"Closing the Implementation Gap to Stop HIV/AIDS"
Dr. Julio Montaner
March 18, 2010
While an outright cure or a preventive vaccine for HIV/AIDS remain elusive, remarkable advances in HIV treatment have been achieved over the past two decades. Most significant among these advances is the development of highly active antiretroviral therapy (HAART). HAART can fully suppress HIV replication and therefore render the number of viral copies present in a patient’s blood undetectable, as measured by commercially available plasma viral load assays. Since 1996, the use of HAART dramatically reduced HIV/AIDS related morbidity and mortality.
More recently, we have provided evidence that the viral load suppression achieved by HAART has a substantial impact on the transmission of HIV. Specifically, in August 2006, we published a viewpoint article in The Lancet that outlined the expansion of HAART coverage to all those in medical need as a key strategy to dramatically reduce HIV transmission to those at risk (Montaner et al, The Lancet, 2006). We further proposed that HAART expansion in addition to preventing AIDS morbidity and mortality, would become cost-averting as it would virtually eliminate vertical transmission of HIV, and dramatically reduce HIV transmission by all routes (Lima et al, JID, 2008). More recently, we published the first study demonstrating the role of HAART in the prevention of HIV transmission in injection drug users in the Downtown Eastside of Vancouver (Wood et al, British Medical Journal, 2009). “Treatment as Prevention” has now gained the support of the international community, including investigators based at the World Health Organization (WHO) (Granich et al, The Lancet, 2009).
The expansion of HAART underway in British Columbia, Canada since 2004, aims to increase HAART coverage among eligible HIV-positive individuals. Ongoing monitoring of the impact of such HAART expansion on HIV incidence, as well as AIDS morbidity and mortality over several years will be critical to inform the ongoing debate surrounding the potential effectiveness of treatment as prevention strategies. We have entitled this initiative Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS).
This work is supported in part by the Provincial Government, and an Avant Garde Award to Dr J Montaner, from the National Institute for Drug Abuse at the NIH.
1. To gain a comprehensive understanding of impact of antiretroviral therapy on HIV related morbidity and mortality.
2. To explore the potential synergy between treatment and prevention.
3. To characterize current gaps in the therapeutic success of antiretroviral therapy.
4. To highlight the role of combination prevention to decrease AIDS related morbidity, mortality and HIV transmission.