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Providing highly active antiretroviral therapy (HAART) to people living with HIV is strongly associated with population-level decreases in viral load and declines in annual new HIV diagnoses, according to research published ahead of the 18th International AIDS Conference in Vienna."The more people you have on treatment, the less people become infected," said lead author Dr. Julio Montaner, president of the International AIDS Society. "We need to step up the role of treatment so it can reshape the curve so the epidemic can contract rather than constantly expand."
As free and easily accessible HAART coverage was expanded across British Columbia, the level of HIV in treated patients' blood, semen, and vaginal secretions became virtually undetectable, said Montaner. That greatly reduced their risk of infecting sex partners, he said.
Montaner and colleagues at the B.C. Center for Excellence in HIV/AIDS examined HAART coverage and HIV transmission in British Columbia between 1996 and 2009. During that time, the number of people with HIV receiving free treatment rose from 837 to 5,413, while the number of new HIV diagnoses fell 52 percent, from 702 per year to 338. In contrast, other STDs such as chlamydia, gonorrhea, and syphilis grew, suggesting there had been no increase in safe sex.
"The overall correlation between number of individuals on HAART and number of individuals newly testing positive for HIV per year was -0.89 (p<0.0001)," wrote Montaner and colleagues. "For every 100 additional individuals on HAART, the number of new HIV cases decreased by a factor of 0.97 (95 percent confidence interval 0.96-0.98). For each 1 log10 decrease in viral load at the population level, the number of new HIV cases decreased by a factor of 0.86 (0.75-0.98)."
"All of the above occurred as a result of us being able to drastically reduce the amount of viral load in the community," Montaner said. "Treatment shuts down the virus' ability to replicate itself, and it becomes undetectable."
"We estimate that probably one-third of all infections could be avoided simply by treating all of those who should be treated," said Dr. Bernhard Schwartlander of UNAIDS. But other prevention tools are still important, he and Montaner emphasized.
The full report, "Association of Highly Active Antiretroviral Therapy Coverage, Population Viral Load, and Yearly New HIV Diagnoses in British Columbia, Canada: A Population-Based Study," was published in the Lancet (2010;doi:10.1016/S0140-6736(10)60936-1).
The Friends of AIDS Foundation is dedicated to enhancing the quality of life for HIV positive individuals and empowering people to make healthy choices to prevent the spread of the HIV virus. To learn more about The Friends of AIDS Foundation, please visit: http://www.friendsofaids.org.
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