1 st International Treatment as Prevention (TasP) Workshop Overview
description
Transcript of 1 st International Treatment as Prevention (TasP) Workshop Overview
![Page 1: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/1.jpg)
1st International Treatment as Prevention (TasP) Workshop
Overview
British Columbia Centre for Excellence in HIV/AIDS
Julio Montaner MD, DSc(hon), FRCPC, FCCP, FRSC, OBCDirector, BC-Centre for Excellence on HIV/AIDS, Providence Health Care
Professor of Medicine and Head, Division of AIDS, University of British ColumbiaPast-President, International AIDS Society
![Page 2: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/2.jpg)
Additional Industry Support:
British Columbia Centre for Excellence in HIV/AIDS
![Page 3: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/3.jpg)
Treatment as Preventionvs
ARV Chemoprophylaxis
![Page 4: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/4.jpg)
Integrating HIV prevention and treatment: From slogans to impact
Salomon JA, Hogan DR, Stover J, Stanecki KA, Walker N, et al. (2005). PLoS Med 2(1): e16
Sub Saharan Africa
![Page 5: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/5.jpg)
Treatment as Prevention
Heterosexual Couples
![Page 6: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/6.jpg)
HIV IncidenceH
IV In
cide
nce
(per
100
-per
son-
year
s)2.24
(1.84-2.72)
0.37(0.09-2.04)
HIV Partner Had Started HAARTNo Yes
92%Reduction
Donnell D, et al. Lancet. 2010;375:2092-2098
![Page 7: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/7.jpg)
![Page 8: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/8.jpg)
HPTN 052 (www.hptn.org)
HR = 0.37 or 96.3% reduction in transmission
No difference whether index pt was M or F
Deferred
Immediate
M Cohen et al, NIH Press Conference May 12th 2011. To be presented at IAS-Rome, July 2011
%
![Page 9: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/9.jpg)
HPTN 052 (www.hptn.org)
Extra-Pulmonary TBDeferred : 17 casesImmediate : 3 cases
84% Reduction
Deferred
Immediate
M Cohen et al, NIH Press Conference May 12th 2011. To be presented at IAS-Rome, July 2011
%
![Page 10: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/10.jpg)
Treatment as Prevention
MSM
![Page 11: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/11.jpg)
Determinants of HIV-1 Transmission in MSM:A Combined Clinical, Epidemiological and Phylogenetic Approach
![Page 12: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/12.jpg)
Treatment as Prevention
IDUs
![Page 13: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/13.jpg)
![Page 14: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/14.jpg)
Wood et al, BMJ, 2009
Whiskers represent 95% confidence intervals.
![Page 15: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/15.jpg)
Wood et al, BMJ, 2009
Whiskers represent 95% confidence intervals.
![Page 16: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/16.jpg)
HAART Reduces HIV incidence in IDUs
G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011
HIV Incidence
Community pVL
% Injecting% on HAART
![Page 17: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/17.jpg)
HAART Reduces HIV incidence in IDUs
G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011
• From 1997, HIV incidence decreased by 74% (IRR 0.26, 0.08-0.81) for each log decline in community pVL
• In a separate model, HIV incidence decreased by 5% (3-8%) for each 1% increase in the proportion of HAART treated patients
• For the entire follow up period, for each 1% decline in the proportion of HIV+ patients actively injecting, there was a 3% decline in HIV incidence.
- However, this effect was largely restricted to the pre-HAART era
![Page 18: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/18.jpg)
Tuesday Feb 8th 2011
![Page 19: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/19.jpg)
Treatment as Prevention
Population Based Studies
![Page 20: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/20.jpg)
![Page 21: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/21.jpg)
Community Viral Load and New HIV
Cases in SFco
Das M, Chu PL, Santos G-M, Scheer S, Vittinghoff E, et al. Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco. PLoS ONE 2010 5(6): e11068. doi:10.1371/journal.pone.0011068
n=12,512 unduplicated HIV-positive individuals.
![Page 22: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/22.jpg)
Treatment as Prevention
Next Steps
![Page 23: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/23.jpg)
The authors estimated that only about 19% of HIV infected individuals in the USA have an undetectable HIV-1 RNA level
Spectrum of Engagement in HIV Care - USA
Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6): 793-800
![Page 24: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/24.jpg)
Spectrum of Engagement in HIV Care - USA
Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6): 793-800
![Page 25: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/25.jpg)
![Page 26: 1 st International Treatment as Prevention (TasP) Workshop Overview](https://reader036.fdocuments.net/reader036/viewer/2022062811/56816080550346895dcfa956/html5/thumbnails/26.jpg)
Montaner J, The Lancet, Vol 378: July 16th 2011, pages 208-209