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Review
. 2020 Apr;17(2):77-87.
doi: 10.1007/s11904-020-00482-6.

The Impact of Treatment as Prevention on the HIV Epidemic in British Columbia, Canada

Viviane D Lima  1   2 , Zabrina L Brumme  1   3 , Chanson Brumme  1   2 , Paul Sereda  1 , Mel Krajden  4   5 , Jason Wong  4   6 , Silvia A Guillemi  1   7 , Bonnie Henry  8 , Robert S Hogg  1   3 , Rolando Barrios  1   9 , Julio S G Montaner  10   11 ; STOP HIV/AIDS Study Group
Affiliations
Review

The Impact of Treatment as Prevention on the HIV Epidemic in British Columbia, Canada

Viviane D Lima et al. Curr HIV/AIDS Rep. 2020 Apr.

Abstract

Purpose of review: This study proposes to describe the impact of a publicly funded Treatment as Prevention (TasP) strategy in British Columbia (BC), Canada, in decreasing the individual and public health impact of the HIV/AIDS Epidemic.

Recent findings: In BC, TasP has been associated with a steady decline in HIV-related morbidity and mortality. At the same time, a demographic transition was observed among people living with HIV (PLWH), with the majority of those on antiretroviral treatment (ART) now ≥ 50 years of age, living with at least one comorbidity, and dying from age-associated comorbidities. We also documented a progressive increase in the proportion of viral load suppression as a result of ART expansion. While the pre-ART CD4 T cell count has increased steadily in recent years, there is still a large proportion of PLWH being diagnosed in later stages of HIV infection. New HIV diagnoses have been rapidly declining, however to a lesser extent among men who have sex with men (MSM), and BC is currently experiencing an increase in infectious syphilis cases in this population. These facts reinforce the effectiveness of TasP in decreasing HIV transmission, but at the same time, it highlights the need for further innovation to enhance the control of HIV and syphilis among MSM. This study supports the development of new approaches that address existing gaps in the TasP strategy in BC, and the future health needs of PLWH.

Keywords: British Columbia; Canada; HIV epidemic; TasP; Treatment as prevention.

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Conflict of interest statement

Conflict of interest

MK has research and contracts paid to his institution from Roche and Hologic unrelated to this work. Institutional grants have been provided to JSGM by Gilead, Johnson & Johnson, Merck, ViiV Healthcare. The remaining authors do not have conflicts to declare.

Figures

Figure 1.
Figure 1.
Surveillance indicators for HIV and infectious syphilis in British Columbia, Canada, by calendar year.
Figure 2.
Figure 2.
Distribution of the number of AIDS-defining illnesses (A) and death cases due to HIV/AIDS and other causes (B) in British Columbia, Canada, by calendar year.
Figure 3.
Figure 3.
Distribution of the age of participants of the Drug Treatment Program in British Columbia, Canada, by calendar year.
Figure 4.
Figure 4.
Distribution of the number of age-associated comorbid conditions by age in British Columbia, Canada, in 2016.
Figure 5.
Figure 5.
Distribution of age-associated comorbid conditions in British Columbia, Canada, in 2016.
Figure 6.
Figure 6.
Distribution of pre-ART CD4 T cell count in British Columbia, Canada, by calendar year of ART initiation
Figure 7.
Figure 7.
Distribution of the highest participant’s viral load in British Columbia, Canada, by calendar year.
Figure 8.
Figure 8.
Progress in the UN 90-90-90 Target in British Columbia, by calendar year.
See this image and copyright information in PMC

References

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      This article provides a summary of key studies that showed unequivocal evidence of the efficacy of TasP in prevention onward HIV transmission.

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