Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study

Abstract

Background Cohort studies and mathematical models have suggested that expanded coverage with highly active antiretroviral therapy (HAART) could decrease HIV transmission. This study focuses on the HIV epidemic, stratified by injection drug use, in the province of British Columbia, Canada, and seeks to estimate the association between plasma HIV-1-viral load, HAART coverage and number of new cases of HIV at the population-level. Methods HAART use, plasma HIV-1-viral level determinations, and rates of reportable sexually transmitted infections, including HIV, are all recorded in province-wide registries allowing for temporal comparisons of these parameters. Trends of new HIV positive tests and number of individuals on HAART were modeled using generalized additive models. Poisson log-linear regression models were used to estimate the association between the outcome new HIV positive tests (per 100 population) and the covariates viral load (log10 transformed), year, and number of individuals on HAART. Conclusions Our results demonstrate a strong association at the population-level between increasing levels of HAART coverage, decreased viral load and decreased new HIV diagnoses/year, against a background of increased HIV testing and increased rates of other STIs in the province. Our results support the proposed secondary benefit of HAART, used within current medical guidelines, on HIV transmission at a population level.

Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

“…HPTN 052 confirmed the results of observational and epidemiological [18][19][20][21] and modelling studies [22][23][24] that earlier ART reduces the sexual transmission of HIV. 6 The findings created hope that elimination of new HIV infections was possible and had a galvanising effect on health authorities, such as the US President's Emergency Plan for AIDS Relief (PEPFAR) and WHO.…”

Tuberculosis in HIV-infected persons in British Columbia during the HAART era

“…Description of HIV prevalence estimates in BC have been published elsewhere. 15 The BC-CfE's HAART guidelines have remained consistent with those of the IAS-USA since 1996. 16,17 Ethical approval for this study was received from the University of British Columbia main campus and St. Paul's Hospital site.…”

Dilemma of concepts and strategies for the prevention of spread of HIV in relation to human behavior, law and human rights

“…The same holds true regarding social and economic circumstances of PLWH (Armstrong and del Rio, 2011). However, several studies showing positive effects from applying TASP (Montaner et al, 2010) must be thoroughly checked against other data. For example, one study showed persistent genital HIV levels in women receiving ART although HI-VL in plasma was undetectable (Cu-Uvin et al, 2010).…”