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1 st International Treatment as Prevention (TasP) Workshop Overview

British Columbia Centre for Excellence in HIV/AIDS . 1 st International Treatment as Prevention (TasP) Workshop Overview. Julio Montaner MD, DSc( hon ), FRCPC, FCCP, FRSC, OBC Director, BC-Centre for Excellence on HIV/AIDS, Providence Health Care

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1 st International Treatment as Prevention (TasP) Workshop Overview

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  1. British Columbia Centre for Excellence in HIV/AIDS 1st International Treatment as Prevention (TasP) Workshop Overview 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

  2. British Columbia Centre for Excellence in HIV/AIDS Additional Industry Support:

  3. Treatment as PreventionvsARV Chemoprophylaxis

  4. Integrating HIV prevention and treatment: From slogans to impact Sub Saharan Africa Salomon JA, Hogan DR, Stover J, Stanecki KA, Walker N, et al. (2005). PLoS Med 2(1): e16

  5. Treatment as PreventionHeterosexual Couples

  6. HIV Incidence 2.24 (1.84-2.72) 92% Reduction HIV Incidence (per 100-person-years) 0.37 (0.09-2.04) No Yes HIV Partner Had Started HAART Donnell D, et al. Lancet. 2010;375:2092-2098

  7. 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

  8. 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 12th 2011. To be presented at IAS-Rome, July 2011

  9. Treatment as PreventionMSM

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

  11. Treatment as PreventionIDUs

  12. Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.

  13. Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.

  14. HAART Reduces HIV incidence in IDUs % Injecting % on HAART Community pVL HIV Incidence G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011

  15. HAART Reduces HIV incidence in IDUs • 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 G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011

  16. Tuesday Feb 8th 2011

  17. Treatment as PreventionPopulation Based Studies

  18. Community Viral Load and New HIV Cases in SFco n=12,512 unduplicated HIV-positive individuals. 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

  19. Treatment as PreventionNext Steps

  20. Spectrum of Engagement in HIV Care - USA The authors estimated that only about 19% of HIV infected individuals in the USA have an undetectable HIV-1 RNA level Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6): 793-800

  21. 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

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

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