1. Julio Montaner, MD Professor of Medicine, and Head, Div. of AIDS, University of British Columbia Director, BC-Centre for Excellence in HIV/AIDS at Providence Health Care UNAIDS Special Advisor on HIV Therapeutics Treatment as Prevention The Key to Eliminate AIDS & HIV AU EDITED FINAL: 03-18-13 Special Technical Satellite, Melbourne 2014

2. The promise of HIV treatment: 1.Prevent HIV-related illness and disability 2.Avert AIDS-related deaths 3.Prevent new HIV infections

3. Increasing HAART Coverage within Evolving Guidelines in BC Source: Montaner et al, Lancet, 2010 January 2004 Summer of 1996 Summer of 2000 Phase I Phase II Phase III # of active participants on HAART in the HIV treatment programme 1994-2009

4. Source: Montaner et al, 2014 New AIDS Cases Diagnosed by Year British Columbia - 1983 to 2013

5. > 90% Decrease in All Cause Mortality among HIV+ Individuals in BC, Canada since 1996 0 50 100 150 200 250 300 350 400 1996199719981999200020012002200320042005200620072008200920102011 Years Frequency Source: Montaner et al, PLOS One, 12 Feb 2014

6. Source: Montaner et al, International AIDS Conference, 2014, Poster # TUPE203 New HIV Cases Diagnosed, Estimated HIV Incidence, & HAART Use by Year in BC

7. A clear correlation exists between HIV treatment and incidence Source: Tanser et al. Science 2013;339:966-971 1.1% (0.8%-1.4%) reduction in HIV incidence, for each 1.0% increase in treatment coverage. ART & HIV incidence: Hlabisa, South Africa p=0.325 p=0.003 p=0.013 p=0.0001 Incidence rate ratio 1.0 0.8 0.6 0.4 0.2 0 ART coverage 0%30%60%

8. HIV incidence vs. ART coverage in 51 countries, weighted by epidemic size (2012 data) AIDS-related death rates vs. ART coverage in 51 countries, weighted by epidemic size (2012 data) Source: Hill, Pozniak, Raymond, Heath and Ford, AIDS 2014, 2014.

9. HIV Transmission According to Sexual Behavior Reported by HIV-Negative Partner Rate of Couple Transmission (per 100 Couple-Years Follow-Up) Heterosexual (Male) Vaginal sex with ejaculation (192 CYFU) Heterosexual (Female) Vaginal sex (272 CYFU) MSM Receptive anal sex: With ejaculation (93 CYFU) Without ejaculation (157 CYFU) Insertive anal sex (262 CYFU) 0 1 2 3 4 Rate (95% CI) Overall risk = Zero through condomless sex with a partner on ART (HIV RNA <200 copies/mL Source: Rodger A, et al. 21 st CROI. Boston, 2014. Abstract 153LB

10. HIV treatment: The most effective biomedical intervention for the prevention of HIV transmission

11. Expanding ART for treatment and prevention of HIV in South Africa: Cost-effectiveness 2011-2050 Lives Saved (x 1,000)U$A Billions Source: Granich et al, PLoS ONE 7(2):e30212, February 2013

12. By 2020… 90% of all people living with HIV will know their HIV status 90% of all people diagnosed with HIV will receive sustained antiretroviral therapy. 90% of all people receiving antiretroviral therapy will have durable suppression.

13. The result = a three-fold increase over current 2014 estimates 72 % of all people living with HIV will be virally suppressed 3

14. The new treatment paradigm Single target → Cascade target Death → Death and transmission Number → Equity Incremental funding→ Frontload Investments

15. The objective “Maximize the effectiveness of existing tools to virtually eliminate progression to AIDS, premature death and HIV transmission, and thereby transform the HIV/AIDS pandemic into a low level sporadic endemic.”

16. THE FINAL CHAPTER OF THE AIDS EPIDEMIC