Agenda Item #3.2

THE UNIVERSITY OF BRITISH COLUMBIA Report to the Board of Governors

SUBJECT TREATMENT AS PREVENTION: THE KEY TO AN AIDS-FREE GENERATION

MEETING DATE 3 April 2013

Forwarded to the Board of Governors on the Recommendation of the President

APPROVED FOR SUBMISSION

President Stephen J. Toope, President and Vice-Chancellor

Presented By David H. Farrar, Provost and Vice-President Academic

Report Date March 12, 2013

DECISION REQUESTED For Information

PRESENTATION ABSTRACT While both an outright cure and a preventive vaccine for HIV/AIDS remain elusive, remarkable advances in HIV treatment have been achieved over the past two decades. Most significant among these advances is the development of highly active antiretroviral therapy (HAART) the standard of care since 1996.1 Use of HAART has led to dramatic decreases in morbidity and mortality among patients engaged in treatment. In August 2006, we proposed that the expansion of HAART coverage to all those in medical need would represent a key strategy to dramatically curb HIV transmission.2 We further suggested that such strategy would be potentially cost-averting.3 This was independently verified by World Health Organization (WHO) based investigators in 2009.4 Epidemiological evidence to support the impact of HAART on HIV transmission can be readily found in the setting of vertical transmission where HAART has virtually led to the near complete prevention of HIV transmission. We have also shown that HAART can similarly prevent HIV transmission among injection drug users5, as recently validated within the ALIVE Cohort in the US.6 More recently, at the population level, we have documented that expansion of HAART uptake between 1996 and 2010 has been associated with a greater than 65% decrease in HIV new diagnoses in BC.7 Of note, this has taken place against a background of stable or rising sexually and blood borne infections in the province. In 2011, HPTN 052 provided definitive and compelling confirmatory evidence of the efficacy of “Treatment as Prevention” among sero-discordant couples.8 HPTN 052 showed a 96.3% decrease in the risk of HIV transmission with immediate HAART. Of note, immediate HAART was also associated with a 41% decrease in disease progression and death, as well as an 83% reduction in the incidence of tuberculosis.8

Academic Presentation by Dr. Julio Montaner Board of Governors 3 April 2013

In 2009, the BC government committed to further expand outreach efforts to maximize HIV testing and facilitated HAART access in BC, this initiative is known as Seek and Treat for Optimal Prevention of HIV/AIDS in BC (STOP HIV/AIDS in BC). Morbidity, mortality and new HIV diagnoses have continued to decrease steadily in BC, as a result. In 2012, based on the continued success of the Treatment as Prevention strategy, the BC government renewed the committed to further expand outreach efforts on a long-term basis. It is clear that expanding access to HAART is highly effective in preventing morbidity and mortality among HIV-infected individuals, and secondarily HIV transmission. The data is conclusive and compelling. The challenge remains to secure the necessary political will to implement the strategy on a global level. An AIDS free generation is within reach, however, this will not be attained if we fail to fully capitalize on the promise of HIV treatment as prevention. References 1. Carpenter et al. Journal of the American Medical Association, 1996 2. Montaner et al. The Lancet, 2006 3. Lima et al. Journal of Infectious Diseases, 2008 4. Granich et al, The Lancet, 2009 5. Wood et al, British Medical Journal, 2009 6. Kirk et al, Conference on Retroviruses and Opportunistic Infections (CROI), 2011 7. Montaner et al, The Lancet, 2010 8. Cohen et al, New England Journal of Medicine, 2011

Biography: Dr. Julio Montaner Julio Montaner, MD, DSc (hon), FRCPC, FCCP, FACP, FRSC, OBC Professor of Medicine and Head of Division of AIDS, Faculty of Medicine, University of British Columbia (UBC); UBC and St. Paul’s Hospital (SPH) Foundation Chair in AIDS Research; Director, BC Centre for Excellence in HIV/AIDS, SPH-Providence Health Care; Vancouver, BC, Canada

Dr. Julio Montaner is originally from , . He received his Medical Degree with Honors from the University of Buenos Aires in 1979. In 1981, he joined the University of British Columbia (UBC) at St Paul’s Hospital (SPH) where he completed his training in Internal Medicine. In the early 80’s, he led several clinical studies that defined best care practice for the management of AIDS related PCP. In 1987, he became the Director of the AIDS Research Program and the Immunodeficiency Clinic at SPH/UBC. Since then, he focused his research predominately towards the development of antiretroviral therapies and management strategies. In the mid 90’s, he played a key role in establishing the efficacy of NNRTI based highly active antiretroviral therapy (HAART). This was one of the pivotal contributions emerging from the IAS-sponsored Vancouver 1996 International AIDS Conference, of which he was a co-organizer. More recently, he played a key role in establishing the efficacy of HAART treatment as prevention with financial support of the BC Ministry of Health, an Avant Garde Award from the National Institute on Drug Abuse in the US, as well as the Canadian Institute for Health Research (CIHR).

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Dr. Montaner has authored over 500 scientific publications on HIV/AIDS. His current research interests include HAART as prevention, optimal use of HAART, salvage therapy, new antiretrovirals, as well as hard to reach populations, treatment as prevention of viral hepatitis and addiction management, including strategies. He is a Professor of Medicine at UBC. He has held the Endowed SPH/UBC Chair in AIDS Research since 1996. He is the Director of the BC Centre for Excellence in HIV/AIDS. He was the President of the International AIDS Society for 2008-2010. In 2008, Dr. Montaner received the inaugural Avant-Garde Award of $2.5 million over 5 years, from the National Institute on Drug Abuse of the National Institutes of Health (NIH), to support his research in the area of Treatment as Prevention. In 2009, he was the recipient of the Knowledge Translation Award from the Canadian Institutes of Health (CIHR) and he was inducted into the Royal Society of Canada (RSC). In 2010, he received an Honorary Doctor of Science from Simon Fraser University, the Prix Galien, the Order of BC, as well as the Albert Einstein World Science Award. In 2012, he was the recipient of the Grand Decoration of Honor for Services to Austria, the Hope is a Vaccine Award from the Global Alliance to Immunize against AIDS, and The Queen Elizabeth II Diamond Jubilee Medal for his contributions to the field of HIV/AIDS.

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