New research, published in Lancet HIV, shows
that providing antiretroviral treatment to all people living with
HIV and preventive treatment to individuals at high-risk of
contracting HIV reduces deaths and new HIV infections by more than
90%
VANCOUVER, BC, July 18,
2024 /CNW/ - The BC Centre for Excellence in HIV/AIDS
(BC-CfE) has released a new research study showing that the
made-in-BC HIV Treatment as Prevention (TasP) strategy coupled with
Pre-Exposure Prophylaxis (PrEP) has dramatically reduced premature
HIV/AIDS-related deaths and new HIV infections in British Columbia, Canada.
The study, published in Lancet HIV, looked at the impact
of three milestones in the fight against HIV – the introduction of
highly effective antiretroviral therapy (ART) in 1996, TasP in
2010, and PrEP in 2018.
ART suppresses the amount of HIV in biological fluids, such as
semen or blood, to undetectable levels. As a result, People Living
with HIV (PLWH) are no longer infectious and can enjoy a near
normal lifespan, free of AIDS. TasP expands access to free ART to
all people immediately after an HIV diagnosis. PrEP refers to the
use of two antiretroviral drugs taken daily to prevent HIV
infections among individuals at high risk of contracting HIV.
"Our results confirm that adding targeted PrEP to TasP is a
critical component of an effective HIV prevention strategy," said
Dr. Julio Montaner, BC-CfE Executive
Director and Physician-in-Chief. "With that in mind, it is
inexcusable that we are still seeing rising rates of new HIV
infections in Canada. We therefore
call on jurisdictions across the country and abroad to implement
TasP plus targeted PrEP to optimize and accelerate the control of
HIV/AIDS, and thereby reach the goal of an HIV-free
generation."
The BC-CfE study results showed free access to TasP for all BC
residents living with HIV coupled with free access to highly
targeted PrEP for residents at high-risk of contracting HIV reduced
HIV/AIDS-related mortality by 95% and HIV new infections (also
known as HIV incidence) by 91% between 1996 and 2022.
Additionally, the study evaluated the relative contributions of
ART, TasP and PrEP on HIV incidence in BC. For every 100 PLWH
actively on ART under the province-wide TasP strategy, the
estimated HIV incidence rate decreased by 2.5%. And for every
increase of 100 high-risk individuals on PrEP, estimated HIV
incidence rate fell by 1.7%. Importantly, the TasP plus targeted
PrEP strategy was cost-saving.
The study results showed that when PrEP is free, introduced at
scale and combined with an ongoing TasP strategy, it significantly
reduced HIV transmission even when analysis was restricted to the
limited number of PLWH in BC with a detectable HIV viral load. As
such, ART, TasP and PrEP were shown to be synergistic in their
ability to most effectively reduce HIV transmission.
ART combined with PrEP decreases HIV transmission by lowering
the amount of HIV circulating in the community. Meanwhile, PrEP
decreases HIV incidence by reducing the number of susceptible
individuals in the community, independent of the plasma viral load
among PLWH.
Notably:
- Study results are consistent with previous economic analysis
that shows widespread deployment of the BC-CfE-pioneered TasP
strategy is cost-saving. Targeting PrEP to individuals at high-risk
optimizes the cost-effectiveness of the strategy.
- Results benefit from the fact the study was conducted in BC,
where universal health care is available to residents and covers
ART, PrEP, laboratory monitoring, and medical services. Thus,
results are not influenced by potential variables related to the
cost of the services. With the support and encouragement of
the BC-CfE, the BC government was the first jurisdiction in
Canada to introduce fully
subsidized PrEP in 2018.
- The study shows: 1) HIV/AIDS mortality rate decreased from 6.0
per 100,000 population in 1994 to 0.3 per 100,000 population in
2022, a 95% decrease; and 2) HIV incidence decreased from 818 cases
diagnosed annually in 1985 to 82 cases in 2022, a 90%
decrease.
- HIV in Canada: 2022
Surveillance Highlights (the most recent available) show that
the number of new HIV diagnoses in Canada rose 24.9% in 2022 over 2021. BC's rate
of new HIV diagnosis is the lowest among Canada's six largest provinces, by almost 40%.
Canada is the only G7 country with
a rising HIV/AIDS rate.
- The BC-CfE is applying TasP® to
therapeutic areas beyond HIV/AIDS, including viral hepatitis and
addiction, to promote Targeted Disease
Elimination® as a means to contribute to healthcare
sustainability.
The BC-CfE's new study, titled the Longitudinal evolution of
the HIV effective reproduction number following sequential
expansion of treatment as prevention and pre-exposure prophylaxis
in British Columbia, Canada: a
population-level programme evaluation, can be found
here.
About the British Columbia Centre for Excellence in
HIV/AIDS
The BC Centre for Excellence in HIV/AIDS (BC-CfE)
is Canada's largest HIV/AIDS
research, treatment and education facility – nationally and
internationally recognized as an innovative world leader in
combating HIV/AIDS and related diseases. The made-in-BC Treatment
as Prevention® strategy (TasP® )
pioneered by BC-CfE, and supported by UNAIDS since 2011, inspired
the ambitious global target for HIV treatment - known as the
90-90-90 Target by 2020 and current 95-95-95 Target by 2025 - to
end AIDS as a pandemic by 2030. The BC-CfE is applying
TasP® to therapeutic areas beyond HIV/AIDS,
including viral hepatitis and addiction, to promote Targeted
Disease Elimination® as a means to contribute to
healthcare sustainability. The BC-CfE works in close collaboration
with key stakeholders, including government, health authorities,
health care providers, academics, and the community to decrease the
health burden of HIV/AIDS, hepatitis C and addictions across
Canada and around the world.
SOURCE British Columbia Centre for Excellence In HIV/AIDS