1 st International Treatment as Prevention (TasP) Workshop Overview British Columbia Centre for Excellence in HIV/AIDS 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
26
Embed
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 - PowerPoint PPT Presentation
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
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
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