1st International Treatment as Prevention (TasP) Workshop

Overview

British Columbia Centre for Excellence in HIV/AIDS

Julio Montaner MD, DSc(hon), FRCPC, FCCP, FRSC, OBCDirector, BC-Centre for Excellence on HIV/AIDS, Providence Health Care

Professor of Medicine and Head, Division of AIDS, University of British ColumbiaPast-President, International AIDS Society

Additional Industry Support:

British Columbia Centre for Excellence in HIV/AIDS

Treatment as Preventionvs

ARV Chemoprophylaxis

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

Treatment as Prevention

Heterosexual Couples

HIV IncidenceH

IV In

cide

nce

(per

100

-per

son-

year

s)2.24

(1.84-2.72)

0.37(0.09-2.04)

HIV Partner Had Started HAARTNo Yes

92%Reduction

Donnell D, et al. Lancet. 2010;375:2092-2098

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 12th 2011. To be presented at IAS-Rome, July 2011

%

HPTN 052 (www.hptn.org)

Extra-Pulmonary TBDeferred : 17 casesImmediate : 3 cases

84% Reduction

Deferred

Immediate

M Cohen et al, NIH Press Conference May 12th 2011. To be presented at IAS-Rome, July 2011

%

Treatment as Prevention

MSM

Determinants of HIV-1 Transmission in MSM:A Combined Clinical, Epidemiological and Phylogenetic Approach

Treatment as Prevention

IDUs

Wood et al, BMJ, 2009

Whiskers represent 95% confidence intervals.

Wood et al, BMJ, 2009

Whiskers represent 95% confidence intervals.

HAART Reduces HIV incidence in IDUs

G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011

HIV Incidence

Community pVL

% Injecting% on HAART

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

Tuesday Feb 8th 2011

Treatment as Prevention

Population Based Studies

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.

Treatment as Prevention

Next Steps

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

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

Montaner J, The Lancet, Vol 378: July 16th 2011, pages 208-209