A dramatic drop in the number of new HIV infections in British Columbia shows that a treatment-as-prevention strategy is making a difference, says a leading AIDS investigator who is frustrated that other parts of the country haven’t embraced the concept to the same extent.
“The truth is that there is no reason why we should be seeing a steady decrease in HIV new cases in British Columbia and we should not expect to see the same thing in the rest of the country,” said Dr. Julio Montaner, director of the British Columbia Centre for Excellence in HIV-AIDS.
Saskatchewan, in particular, has been struggling with an incremental increase in new cases almost every year since 2004.
In British Columbia, the number of deaths from AIDS since 2005 has steadily declined to 55 in 2010, while the number of people receiving HIV antiretroviral treatment has risen.
New HIV diagnoses fell to a low of 301 in 2010 even as testing for the virus increased, said Dr. Montaner as he revealed previously unpublished figures. In 1996, there were more than 700 new diagnoses and throughout the early 2000s, the number of new HIV diagnoses each year was above 400.
Dr. Montaner is a strong proponent of a treatment-as-prevention model that involves seeking out people at risk for HIV infection, treating those who are infected with antiretroviral drugs, keeping them on treatment and supporting them.
Treatment reduces the amount of virus in the bodily fluids of someone with HIV infection. A clinical trial of 1,763 couples in which one partner had a known HIV infection showed that antiretroviral therapy reduced the risk of heterosexual transmission by 96 per cent. The findings of the HPTN 052 trial, led by a North Carolina researcher, were reported in the New England Journal of Medicine in August.
Because of the trial’s profound implications for the future response to the AIDS epidemic, the magazine Science recently named it the breakthrough of the year for 2011.
Dr. Montaner said this made-in-Canada strategy now has been formally adopted by China, which has requested support to implement it, and the United States has said treatment as prevention will become a pillar of its international program.
His New Year’s resolution, he said, is to make it clear to the rest of Canada that “we are missing the boat.”
“Hello, the rest of the world is running behind it. Science magazine is calling it breakthrough of the year. British Columbia has been leading the charge now for what, five years – going onto six – and we in Canada, we’re happy to just walk away and say that nothing happened. This is the biggest disappointment of the last decade,” he said in an interview.
The Public Health Agency of Canada said Tuesday that no one was available for an interview on the subject.
In Saskatchewan, Jim Myres, director of disease prevention at the Population Health Branch, said there is no question that HIV infection has been an issue in his province, but a four-year strategy and “an aggressive campaign” is underway.
“We’re not calling it seek and treat, but essentially that’s what we’re doing. We’re actually going on reserve with an ID [infectious diseases] clinic and trying to get people to do the tests,” he said. “We’re actually seeing a bit of the numbers decline in our big urban centres, and the numbers out in the rural areas increasing as we implement this strategy.”
In 2009, there were 200 new cases of HIV in Saskatchewan and the figure dropped to 2010 to 172, he said. It’s expected to rise for 2011 because of new efforts to go out and find cases.
“We’ve actually had chiefs come to us and say ‘We want you to come on reserve and do an HIV ID clinic.’ I don’t think that’s done anywhere else in Canada.”
