A new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) shows highly active antiretroviral therapy (HAART) reduces new HIV diagnoses, deaths and HIV prevalence, suggesting that the made-in-Canada Treatment as Prevention strategy should be implemented across the country.
The study, published today in the online journal PLOS One, investigated patterns of new HIV diagnoses, HIV-related mortality and HAART use in Canada from 1995 to 2008. Analysis showed that for each 10 per cent increment in HAART coverage, the rate of new HIV diagnoses decreased by eight per cent in B.C., Ontario and Quebec — three provinces with the largest epidemics.
In B.C., the Treatment as Prevention strategy has led to the widespread expansion of HAART coverage. The total number of new HIV diagnoses in the province dropped during the period of the study from 682 in 1995 to 348 in 2008, and the decline continues, with 289 new HIV diagnoses in 2011.
B.C. has also averted more cases of HIV than Ontario and Quebec combined. Findings showed that in 2008, the province averted 10.33 cases of HIV per 100,000 population compared to 3.40 and 0.33 averted cases for Ontario and Quebec respectively. In other provinces HAART coverage is more limited, and the number of new HIV diagnoses per year has remained relatively unchanged, even increasing in some jurisdictions. B.C. is the only province to offer fully free HAART to all HIV infected individuals.
“The dramatic and sustained decrease in AIDS-related morbidity and mortality and new HIV infections in British Columbia reinforces Treatment as Prevention as a highly effective approach in the fight against HIV/AIDS,” said Dr. Julio Montaner, senior author of the study, director of the BC-CfE and head of the Division of AIDS in the Faculty of Medicine at the University of British Columbia. “The evidence is clear: the time is now for Canada’s leaders to take action and implement Treatment as Prevention as the national strategy in the fight against HIV/AIDS. To do anything less would be a failure in their duty to protect the health of all Canadians.”
Every year, 3,300 men and women in Canada are diagnosed with HIV infection and it is estimated that 65,000 Canadians are now living with HIV. Study findings show that this number could double within the next 15 years if the current rate of new infections continues and treatment is not expanded across Canada.
“This comprehensive study provides us with clear evidence that expanding Treatment as Prevention in the context of comprehensive harm reduction supports, is the best way forward to fight HIV/AIDS,” said Dr. Perry Kendall, provincial health officer for B.C. “We should take the lessons learned in British Columbia and apply them in other jurisdictions to maximize our ability to decrease morbidity, mortality and new HIV infections.”
The Prairies showed a four-fold increase in rates of new diagnoses over the course of the study period, driven by new infections in Saskatchewan, where each year on average, 200 new people are diagnosed with HIV infection. Manitoba has also demonstrated an increase in new diagnoses, from 51 in 1995 to 105 in 2009.
According to a report released by Ottawa’s public health officials last year, there was a sharp increase in the number of new reported HIV cases in the first half of 2011 compared to the same time frame in 2010. HIV cases in Ottawa increased by almost 50 per cent from 32 cases in 2010 to 46 reported new HIV infections in 2011. In comparison, new HIV diagnoses in Toronto dropped from 596 in 2009 to 502 in 2010. In Vancouver, new HIV diagnoses remained steady (167 in 2010 and 164 in 2009) and represented a drop from the 10-year high of 242 new cases in 2002.
“This BC-CfE study provides compelling evidence that expanded HAART coverage can markedly curb the impact of HIV,” said Dr. Robert Hogg, lead author of the study, director of the Epidemiology and Population Health Program at the BC-CfE and a professor at Simon Fraser University. “The implications for public health are enormous. Policymakers cannot afford to ignore the evidence. Immediate access to free HAART should be considered a clinical imperative and a human rights priority.”
BACKGROUND | 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.