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Julio Montaner, MD Professor of Medicine, and Head, Div. of AIDS, University of British Columbia

Special Technical Satellite , Melbourne 2014. Treatment as Prevention The Key to Eliminate AIDS & HIV. Julio Montaner, MD Professor of Medicine, and Head, Div. of AIDS, University of British Columbia Director, BC-Centre for Excellence in HIV/AIDS at Providence Health Care

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Julio Montaner, MD Professor of Medicine, and Head, Div. of AIDS, University of British Columbia

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  1. Special Technical Satellite, Melbourne 2014 Treatment as PreventionThe Key to Eliminate AIDS & HIV Julio Montaner, MD Professor of Medicine, and Head, Div. of AIDS, University of British Columbia Director, BC-Centre for Excellence in HIV/AIDS at Providence Health Care UNAIDS Special Advisor on HIV Therapeutics AU EDITED FINAL: 03-18-13

  2. The promise of HIV treatment: Prevent HIV-related illness and disability Avert AIDS-related deaths Prevent new HIV infections

  3. Increasing HAART Coverage within Evolving Guidelines in BC January 2004 Summer of 2000 Summer of 1996 # of active participants on HAART in the HIV treatment programme 1994-2009 Phase I Phase II Phase III Source: Montaner et al, Lancet, 2010

  4. New AIDS Cases Diagnosed by Year British Columbia - 1983 to 2013 Source: Montaner et al, 2014

  5. 400 350 300 250 200 Frequency 150 100 50 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Years > 90% Decrease in All Cause Mortality among HIV+ Individuals in BC, Canada since 1996 Source: Montaner et al, PLOS One, 12 Feb 2014

  6. New HIV Cases Diagnosed, Estimated HIV Incidence, & HAART Use by Year in BC Source: Montaner et al, International AIDS Conference, 2014, Poster # TUPE203

  7. A clear correlation exists between HIV treatment and incidence 1.1% (0.8%-1.4%) reduction in HIV incidence, for each 1.0% increase in treatment coverage. 1.0 p=0.325 p=0.003 0.8 p=0.0001 p=0.013 Incidence rate ratio 0.6 0.4 0.2 ART & HIV incidence: Hlabisa, South Africa 0 0% 30% 60% ART coverage Source: Tanseret al. Science 2013;339:966-971

  8. AIDS-related death rates vs. ART coverage in 51 countries, weighted by epidemic size (2012 data) HIV incidence vs. ART coverage in 51 countries, weighted by epidemic size (2012 data) Source: Hill, Pozniak, Raymond, Heath and Ford, AIDS 2014, 2014.

  9. HIV Transmission According to Sexual Behavior Reported by HIV-Negative Partner Rate of Couple Transmission (per 100 Couple-Years Follow-Up) Overall risk = Zero through condomless sex with a partner on ART (HIV RNA <200 copies/mL Heterosexual (Male) Vaginal sex with ejaculation (192 CYFU) Heterosexual (Female) Vaginal sex (272 CYFU) MSM Receptive anal sex: With ejaculation (93 CYFU) Without ejaculation (157 CYFU) Insertive anal sex (262 CYFU) 0 1 2 3 4 Rate (95% CI) Source: Rodger A, et al. 21st CROI. Boston, 2014. Abstract 153LB

  10. HIV treatment:The most effective biomedical intervention for the prevention of HIV transmission

  11. Expanding ART for treatment and prevention of HIV in South Africa: Cost-effectiveness 2011-2050 Lives Saved (x 1,000) U$A Billions Source: Granich et al, PLoS ONE 7(2):e30212, February 2013

  12. By 2020… 90% of all people living with HIV will know their HIV status 90% of all people diagnosed with HIV will receive sustained antiretroviral therapy. 90% of all people receiving antiretroviral therapy will have durable suppression.

  13. The result 72% 3 of all people living with HIV will be virally suppressed = a three-fold increase over current 2014 estimates

  14. The new treatment paradigm Single target → Cascade target Death → Death and transmission Number → Equity Incremental funding→ Frontload Investments

  15. The objective “Maximize the effectiveness of existing toolsto virtually eliminate progression to AIDS, premature death and HIV transmission, and thereby transform the HIV/AIDS pandemic into a low level sporadic endemic.”

  16. THE FINAL CHAPTER OF THE AIDS EPIDEMIC

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