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Treatment as prevention: why?

Treatment as prevention: why?. Gus Cairns Editor, HIV Treatment Update. HIV diagnoses. Condom use in UK gay men. Treatment as prevention: evidence?. Montaner, Lancet 376: 532 – 539, 2010. BC study again. San Francisco. Das-Douglas, CROI 2010, abstract #33.

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Treatment as prevention: why?

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  1. Treatment as prevention: why? Gus Cairns Editor, HIV Treatment Update

  2. HIV diagnoses NAT Treatment as Prevention

  3. Condom use in UK gay men NAT Treatment as Prevention

  4. Treatment as prevention: evidence? NAT Treatment as Prevention Montaner, Lancet 376: 532 – 539, 2010

  5. BC study again NAT Treatment as Prevention

  6. San Francisco Das-Douglas, CROI 2010, abstract #33 NAT Treatment as Prevention

  7. What would it take in San Francisco? • In San Francisco 85.5% are diagnosed of whom 78% are linked to care of whom 90% are on ARVs of whom 72% are undetectable = 43.2% of people with HIV in San Francisco have an undetectable viral load (due to treatment) NAT Treatment as Prevention

  8. Imperial College mathematical model • Getting 80% of people with CD4 under 350 on treatment would be enough to reduce transmission by >90% if: • Lower-risk pops tested every 2-3 years • High-risk pops test every 6m • Dodd PJ, Garnett GP, Hallett TB. Examining the promise of HIV elimination by 'test and treat' in hyperendemic settings. AIDS 24: 729-735, 2010 NAT Treatment as Prevention

  9. A wild card: PrEP • IPrEx study, results 2 days ago • 44% efficacy on 51% adherence • Potentially 70-90% efficacy: cf condoms • Practical? Affordable? Applicable? Dangerous? • We may need to start thinking of ARVs-as-prevention for HIV-negative as well as HIV-positive people • ?Pilot study of ARV treatment for high-risk HIV-negative testers nested within TasP project? NAT Treatment as Prevention Grant RM et al. Preexposure chemoprophylaxis for HIV prevention in men. New Engl Jour Med 23 November 2010.

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