New study reinforces effect of antiretroviral treatment on prevention of HIV and calls for national action
Study stresses need for political will and funding to implement the made-in-Canada Treatment as Prevention strategy to save lives and prevent new infections
Vancouver, B.C. [May 14, 2013] — A new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) and University of British Columbia shows there is strong and consistent evidence that expanded use of highly active antiretroviral therapy (HAART) decreases HIV transmission across a variety of geographical regions and sub populations.
Researchers reviewed scientific evidence published in peer-reviewed journals about the benefit of HAART among HIV-positive individuals in preventing HIV transmission. Their analysis of existing literature reinforced the strong relationship between use of HAART and reduced transmission among not only stable heterosexual serodiscordant (where one partner is HIV positive) population, but also high-risk groups such as men who have sex with men (MSM) and injection drugs users (IDU).
“There is no doubt HIV Treatment as Prevention is a game changer,” said Dr. Julio Montaner, director of the BC-CfE and senior author of the study. “It is imperative for the Canadian government to mobilize political will and funds to nationally expand testing, treatment and support to people living with HIV/AIDS. This is the moral thing to do if we want to end AIDS and secure the health of our future generations.”
Study authors noted the effectiveness of abstinence promotion, condom use and needle exchange programs have been limited. In 2010 there were 2.5 million new infections, 1.8 million AIDS-related deaths and 390,000 children infected globally, with disproportionate representation in low-income countries. Only 54 per cent of HIV-infected individuals with severe immunodeficiency are on HAART, and only 20 per cent of people with HIV know their status.
Over the years, scientific evidence has mounted nationally and internationally in favour of HAART’s impact on reducing disease progression to AIDS and death and secondarily decreasing HIV transmission. In B.C., between 1996 and 2009, the number of individuals receiving HAART increased from 837 to 5,413 and the number of new HIV diagnoses fell from 702 to 338 per year (52 per cent decrease). The rates of HIV testing increased throughout the study period. In addition, in 2011, the HIV Prevention Trials Network (HPTN) reported that HAART led to a 96 per cent reduction in HIV transmission among serodiscordant couples.
“I am living proof of the long-term benefits of HIV treatment,” said Bob Leahy, editor of PositiveLite.com, Canada’s online HIV magazine, and someone who has lived with HIV for 20 years. “HAART has allowed me to live a normal and productive lifestyle and this is nothing short of a miracle for people like myself who have been given a second chance. It makes so much sense, and is the right and ethical thing to do, to ensure we quickly scale up testing across Canada so that every HIV-positive person has access to HAART, both to improve their own health and to very significantly reduce the risk of transmission.”
The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently reported a 10 per cent drop in HIV/AIDS funding from 2009 to 2010 to support the Universal Access pledge. The U.S.’ budgeted contribution to the Global Health Initiative is projected to fall 10.8 per cent for 2013.
“We have the tools to end HIV/AIDS, and B.C. is a shining example of what can be achieved through universal implementation of Treatment as Prevention,” said Stephen Lewis, co-director of AIDS-Free World and renowned HIV/AIDS activist. “We are talking about human lives and the future health of Canadians. We cannot afford any further debate or more expensive clinical trials to prove what we already know. What is urgently needed is for the Canadian government to do the right thing and that is to expand HIV testing and treatment nationwide.&rdquo
The B.C. pioneered Treatment as Prevention strategy has led to the widespread expansion of HAART coverage in British Columbia. It has demonstrated a marked decrease in morbidity, mortality and new HIV cases. As the only province to implement the Treatment as Prevention strategy, B.C. stands alone as the sole province to show a consistent decline in new HIV diagnoses since 1996.
“While expansion of Treatment as Prevention will no doubt be lifesaving, evidence shows the long-term financial benefits can be tremendous,” said Dr. Bohdan Nosyk, lead author of the study and health economist at the BC-CfE. “HAART has evolved beyond individual health benefits to the HIV-positive person to secondary preventive benefits for the community at large. Failing to expand HIV funding can reverse the gains made against the epidemic and undermine the promise of HIV Treatment as Prevention.”
Research by the Canadian AIDS Society suggests the lifetime economic cost of each HIV infection is over $425,000, including health care costs and lost productivity.
Every year, 3,300 men and women in Canada are diagnosed with HIV infection and it is estimated more than 71,000 Canadians are now living with HIV.
The full study authored by several renowned HIV/AIDS experts and published in AIDS, official journal of the International AIDS Society, can be found here.
What is Treatment as Prevention?
The Treatment as Prevention strategy has been pioneered by BC-CfE’s Dr. Julio Montaner. It involves widespread HIV testing and immediate provision of anti-HIV drugs known as HAART to medically eligible people with HIV. The BC-CfE has demonstrated that the benefits of early HAART treatment are twofold: it reduces the level of HIV in the blood to undetectable levels thus improving the health of people with HIV, and decreases the level of HIV in sexual fluids to undetectable levels thus reducing the likelihood of HIV transmission by more than 95 per cent. In 2009, the BC government invested $48 million over four years in the BC-CfE-led Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) pilot project. The intent of the pilot is to expand HIV testing and treatment among hard-to-reach populations such as injection drug users in Vancouver’s inner city and Prince George.
Treatment as Prevention is internationally recognized by organizations such as the World Health Organization, International AIDS Society and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Treatment as Prevention has been endorsed by U.S. President Barack Obama, Secretary of State Hillary Clinton and former U.S. President Bill Clinton as an effective strategy in the fight against HIV/AIDS.
About the British Columbia Centre for Excellence in HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility and is internationally recognized as an innovative world leader in combating HIV/AIDS and related diseases. BC-CfE is based at St. Paul’s Hospital, Providence Health Care, a teaching hospital of the University of British Columbia. The BC-CfE works in close collaboration with key provincial stakeholders, including health authorities, health care providers, academics from other institutions, and the community to decrease the health burden of HIV and AIDS and to improve the health of British Columbians living with HIV through developing, monitoring and disseminating comprehensive research and treatment programs for HIV and related illnesses.
About the University of British Columbia
The University of British Columbia (UBC) is one of North America’s largest public research and teaching institutions, and one of only two Canadian institutions consistently ranked among the world’s 40 best universities. Surrounded by the beauty of the Canadian West, it is a place that inspires bold, new ways of thinking that have helped make it a national leader in areas as diverse as community service learning, sustainability and research commercialization. UBC offers more than 55,000 students a range of innovative programs and attracts $550 million per year in research funding from government, non-profit organizations and industry through 7,000 grants.
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