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| |  Study Shows Introduction of HAART Has Halved New HIV Diagnoses Since 1996 VIENNA -- July 20, 2010 -- A Canadian study presented at the 18th International AIDS Conference and published online in The Lancet shows that the annual number of new HIV diagnoses has more than halved since the introduction of highly active antiretroviral therapy (HAART) in 1996. For every 100 patients placed on HAART, new HIV diagnoses fell by 3%. Julio Montaner, MD, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, and colleagues undertook a population-based study of HAART coverage and HIV transmission in British Columbia. Data for number of HIV tests done and new HIV diagnoses were obtained from the British Columbia Centre for Disease Control. Data for viral load, CD4 cell count, and HAART use were extracted from the British Columbia Centre for Excellence in HIV/AIDS population-based registries. The authors found that, between 1996 and 2009, the number of individuals actively receiving HAART increased from 837 to 5,413 (547% increase), and the number of new HIV diagnoses fell from 702 to 338 per year (52% decrease). There was a strong association between increasing number of patients on HAART and decreasing number of new diagnoses. For every 100 additional individuals on HAART, the number of new HIV cases decreased by 3%. Mean HIV viral load concentrations also decreased markedly and were linked to a decrease in new HIV cases. New HIV diagnoses fell by 30% in 1996-2000, remained fairly stable in 2001-2003 (2% reduction), and decreased by 17% in 2004-2009. HAART use expanded substantially in 1996-2000 and 2004-09, and remained stable in 2001-2003, driven by evolving contemporary treatment guidelines. The authors showed that the decrease in new HIV diagnoses per year was driven to a large extent by the subset of individuals with documented history of injecting drug use, in whom new HIV diagnoses per year decreased by nearly 50% during the study. Rates of sexually transmitted infections and hepatitis C infection increased during the last 15 years of the study, which implies that these findings cannot be accounted for by decreasing sexual HIV risk behaviour. "Our results show a strong and significant association between increased HAART coverage, reduced community viral load, and decreased number of new HIV diagnoses per year in the population of a Canadian province," the authors wrote. In an accompanying comment, Franco Maggiolo, MD, and Sebastiano Leone, MD, Division of Infectious Diseases, Ospedali Riuniti, Bergamo, Italy, said: "HAART might prove effective within other risk populations provided that the source individuals are thoroughly identified and correctly treated. Therefore we must couple the use of antiretrovirals with risk-reduction strategies, and identify infected individuals through information or education interventions that favour individual access to screening programmes. Integrated experiences that provide voluntary routine HIV testing and rapid entry into care, such as those recently implemented in Washington, DC, would tell us whether HAART can succeed as an epidemic control measure." "While waiting for an effective vaccine, experiences such as those reported today should be strongly considered by clinicians, national and international agencies, policy makers, and all parties involved in the development of treatment guidelines, because the population-based dimension of HAART might play an important part in the future control of the HIV epidemic," they concluded.
SOURCE: The Lancet
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