New strategy could reduce global HIV prevalence seventy-fold

published on August 4, 2006

Vancouver – A new strategic shift in the use of HIV drugs could hypothetically reduce global prevalence of the virus seventy-fold, says a B.C. Centre for Excellence in HIV/AIDS article published in The Lancet.

The model is outlined in a special HIV/AIDS-themed issue of the widely respected international journal, published to coincide with the 16th International AIDS Conference, to be held in Toronto, Aug. 13-18. The novel strategy will also be unveiled to conference delegates in an Aug. 16 plenary address by Dr. Julio Montaner, Director of the Centre and lead author of the strategy.

The Lancet “ViewPoint” article highlights the use of triple-drug therapy (formally known as highly active antiretroviral therapy, or HAART) has been historically focused on improving patient outcomes, not transmission rates. Emerging evidence underlines transmission of the virus is rare by persons with undetectable viral loads of HIV in their blood, owing to use of HAART. The article presents the available evidence to support the expansion of HAART programs for those requiring treatment as a cornerstone of the HIV prevention strategy.

“We must stress that we do not see HAART as a replacement for the prevention effort --including vaccine research -- but rather as an essential part of it,” cautions Montaner, who will become president-elect of the International AIDS Society at the completion of the conference. “The transmission of the virus could be dramatically reduced with the appropriate expansion of HAART for those requiring treatment.”

Data from B.C. and Taiwan, for example, indicates an approximate 50% reduction in new HIV cases can be reasonably attributed to the introduction of free access to HAART. This proportion would represent about 40,000 new cases in North America in 2005, which in turn translates to an averted HAART cost of more than $10 billion US.

The Centre designed a hypothetical, population-based model demonstrating HIV prevalence could, over a 45-year-period, be reduced by more than seventy fold – from over seven cases to less than 0.1 of a case per 1,000 population. The number of HIV infected people could decrease from 40 million to less than one million if all required treatment.

The renewed understanding of the role of HAART dramatically increases the cost-effectiveness of anti-HIV drug programs. Results of new modelling demonstrate the short-term cost of hypothetically treating all HIV-infected individuals in the world today would be more than offset by the number of new infections prevented.

The availability of rapid HIV testing coupled with a new highly effective one-pill-a-day, fixed-dose, drug combination represents a unique opportunity to expand global HAART programs and potentially curb the global growth of the pandemic.

UNAIDS estimates that there were 40 million people living with HIV in the world at the end of 2005, with five million new infections occurring that year. While the majority of new cases continue to emerge from developing nations, HIV incidence levels remain unacceptably high in developed countries with comprehensive prevention programs.

The Centre’s model must be urgently evaluated, both locally and internationally, says Montaner.

“The status quo is no longer acceptable. The current approach to the management of the HIV/AIDS pandemic is rapidly becoming unsustainable,” says Montaner. “ We plan to expand HAART in a controlled, responsible fashion within a very well characterized setting where we can determine its impact on HIV incidence rates -- the results of which will be critical to informing health policy worldwide.”

BC Centre for Excellence in HIV/AIDS

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New strategy could reduce global HIV prevalence seventy-fold

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