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and Hepatitis.com Coverage of the
XVIII International AIDS Conference (AIDS 2010) July 18 - 23, 2010, Vienna, Austria
Early Antiretroviral Treatment Reduces New HIV Infections, Says British Columbia Study
Effective combination ART reduces HIV viral load to a very low or undetectable level and thereby dramatically decreases the likelihood of HIV transmission on an individual level.
Mathematical models developed over the past fefw years have suggested that expanded use of ART sooner after HIV diagnosis could lower HIV incidence within a population. A World Health Organization (WHO) model published in January 2009 found that HIV transmission could potentially be eliminated if universal testing were implemented and all people who test positive received prompt treatment.
More recently, Julio Montaner from the British Columbia Centre for Excellence in HIV/AIDS and colleagues last month reported findings from a model indicating that if all people with HIV in Vancouver were treated according to International AIDS Soceity-USA guidelines then in effect, the rate of new infections would decrease by almost half.
British Columbia researchers have shown that the outcomes predicted
by modelling appear to be occurring in real life.
on these findings, the study authors wrote, "We have shown a strong
population-level association between increasing HAART coverage, decreased
viral load, and decreased number of new HIV diagnoses per year."
Further analysis showed that the association between increased HAART coverage, decreased community viral load, and reduction in new HIV diagnoses was largely attributable to injection drug users.
After declining slowly for several years, there was a sharp decrease in new infections among current or former drug users during 2007-2008 -- and the number with undetectable viral load increased by 86% -- after a specific outreach effort was implemented. This is a promising finding since most previous research showing declines in community viral load and HIV incidence have focused on sexual transmission.
These results also offer evidence to refute the stereotype that active drug users are unable to adhere to and benefit from antiretroviral treatment.
In an accompanying Lancet editorial, Franco Maggiolo and Sebastiano Leone from Ospedali Riuniti in Bergamo, Italy, wrote, "While waiting for an effective vaccine, experiences such as those reported today should be strongly considered by clinicians, national and international agencies, policymakers, and all parties involved in the development of treatment guidelines, because the population-based dimension of HAART might play an important part in the future control of the HIV epidemic."
Investigator affiliations: British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, BC, Canada; Division of AIDS, University of British Columbia, Vancouver, BC, Canada; Department of Psychiatry, University of California, San Diego, CA; Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada; Vancouver Coastal Health Authority, Vancouver, BC, Canada; Office of the Provincial Health Officer, Ministry of Healthy Living and Sport, Government of British Columbia, Victoria, BC, Canada.
JS Montaner, VD Lima, R Barrios, and others. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet (Free full text with registration). July 18, 2010 (Epub ahead of print).
Maggiolo and Sebastiano Leone. Is HAART modifying the HIV epidemic?
Lancet. July 18, 2010 (Epub ahead of print).