Canadian study shows introduction of highly active antiretroviral treatment for HIV patients has halved new HIV diagnoses since 1996

July 18, 2010

A Canadian study being presented at the forthcoming International AIDS Society (IAS) conference shows that the annual number of new HIV diagnoses has more than halved since the introduction of highly active antiretroviral therapy (HAART) for HIV patients in 1996. For every 100 patients placed on HAART, new HIV diagnoses fell by 3%. The Article is published Online First and written by Professor Julio Montaner, Director, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, and colleagues.

The authors undertook a population-based study of HAART coverage and HIV transmission in British Columbia, Canada--a Canadian Province with free access to HIV care. Data for number of HIV tests done and new HIV diagnoses were obtained from the British Columbia Centre for Disease Control. Data for viral load, CD4 cell count, and HAART use were extracted from the British Columbia Centre for Excellence in HIV/AIDS population-based registries.

The authors found that, between 1996 and 2009, the number of individuals actively receiving HAART increased from 837 to 5413 (547% increase), and the number of new HIV diagnoses fell from 702 to 338 per year (52% decrease). There was a strong association between increasing number of patients on HAART and decreasing number of new diagnoses. For every 100 additional individuals on HAART, the number of new HIV cases decreased by 3%. Mean HIV viral load concentrations also decreased markedly and were linked to a decrease in new HIV cases.

New HIV diagnoses fell by 30% in 1996, remained fairly stable in 2001󈝯 (2% reduction), and decreased by 17% in 2004󈝵. HAART use expanded substantially in 1996-2000 and 2004-09, and remained stable in 2001-03, driven by evolving contemporary treatment guidelines. The authors show that the decrease in new HIV diagnoses per year was driven to a large extent by the subset of individuals with documented history of injecting drug use, in whom new HIV diagnoses per year decreased by nearly 50% during the study.

Rates of sexually transmitted infections and hepatitis C infection increased during the last 15 years of the study, which implies that these findings cannot be accounted for by decreasing sexual HIV risk behaviour.

The authors say: "Our results show a strong and significant association between increased HAART coverage, reduced community viral load, and decreased number of new HIV diagnoses per year in the population of a Canadian province."

The authors conclude: "Our results support the proposed secondary benefit of HAART used within existing medical guidelines to reduce HIV transmission..[and] provide a strong rationale for re-examination of the HIV prevention and treatment dichotomy, as has been strongly advocated by the UN Joint Programme on HIV/AIDS (UNAIDS) as part of a comprehensive combination prevention strategy. Furthermore, our results should serve to reenergise the G8's universal access pledge as a means to curb the effect of AIDS and the growth of the HIV pandemic."

Professor Montaner adds that this work and a previous paper on this subject by himself and colleagues have helped UNAIDS shape their strategy on the new Treatment 2.0 initiative, which calls for 15 million people worldwide to be treated with antiretroviral drugs that can slow the progression of HIV-AIDS symptoms - up from the five million currently undergoing treatment. This strategy would cost some $26 billion per year. Such a plan would require innovations such as simpler, safer, and more resilient treatment regimens as well as minimal laboratory monitoring.

In an accompanying Comment, Dr Franco Maggiolo and Dr Sebastiano Leone, Division of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy, say: "HAART might prove effective within other risk populations provided that the source individuals are thoroughly identified and correctly treated. Therefore we must couple the use of antiretrovirals with risk-reduction strategies, and identify infected individuals through information or education interventions that favour individual access to screening programmes. Integrated experiences that provide voluntary routine HIV testing and rapid entry into care, such as those recently implemented in Washington, DC, would tell us whether HAART can succeed as an epidemic control measure."

They conclude: "While waiting for an effective vaccine, experiences such as those reported today should be strongly considered by clinicians, national and international agencies, policy makers, and all parties involved in the development of treatment guidelines, because the population-based dimension of HAART might play an important part in the future control of the HIV epidemic."
For Professor Julio Montaner, Director, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada, please contact Ian Noble +1 604-809-9650/ or Irene Day +1 604-377-6226 / /

Dr Franco Maggiolo and Dr Sebastiano Leone, Division of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy. T) +39 3388172182 E)

For full Article and Comment, see:


Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to