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Treatment as Prevention: The Key to an AIDS-Free Generation. Julio S. G. Montaner, MD Professor of Medicine University of British Columbia. From JS Montaner , MD, at San Francisco, CA: March 29, 2013, IAS-USA. . Death Rate per 1000. Life Expectancy at age 20. 140. 35. 120. 30. 100. 25.
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Treatment as Prevention:The Key to an AIDS-Free Generation Julio S. G. Montaner, MDProfessor of MedicineUniversity of British Columbia From JS Montaner, MD, at San Francisco, CA: March 29, 2013, IAS-USA.
Death Rate per 1000 Life Expectancy at age 20 140 35 120 30 100 25 80 20 60 15 40 10 20 5 0 0 1993-94 1995-96 1997-98 1999-00 2001-02 2003-04 1993-94 1995-96 1997-98 1999-00 2001-02 2003-04 Impact of HAART in BC-CfE Modified from Hogg et al, Lancet. 2009
New HIV and Syphilis in BC BC-CDC, 2005
Slide 4 of 20 From JS Montaner, MD, at San Francisco, CA: March 29, 2013, IAS-USA.
Slide 5 of 20 HAART stops HIV replication HIV load falls to undetectable levels in plasma as well as in sexual fluids Sharp reduction in HIV transmission From JS Montaner, MD, at San Francisco, CA: March 29, 2013, IAS-USA.
Slide 6 of 20 Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.
HAART Reduces HIV incidence in IDUs • From 1997, HIV incidence decreased by 74% for each log decline in community HIV viral load • In a separate model, HIV incidence decreased by 5% for each 1% increase in HAART coverage Modified from G Kirk et al, for the Alive Cohort, CROI 2011
HPTN 052: Immediate vs Delayed ART in Sero-discordant Couples • HR = 96.3% reduction in transmission • No difference whether index pt was M or F % Deferred Immediate Cohen MS, et al. IAS 2011. Abst MOAX0102 Cohen MS, et al. N Engl J Med. 2011
Slide 9 of 20 Increasing HAART Coverage within Evolving Guidelines in BC N = 7492 by the end of 2011 January 2004 Summer of 2000 Summer of 1996 Phase I Phase II Phase III Year Montaner et al, Lancet, 2010 From JS Montaner, MD, at San Francisco, CA: March 29, 2013, IAS-USA.
BC: AIDS Cases Diagnosed (Rate per 100K) > 80% Decrease in AIDS case report rate in BC since the pre cART era
BC: All Cause Mortality (#) > 90% Decrease in All Cause Mortality among HIV Infected Individuals in BC since 1996 Montaner et al, TasP Workshop, April 2012
Increasing HAART Coverage within Evolving Guidelines in BC - Impact on New Diagnoses Slide 12 of 20 Updated from Montaner et al, Lancet, 2010, presented at TasP-Workshop, Vancouver 2012
Slide 13 of 20 Hepatitis C, 1999-2008 Infectious Syphilis, 1999-2008 2004 • BC • BC 2004 x Canada x Canada Genital Chlamydia, 1999-2008 Gonorrhea, 1999-2008 x Canada • BC x Canada • BC 2004 2004
Department of Medicine Chart Audit Data: October 2011 –December 2, 2012 Routine HIV testing - Acute Care 1 Departments of Medicine only at each hospital site 2 Acceptance rate excludes all “Not Accepted” (i.e. recent test, known HIV positive) except Pt Refusal Preliminary Results, Courtesy of Scott Harrison et al
Spectrum of Engagement in Care - USA 19% are estimated to be undetectable as a result of HAART use* * More recently CDC-USA revised the estimate to 28% Gardner et al. CID, 2011
The Cascade of Care - 1996-2010 * Nosyk et al, CROI, 2013
Lives Saved (x 1,000) U$A Billions Granich et al
