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HAART has been shown to decrease HIV transmission • Vertical (MTCT) Setting • Heterosexual Sero-discordant Couples •

HAART has been shown to decrease HIV transmission • Vertical (MTCT) Setting • Heterosexual Sero-discordant Couples • Injection Drug Users Cohort • Mathematical Models. Unique Study Features: • Population Based • Free Access to HAART and Medical Monitoring

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HAART has been shown to decrease HIV transmission • Vertical (MTCT) Setting • Heterosexual Sero-discordant Couples •

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  1. HAART has been shown to decrease HIV transmission • Vertical (MTCT) Setting • Heterosexual Sero-discordant Couples • Injection Drug Users Cohort • Mathematical Models

  2. Unique Study Features: • Population Based • Free Access to HAART and Medical Monitoring • Centralized Data Capture / Single Source • Access to Blood Borne Dxs – BCCDC • Retrospective & Prospective Phases

  3. January 2004 Summer of 1996 Summer of 1996 Phase I Phase II Phase III Year Montaner et al, Lancet, June 18th 2010

  4. Incidence/yr Acquired resistance falling 90 80 70 60 Plasma viral load suppression rising Viral load < 50/mL (%)

  5. Population Plasma HIV-1-RNA % <500 copies/mL

  6. Highest HIV-1- Plasma Viral load per Year Non IDU IDU Ever on Treatment & Censoring at the time of Death or Move The proportion of HIV infected IDUs engaged in care in BC with plasma viral load >1500 c/mL, as a surrogate for “high” community HIV-1-viral load, decreased from ~50% in 2000-04 to ~20% in 2009 (p<0.001) Montaner et al, Lancet 2010

  7. “Provincial Viral Load” All Patients Ever Tested for Plasma HIV-1-Viral Load in BC Censoring at the time of Death or Move

  8. Number of HIV tests per Year in BC 1994 2000 2008 BC-CDC Report, 2009

  9. Hepatitis C, 1999-2008 Infectious Syphilis, 1999-2008 2004 • BC • BC 2004 x Canada x Canada Genital Chlamydia, 1999-2008 Gonorrhea, 1999-2008 x Canada • BC x Canada • BC 2004 2004

  10. Key Findings: Overall correlation between the number of pts on HAART and the number of new HIV cases diagnosed per year was -0.89 (p<0.0001) For every 100 additional patients on HAART, the number of new HIV cases decreased by a factor of 0.97 (95% CI 0.96-0.98) • ie: new HIV diagnoses fell by 3%. For every 1 log10 decrease in viral load, the number of new HIV cases decrease by a factor of 0.86 (95% CI 0.75-0.98)

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