In the absence of treatment, genetic mutations of HIV can lead to more rapid progression to AIDS, highlighting the urgent need for testing and treatment
[Vancouver, BC | July 26, 2018] The BC Centre for Excellence in HIV/AIDS (BC-CfE) and Simon Fraser University (SFU) conducted research in response to reports in Saskatchewan of unusually rapid progression of HIV to AIDS-defining illnesses in the absence of treatment-revealing genetic mutations in HIV strains in that province.
The study, presented today at the 2018 AIDS Conference in Amsterdam and published in the scientific journal AIDS, shows that HIV strains circulating in Saskatchewan have adapted to evade host immune responses. These HIV strains are being commonly transmitted and, if the resulting HIV infections are left untreated, rapid progress to AIDS-related illnesses may happen.
“This is the first molecular epidemiology study of HIV in Saskatchewan and it confirms some of what we have been seeing on the ground,” said Dr. Alex Wong, an infectious disease specialist in Regina with the Saskatchewan Health Authority, researcher at the University of Saskatchewan and an author on the study.
Researchers on the study-from the BC-CfE, SFU and the Public Health Agency of Canada (PHAC), in partnership with Saskatchewan physician-researchers and with funding from the Canadian Institutes of Health Research (CIHR)-were startled at the prevalence of immune resistance mutations. One key mutation was found in more than 80% of Saskatchewan HIV strains, compared with only about 25% of HIV strains found elsewhere in North America. The pervasiveness of such mutations is increasing over time. More than 98% of the HIV sequences collected in Saskatchewan most recently (between 2015 and 2016) harboured at least one major immune resistance mutation.
HIV antiretroviral treatment, however, works equally effectively against immune-resistant HIV strains. In the 2018-19 budget, the Government of Saskatchewan announced an additional $600,000 investment to provide universal drug coverage for HIV medications, including antiretroviral therapy and pre-exposure prophylaxis (PrEP).
“The findings of this study are concerning but the good news is, once people get tested, we can get them on life-saving treatment immediately,” said Dr. Zabrina Brumme, Research Scientist with the BC-CfE, Associate Professor in SFU’s Faculty of Health Sciences and the lead author on the study.”It is critical for individuals to take action to protect their health, get tested for HIV and access HIV care and treatment immediately following a diagnosis.”
The multi-year analysis compared more than 2,300 anonymized HIV sequences from Saskatchewan with data sets from sites across the United States and Canada. Genetic analyses of HIV strains in Saskatchewan showed high levels of clustering-indicating that viruses with similar mutations are being frequently and widely transmitted. Seventy-eight per cent of Saskatchewan HIV strains reside within transmission clusters compared with only 15% of HIV strains found elsewhere in North America.
“Our finding that immune-resistant HIV strains are being commonly transmitted in Saskatchewan means that it is critical we work together to expand access to HIV testing and treatment,” said Dr. Jeffrey Joy, Research Scientist with the BC-CfE and an author on the study.”We know that HIV does not stay confined to geographical clusters-it spreads. We need to work together to make HIV testing routine and stigma-free.”
“The discoveries made in this research project are very important for public health purposes as these empower health professionals to better understand transmission dynamics on how HIV is being spread in Saskatchewan,” said Dr. Paul Sandstrom, Director of PHAC’s National HIV and Retrovirology Laboratory and an author on the study.”This increased understanding will improve the targeting and evaluation of prevention strategies to help stop the spread of the virus.”
This study is significant as HIV incidence rates in Saskatchewan are among the highest in North America, with 2016 rates in some regions more than ten times the national average. Saskatchewan’s HIV epidemic is also unique in that nearly 80% of infected persons self-identify as having Indigenous ancestry.
“These findings add further urgency to addressing the Saskatchewan epidemic, in which infection burden is concentrated among the most marginalized,” said Dr. Julio Montaner, Director of the BC-CfE.”The global scientific consensus is that HIV treatment should be provided immediately upon diagnosis. We support continued expansion of testing and treatment for HIV in Saskatchewan. The BC experience fully supports this approach. Indeed, offering universal access to HIV treatment immediately upon diagnosis has been shown to be a successful and cost-effective Treatment as Prevention¨ strategy, leading to a consistent decline in HIV/AIDS morbidity and mortality, as well as in new HIV cases.”
Dr. Alexandra King, the Inaugural Cameco chair in Indigenous Health at the University of Saskatchewan, further underscored the need to partner with communities, saying:”Given the complex needs of those affected by the epidemic, we need to have a coordinated approach to addressing HIV in Saskatchewan, with community as equal partners.”
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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 Treatment as Prevention¨ (TasP¨) strategy, pioneered by BC-CfE, inspired the ambitious global UNAIDS 90-90-90 to end AIDS as a pandemic by 2030. The BC-CfE is applying TasP¨ to therapeutic areas beyond HIV/AIDS, including viral hepatitis, through Targeted Disease Elimination¨ (TDE). The BC-CfE works in close collaboration with key stakeholders, including government, health authorities, health care providers, academics and the community to reduce disease burden and increase health care sustainability. The BC-CfE Laboratory has provided HIV drug resistance genotyping for virtually all Canadian provinces and territories since 1998, as well as for many countries worldwide.
For more information, please contact:
Caroline Dobuzinskis, BC-CfE Communications Coordinator
Phone: 604-366-6540
Email: cdobuzin@bccfe.ca
Rena Heer
Cell: 604-250-2800
Email: rena.heer@edelman.com
