STOP HIV/AIDS Backgrounder
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TREATMENT AS PREVENTION STOP HIV/AIDS STOP HIV/AIDS In 2008, the BC-CfE developed a mathematical On February 4, 2010, then-Minister of Health “TREATMENT AS model and a cost-effectiveness evaluation Kevin Falcon announced a four-year $48 million that suggested that the expansion of HAART pilot aimed to evaluate the impact of the HIV PREVENTION” IN coverage would be highly cost-effective, as it Treatment as Prevention strategy in BC. The would prevent AIDS morbidity and mortality. strategy is a pilot project called STOP HIV/AIDS ACTION However, when the impact of the expansion of (Seek and Treat for Optimal Prevention of HIV HAART coverage on HIV transmission was taken and AIDS). Extending HAART via Treatment as into account, the strategy was found to have the The STOP HIV/AIDS pilot aims to expand access Prevention saves lives, prevents potential of becoming cost-averting, as it would to HIV/AIDS treatment and medication among HIV transmission and reduces health costs virtually eliminate vertical transmission of HIV, hard-to-reach and vulnerable populations in and dramatically reduce HIV transmission by all hile an outright cure or a preventive Vancouver’s Downtown Eastside and Prince other routes. Wvaccine for HIV/AIDS remains elusive, George. These regions had been identified as remarkable advances in HIV treatment have Most recently, HPTN 052—a randomized trial of priority sites for the pilot project because they been achieved over the past two decades. HIV sero-discordant (primarily heterosexual) were disproportionately affected by HIV/AIDS. Most significant among these advances is the couples—provided definitive proof of the The pilot project specifically serves individuals development of highly active antiretroviral efficacy of HIV Treatment as Prevention. The facing multiple barriers to care including therapy (HAART). study found an impressive 96% decrease in the addiction, mental health issues, homelessness, risk of HIV transmission with immediate HAART. and other social factors. WHAT IS HAART? Of note, immediate HAART was also associated The four-year pilot under the leadership of the HAART is a combination of antiretroviral drugs with a 30% decrease in the combined endpoint of BC-CfE operates until 2013. The pilot is being that fully suppress HIV replication and therefore disease progression and death as well as an 83% carried out in collaboration with Vancouver renders the number of viral copies present in reduction in the incidence of extra-pulmonary Coastal Health, Northern Health, the Provincial a patient’s blood undetectable, as measured by tuberculosis. Health Services Authority and Providence commercially available plasma viral load assays. The concept of HIV Treatment as Prevention Health Care. The pilot is been implemented with HAART became the standard of care in has progressively gained support from the the involvement of key community partners, developed nations around the world following international community, including the including the Aboriginal community. the International AIDS Conference in Vancouver International AIDS Society, the World Health in 1996. HAART use significantly reduced Organization (WHO), UNAIDS, PEPFAR, the PROJECT GOALS morbidity and mortality among treated patients, Clinton Initiative, Médecins Sans Frontières, the ✓ Ensure timely access to high quality allowing dramatic improvements in the quality National Institutes of Health, and international and safe HIV/AIDS care and treatment and duration of life for HIV-infected individuals. research-based pharmaceutical industries, In BC, by 1999, (within three years of deployment among other key international stakeholders. ✓ Reduce the number of new of our HAART program) the BC-CfE documented In November 2011 US Secretary of State Hillary HIV/AIDS diagnoses an 85% reduction in HIV/AIDS mortality among Clinton publicly endorsed HIV Treatment as ✓ Reduce the impact of HIV/AIDS through patients engaged in treatment. Prevention as a central piece within the PEPFAR effective screening and early detection global strategy. This was further emphasized In July 2006 at the International AIDS Conference ✓ Improve the patient experience in by US President Obama on December 1, 2011, in Toronto, the BC-CfE provided compelling every step of the HIV/AIDS journey during his International AIDS Day speech. In evidence that the viral load suppression achieved December 2011, Science, the official Journal of ✓ Demonstrate system and by HAART substantially reduced transmission the AAAS named HIV Treatment as Prevention cost optimization of HIV. In a viewpoint article published in The the #1 Scientific Breakthrough of 2011. Lancet in the summer of 2006, the BC-CfE Dr. Montaner jointly with Dr. Myron Cohen, the proposed that the expansion of HAART coverage lead investigator of HPTN 052, shared the 2011 to all those in medical need would be the most GAIA award for their work on HIV Treatment as effective strategy to dramatically reduce HIV Prevention. transmission to those at risk. NUMBERS SHOW BC IMPROVING WITH HAART HIV DIAGNOSES BY REGION AND YEAR THE CASCADE OF CARE Public Health Agency of Canada, 1995-2011 Nosyk et al., Upcoming Publication 20 B.C. 10000 15 8000 Ontario 6000 # Patients 10 10000 Québec Ontario 4000 Prairies 8000 B.C. 2000 Québec 5 Prairies 6000 2009 HIV Diagnoses per 100,000 Population 2008 Atlantic 4000 2007 # Patients 2006 Atlantic 2005 2000 2004 2003 1995 1998 2001 2004 2007 2010 2002 2001 Year 2000 Year 1999 DiagnosedLinked 1998 1997 Retained 1996 NeedOn ARV ARV Adherent Suppressed DR. JULIO MONTANER The BC Centre for Excellence in HIV/AIDS (BC-CfE) is headed by Dr. Julio Montaner, a world-renowned researcher and a respected leader on HIV/ CONSULTING WITH HIS PATIENT WITH PREMIER CHRISTY CLARK SPEAKING AT IAS 2012 AIDS issues and advocacy. Since 1987, Dr. Montaner has Dr. Montaner has pioneered new salvage therapy Among other international accomplishments, been making a difference in the lives strategies for patients harbouring multiple drug- Dr. Montaner was instrumental in working of people living with HIV and AIDS. resistant HIV infection. In the early 2000’s, Dr. with China to implement BC’s Treatment Born in Argentina, Dr. Montaner knew Montaner began exploring the idea of Treatment as Prevention strategy in their fight against at a very early age he wanted to be a as Prevention. The idea was to expand the use of HIV/AIDS. doctor — just like his father. He arrived HAART to decrease AIDS-related morbidity and In 2007, he was appointed Head of the newly at St. Paul’s Hospital in 1981 on a UBC mortality and to decrease HIV incidence and established Division of AIDS at the University fellowship. He completed his training prevalence. in Internal Medicine and Respiratory of British Columbia Department of Medicine, Medicine at UBC and was St. Paul’s Since 2005, as director of the BC-CfE, Dr. the first such initiative in Canada and one chief resident. In 1988, he took the Montaner leads the BC-CfE’s efforts to translate of only three in North America. His peer- position of Director of AIDS Research. research advances into clinical practice. In reviewed research papers dealing with HIV/AIDS In the mid-1990’s, working with other 2006, he introduced the pioneering Treatment have been published extensively. His current researchers at the BC-CfE, Dr. Montaner as Prevention concept to the International research interests include HAART as prevention, played a key role in the discovery of a AIDS Society conference in Toronto. He served optimal use of HAART, salvage therapy, new drug cocktail, since known as highly the IAS as President-Elect, President and Past- antiretrovirals, as well as hard-to-reach active antiretroviral therapy (HAART), President from 2006 – 2011, a fitting recognition populations and harm reduction. which reduces the amount of HIV in of Dr. Montaner’s ongoing leadership and strong an infected individual’s bloodstream commitment to the international fight against to undetectable levels and restores HIV and AIDS. immune function. BACKGROUNDER CORE PROGRAMS AND INITIATIVES LABORATORY PROGRAM ADDICTION AND URBAN The BC-CfE conducts translational HIV research HEALTH RESEARCH INITIATIVE and coordinates some of the world’s largest The BC-CfE conducts U � � � � cohort studies examining human and virus population-based H � � �� � Together we can stop HIV/AIDS R � � � � � � � variability. research on HIV/AIDS I � � � � � � � � � and related diseases The British Columbia Centre for Excellence among urban populations and those suffering in HIV/AIDS (BC-CfE) is Canada’s largest addiction. Funded cohort studies involve drug HIV/AIDS research, treatment and education users, street-involved youth and health services facility. When the BC-CfE opened in 1992, a evaluation studies. British Columbian was dying from AIDS almost INTERNATIONAL CENTRE every day. Today, advances in HIV treatment and EPIDEMIOLOGY AND POPULATION prevention — many of them developed by the FOR SCIENCE IN DRUG HEALTH BC-CfE — have made HIV infection preventable POLICY INITIATIVE and transformed HIV disease a chronic, This comprehensive program identifies risks The BC-CfE’s Addiction and manageable illness. for HIV infection while tracking access to Urban Health Research Initiative antiretroviral therapy and clinical outcomes However, much work remains to be done. Drug serves as the Secretariat for the ICSDP. Founded among vulnerable populations. resistance, adverse reactions to medication and by BC-CfE scientists in 2010, the ICSDP brings barriers to accessing treatment