This document summarizes the impact of antiretroviral treatment (HAART/ART) on HIV/AIDS in British Columbia, Canada from the 1990s onwards. Key points include: - The introduction of HAART in the late 1990s led to sharp declines in AIDS-related deaths and increases in life expectancy for those with HIV in BC. - Expanded access to ART through evolving treatment guidelines in BC was associated with decreases in new HIV diagnoses, AIDS cases, and all-cause mortality in the province. - Combination prevention approaches including expanded ART access have helped control the HIV epidemic in BC and provide a model for other regions seeking to curb new infections through Treatment as Prevention.

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Data Effect: April 17, 2013
Irene Day, Director of Operations
BC Centre for Excellence in HIV/AIDS
Dr Robert Hogg, Director Epidemiology & Population Health
BC Centre for Excellence in HIV/AIDS
Treatment as Prevention:
THE KEY TO AN AIDS FREE GENERATION
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Vancouver 1996
“One World One Hope”
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Impact of HAART in BC-CfE
0
20
40
60
80
100
120
140
1993-94 1995-96 1997-98 1999-00 2001-02 2003-04
Death Rate per 1000
0
5
10
15
20
25
30
35
1993-94 1995-96 1997-98 1999-00 2001-02 2003-04
Life Expectancy at age 20
Modified from Hogg et al, Lancet. 20093

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New HIV and Syphilis in BC
BC-CDC, 20054

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HAART stops HIV replication

HIV load falls to undetectable levels in plasma
as well as in sexual fluids

Sharp reduction in HIV transmission
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The BC Experience
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January 2004
Summer of 1996
Summer of 2000
Phase I Phase II Phase III
Montaner et al, Lancet, 2010
Increasing HAART Coverage within
Evolving Guidelines in BC
N = 7492 by the
end of 2011
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8. BC: AIDS cases Diagnosed
Rate per 100K
> 80% Decrease in AIDS
case report rate in BC
since the pre cART era
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BC: All Cause Mortality (#)
All Cause Mortality in BC
0
50
100
150
200
250
300
350
400
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Years
Frequency
Montaner et al, TasP Workshop, April 2012
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10. Increasing HAART Coverage within Evolving
Guidelines in BC - Impact on New Diagnoses
51 48
301 289
Down to 248
in 2012
Updated from Montaner et al, Lancet, 2010, & TasP-Workshop, Vancouver 201210

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Hepatitis C, 1999-2008 Syphilis, 1999-2008
Chlamydia, 1999-2008 Gonorrhea, 1999-2008
• BC
x Canada
• BC
x Canada
• BC
x Canada
• BC
x Canada
2004
2004 2004
2004
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Let’s talk about $$$
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13. Granich et al
Expanding ART for Treatment & Prevention of HIV
Estimated Cost and Cost-Effectiveness
South Africa, 2011-2050
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HIV Testing
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Cascade of Care

16. HIV Diagnoses by Region and Year
Public Health Agency of Canada
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New HIV Diagnoses among First Nations in BC
BC CDC, 1995–2011

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The Honourable Minister of Health, Kevin Falcon
announces the launch of the STOP HIV & AIDS in BC Pilots

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Treatment 2.0:
A new prevention-
treatment paradigm in
the global response to
HIV/AIDS
UNGASS
New York, 9 June 2010
The role of antiretroviral treatment in
stopping new infections and how it can be
effectively used as part of combination
HIV prevention approaches must be
further explored, as shown by Dr. Julio
Montaner, President of the International
AIDS Society.
Michel Sidibé
Executive Director, UNAIDS
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21. PS: By the end of 2013, PEPFAR
will directly support more than 6 M
people on HAART– 2M more than
previously targeted.
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"To cut new infections in
half, we'll have to heed Julio
Montaner's years of pleas to
implement Treatment as
Prevention and implement
combination prevention
programs. We can save a lot
of lives if all this is done..."
President Clinton
Washington AIDS Conference
July 2012
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What’s Next?
HIV/AIDS
Viral Hepatitis Addiction

25. Supported by $48M (+ARV Drugs) 4 year award from the MoH, Gov of British Columbia, $2.5M 5 year
Avant-Garde Award (No 1DP1DA026182-01) from the National Institute for Drug Abuse (NIDA) at the NIH,
$110K Knowledge Translation Award from CIHR, and grants from Merck, Gilead, ViiV and BMS
In collaboration with PHC,
VCHA, NHA, PHSA,
Community, and MoH
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