slide 1 of 42 ias–usa au edited final: 03-18-13 julio montaner, md professor of medicine, and...
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IAS–USAAU EDITED FINAL: 03-18-13
Julio Montaner, MDProfessor of Medicine, and Head, Div. of AIDS, University of British Columbia
Director, BC-Centre for Excellence in HIV/AIDS at Providence Health CarePast President, International AIDS Society (2008-2010)
Treatment as Prevention:The Key to an AIDS-Free Generation
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January 2004
Summer of 1996
Year
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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Slide 3 of 44
Pre-HAART CD4 counts in BCby year, 2003-2012
Lima et al, in preparation, 2013
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Adherence to HAART in BCby year, 1996-2012
Lima et al, in preparation, 2013
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Slide 5 of 44
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Slide 6 of 44HIV Drug Resistance in BC
by year, 1996-2012
Lima et al, in preparation, 2013
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BC: All Cause Mortality (#)
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
Freq
uenc
y
> 90% Decrease in All Cause Mortality among HIV Infected Individuals in BC since 1996
Montaner et al, TasP Workshop, April 2012
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Slide 8 of 44AIDS New Cases for BC by year, 1996-2011
Lima et al, in preparation, 2013
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BC: HIV Prevalence and TB Incidence
James Johnston, WIP, May 2013
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Slide 10 of 44HAART Use & New HIV Diagnoses for BC by year, 1996-2012
Lima et al, in preparation, 2013
HIV Incidence
Active on HAART
New HIV Diagnoses (All)
New HIV Diagnoses (Ever IDU)
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Slide 11 of 44Annual rates (per 100,000 population) for new cases of genital chlamydia, genital gonorrhea, infectious syphilis and
hepatitis C, 1996-2012
Lima et al, in preparation, 2013
Hepatitis C Syphilis
GonorrheaChlamydia
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Programmatic Compliance Score Assesses the impact of non-
compliance with HIV treatment guidelines on all-cause mortality
PCS components include: Baseline CD4 > 200/mm3 Three CD4 in 1st year Three VL in 1st year Baseline resistance Recommended HAART Undetectable pVL at 9 months
Failure to meet a given component add one to the score
PCS predicts mortality
Lima et al. PLoS ONE 7(11): e47859. 2012
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PCS in BC 2000 to 2011
Lima et al, in preparation, 2013
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R Lester, M Morshed, and M Gilbert, BCMJ, May 4th 2013
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red = drug resistance at
baselinenode size = date
of baseline sample
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HIV Diagnoses by Region and YearPublic Health Agency of Canada
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Link4th Intl HIV TREATMANT AS PREVENTION Workshop
April 1st to 4th 2014 - Vancouver, BC, Canada.
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In Collaboration with PHC, VCHA, NHA, PHSA, Community, and MoH