HIV Treatment To Prevent Morbidity, Mortality, and Transmission

While an outright cure or a preventive vaccine for HIV/AIDS remain elusive, remarkable advances in HIV treatment have been achieved over the past two decades.  Specifically, highly active antiretroviral therapy (HAART) has been shown to dramatically reduce HIV/AIDS morbidity and mortality. This is due to the ability of HAART to fully suppress HIV replication, which renders the number of viral copies present in a patient’s blood and body fluids undetectable.

In addition, HAART induced viral load suppression has a powerful preventive impact on HIV transmission. For example, HAART has led to the near complete prevention of vertical transmission of HIV. HAART has also been shown to decrease sexual HIV transmission by 96%. More recently, we demonstrated that HAART prevents HIV transmission in injection drug users. Further, at the population level, we have documented that expanded HAART uptake was associated with an approximately 50% reduction in HIV incidence in BC between 1996 and 1999. Therefore, expansion of HAART coverage in addition to preventing AIDS morbidity and mortality can be cost-averting, as it can dramatically reduce HIV transmission by all routes.

In May 2009, the BC government formally approved the staged implementation of “Treatment as Prevention” in BC, known as the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) pilot. This pilot project aims to increase HAART coverage from 4,000 to 6,000 clinically eligible HIV-positive individuals on treatment, measuring its impact on HIV new diagnoses, as well as AIDS morbidity and mortality over four years. Mathematical modeling suggest that with a baseline incidence of 400 new cases per year, increasing HAART uptake by 2,000 individuals will lead to a 30% decline in HIV new cases per year.