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B.C. treatment as prevention strategy gains ground on HIV/AIDS

British Columbia Health Minister Margaret MacDiarmid, right, is given a demonstration by research assistants Jeremy Taylor, second left, and Carmond Ng, hidden at left, in the lab at the B.C. Centre for Excellence in HIV/AIDS before announcing $19.9 million in annual funding for a program to combat the disease in Vancouver, B.C., on Friday November 30, 2012. Treatment as prevention, or TasP for short, is a strategy pioneered in B.C. which has now been adopted by a number of countries around the world.

Darryl Dyck/The Canadian Press

The number of people becoming newly infected with HIV and those dying of AIDS-related causes have both plummeted in British Columbia, thanks largely to the widespread use of antiretrovirals.

Only 84 new cases were diagnosed in the province in 2013, down from 253 in 1997; that's a 67-per-cent drop. The number of AIDS-related deaths fell to 44 from 241 in the same period, an 82-per-cent reduction.

"What the numbers tell us is that our approach – treatment as prevention – is working by minimizing mortality, morbidity and HIV transmission," Viviane Dias Lima, senior statistician at the B.C. Centre for Excellence in HIV/AIDS (BC-CfE), said in an interview.

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The findings are published in Friday's edition of the medical journal, The Lancet.

Treatment as prevention, or TasP for short, is a strategy pioneered in B.C. which has now been adopted by a number of countries around the world.

The concept is that by diagnosing HIV early, with near-universal testing, then treating aggressively with cocktails of antiretrovirals, the amount of virus circulating in a person's body can be suppressed to the point of being undetectable. This, in turn, dramatically decreases the likelihood of spreading HIV (even if an infected person does not practise safer sex), and it improves longevity and quality of life by reducing HIV-related symptoms.

Antiretroviral therapy – using cocktails of drugs to keep the AIDS virus from replicating – was introduced widely in 1996, and it has dramatically changed the lives of the HIV-positive, as the new numbers demonstrate.

In 1996, there were 252 deaths among the HIV-positive population, 241 of whom died of AIDS-related causes. That's 96 per cent. By contrast, in 2013, there were 218 deaths among the HIV-positive, but only 44 were AIDS-related. That's 20 per cent.

"This is an aging population and they are no longer dying of AIDS-defining illnesses, but of heart disease, cancer and respiratory illnesses, just like everyone else," Dr. Lima said.

While the life expectancy of people with HIV/AIDS is now approaching that of the general population, one of the unknowns is whether HIV infection, which attacks the immune system, is accelerating the aging process.

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"That's the question everyone is asking and we're going to do a study to try and find out," Dr. Lima said.

There is also evidence that antiretrovirals, while extending life, can damage the heart and other internal organs.

Julio Montaner, director of the BC-CfE, said the new B.C. numbers are encouraging and demonstrate again that the "treatment-as-prevention experience provides a road map for global HIV/AIDS control and, eventually, the elimination of the pandemic." The TasP strategy was adopted by B.C. in 2006, but other provinces and territories have been slow to follow suit.

However, TasP is a cornerstone of UNAIDS' ambitious 90-90-90 target, a three-pronged plan that aims to have 90 per cent of people who are infected with HIV/AIDS aware of their status by 2020; 90 per cent of those who know their status being treated with antiretrovirals; and 90 per cent of those in treatment having undectable levels of the virus in their body so they cannot infect others.

If those targets are met, it is believed that transmission of HIV can be stopped within a generation, by the year 2030.

An estimated 65,000 people in Canada are living with HIV/AIDS. In 2012, the most recent year for which there are detailed data, there were 2,062 new cases, the lowest number since reporting began in 1985.

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Worldwide, an estimated 35 million people are living with HIV/AIDS.

Editor's note: Between 1997 and 2013, British Columbia has had an 82-per-cent reduction in AIDS-related deaths. An earlier version of this story gave an incorrect percentage.

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About the Author
Public health reporter

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books.André has received much acclaim for his writing. More

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