BC Centre for Excellence in HIV/AIDS study reveals Treatment as Prevention combined with targeted Pre-Exposure Prophylaxis can stop HIV/AIDS

published on July 18, 2024

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: 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. 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.
-- Dr. Julio Montaner, BC-CfE Executive Director and Physician-in-Chief

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.

For more information, please contact:
Ian Noble: ian@noblepr.ca

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BC Centre for Excellence in HIV/AIDS study reveals Treatment as Prevention combined with targeted Pre-Exposure Prophylaxis can stop HIV/AIDS

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