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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
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Additional Industry Support: British Columbia Centre for Excellence in HIV/AIDS
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Treatment as Prevention vs ARV Chemoprophylaxis
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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
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Treatment as Prevention Heterosexual Couples
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HIV Incidence (per 100-person-years) 2.24 (1.84-2.72) 0.37 (0.09-2.04) HIV Partner Had Started HAART NoYes 92% Reduction Donnell D, et al. Lancet. 2010;375:2092-2098
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HPTN 052 (www.hptn.org) 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 2011. To be presented at IAS-Rome, July 2011 %
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HPTN 052 (www.hptn.org) Extra-Pulmonary TB Deferred : 17 cases Immediate : 3 cases 84% Reduction Deferred Immediate M Cohen et al, NIH Press Conference May 12 th 2011. To be presented at IAS-Rome, July 2011 %
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Treatment as Prevention MSM
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Determinants of HIV-1 Transmission in MSM: A Combined Clinical, Epidemiological and Phylogenetic Approach
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Treatment as Prevention IDUs
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Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.
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Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.
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HAART Reduces HIV incidence in IDUs G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011 HIV Incidence Community pVL % Injecting % on HAART
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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, 0.08-0.81) 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
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Tuesday Feb 8 th 2011
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Treatment as Prevention Population Based Studies
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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 2010 5(6): e11068. doi:10.1371/journal.pone.0011068 n=12,512 unduplicated HIV-positive individuals.
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Treatment as Prevention Next Steps
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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): 793-800
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Spectrum of Engagement in HIV Care - USA Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6): 793-800
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Montaner J, The Lancet, Vol 378: July 16 th 2011, pages 208-209
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