This commentary was released in the wake of an International Workshop on HIV Treatment as Prevention in Vancouver in 2011. In this editorial Dr. Julio Montaner, the chair of the workshop, argued that in the absence of a cure or a vaccine to HIV, new HIV infections continue to accumulate 30 years into the pandemic. However, over the past 15 years, HIV treatment has prevented progression to AIDS and death for millions of people. The evidence is in: HIV Treatment is Prevention. The challenge remains to optimize the impact of this valuable intervention. Failure to do so is not an option.

Known as the HPTN 052 protocol, this study examined the impact of highly active antiretroviral therapy (HAART) treatment on the transmission of HIV in couples where one partner was HIV positive, and the other HIV negative. The results of HPTN 052 confirmed that the use of HAART decreased HIV transmission by 96%. Additionally, the study showed that starting HAART earlier was associated with more than a 40% reduction in the rate of disease progression. The findings of HPTN 052 confirmed those previously reported by the BC-CfE.

Between 1996 and 2009, the number of individuals receiving highly active antiretroviral therapy (HAART) in British Columbia increased from 837 to 5,413. In the same period of time, the number of new HIV diagnoses fell from 702 to 338 per year. This study shows a strong population-level association between increasing HAART coverage, decreased the amount of virus in the blood, and decreased number of new HIV diagnoses per year. Results support the proposed secondary benefit of HAART to reduce HIV transmission.

This paper explores the potential impact of expanding coverage for HIV treatment with highly active antiretroviral therapy (HAART). The results reinforce previous findings that the individual and public health benefits of expanded HAART coverage are immense. Specifically, increasing the number of people on HAART saves lives, saves money, and decreases the number of new HIV infections.

Given the high direct medical and social costs associated with the HIV, prevention of new transmission is critical for limiting economic burden. In addition to providing therapeutic benefit, HIV treatment has potential to prevent transmission of HIV. The objective in this study was to do an economic evaluation of the economic benefits associated expanding HIV treatment in British Columbia. Results of this study showed that, over 30 years, the expansion of HIV treatment was associated with a net benefit of US$ 900 million. Increasing HIV treatment coverage from 50 to 75% of clinically eligible individuals in British Columbia is a cost-effective strategy based on this model. These cost-effectiveness results are consistent with public health objectives: all individuals who are eligible for an established life-saving treatment should receive it.

Roughly 3 million people worldwide were receiving antiretroviral therapy (ART) at the end of 2007, but an estimated 6.7 million were still in need of treatment and a further 2.7 million became infected with HIV in 2007. Prevention efforts might reduce the spread of HIV, but are unlikely to eliminate the disease. This paper investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination. The study found that universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on the HIV/AIDS epidemic.

Current HIV treatments have been shown to lower the amount of virus in the body (known as the ‘viral load’) to undetectable levels which allows people to live longer. In addition, by lowering the amount of virus in the body, HIV treatment can also reduce the chances of transmitting the virus, making HIV treatment a potentially powerful tool for HIV prevention. By following injection drug users in Vancouver’s Downtown East Side (DTES) who are HIV positive, researchers at the BC-CfE measured their viral loads yearly for more than 10 years. They then compared these viral load measures with the number of new HIV infections in the DTES to determine whether the number of new HIV infections decreased when viral load levels were lower in this community. They found that indeed the number of new HIV infections decreased significantly when the community viral load was lower.

This paper, produced by researchers at the BC-CfE, indicates how expanding highly active antiretroviral therapy (HAART) coverage in British Columbia might decrease the rate of new HIV infection. Different scenarios are outlined, including drug resistance, adherence to HAART, therapeutic guidelines, degree of HAART coverage, and the timing of HAART uptake. Results show that the expansion of HAART lead to substantial reductions in the growth of HIV and related costs. These results provide powerful additional motivation to accelerate the roll out of HAART programs as a means of reducing new HIV infections.

Highly active antiretroviral therapy (HAART), first introduced in 1996, is currently the most effective life-saving HIV treatment and is key for preventing the spread of HIV (therefore, HIV treatment is prevention). This paper by the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE) discusses expanding access to HAART on a global scale, providing the means to curb the spread of HIV/AIDS. As BC-CfE researchers explain in the paper, “expansion of HAART programs could have a major role in the much needed strengthening of the prevention effort.”