largely restricted to the pre-HAART era
Tuesday Feb 8 th 2011
Treatment as Prevention Population Based Studies
Community Viral Load and New HIV Cases in SFco Das M, Chu PL, Santos G-M, Scheer S, Vittinghoff E, et al. Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco. PLoS ONE (6): e doi: /journal.pone n=12,512 unduplicated HIV-positive individuals.
Treatment as Prevention Next Steps
The authors estimated that only about 19% of HIV infected individuals in the USA have an undetectable HIV-1 RNA level Spectrum of Engagement in HIV Care - USA Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6):
Spectrum of Engagement in HIV Care - USA Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6):
Montaner J, The Lancet, Vol 378: July 16 th 2011, pages