Landmark study reinforces benefits of antiretroviral treatment

BC-CfE researchers call for national implementation of made-in-Canada Treatment as Prevention strategy to save lives and curb the spread of HIV

Study results show B.C. is the only province with a significant decrease in new HIV diagnoses, in part due to expansion of free antiretroviral treatment.

A new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) showed that highly active antiretroviral therapy (HAART) reduces new HIV diagnoses, deaths and HIV prevalence, suggesting that the made-in-Canada Treatment as Prevention strategy should be implemented across the country.

The study, published in the peer-reviewed journal PLOS ONE, investigated patterns of new HIV diagnoses, HIV-related mortality and HAART use in Canada from 1995 to 2008. Analysis showed that for each 10 per cent increment in HAART coverage, the rate of new HIV diagnoses decreased by eight per cent in B.C., Ontario and Quebec — the three provinces with the largest epidemics.

In British Columbia, the B.C.-pioneered Treatment as Prevention strategy has led to the widespread expansion of HAART coverage. The total number of new HIV diagnoses in the province dropped during the period of the study from 682 in 1995 to 348 in 2008, and the decline continues, with 289 new HIV diagnoses in 2011 despite an increasing number of tests being done.

“The dramatic and sustained decrease in AIDS-related morbidity and mortality and new HIV infections in British Columbia reinforces Treatment as Prevention as a highly effective approach in the fight against HIV/AIDS,” said Dr. Julio Montaner, senior author of the study and director of the BC-CfE.

“The evidence is clear: the time is now for Canada’s leaders to take action and implement Treatment as Prevention as the national strategy in the fight against HIV/AIDS. To do anything less would be a failure in their duty to protect the health of all Canadians.”

The study found that B.C. has also averted more cases of HIV than Ontario and Quebec combined, in part because B.C. is the only province to offer completely free HAART to virtually all HIV-infected individuals. Findings showed that in 2008, the province averted 10.33 cases of HIV per 100,000 population compared to 3.40 and 0.33 averted cases for Ontario and Quebec respectively. In other provinces, HAART coverage is more limited and the number of new HIV diagnoses per year has remained relatively unchanged, even increasing in some jurisdictions.

For instance, the Prairies showed a four-fold increase in rates of new diagnoses over the course of the study period, driven by new infections in Saskatchewan, where each year on average, 200 people are newly diagnosed with HIV infection.

“This study provides compelling evidence that expanded HAART coverage can markedly curb the impact of HIV,” said Dr. Robert Hogg, lead author of the study and director of the Epidemiology and Population Health Program at the BC-CfE. “Immediate access to free HAART should be considered a clinical imperative and a human rights priority.”

Every year, 3,300 men and women in Canada are diagnosed with HIV infection and it is estimated that 65,000 Canadians are now living with HIV. Study findings show that this number could double within the next 15 years if the current rate of new infections continues and treatment is not expanded across Canada.