BACKGROUND: Results of cohort studies and mathematical models have suggested that increased coverage with highly active antiretroviral therapy (HAART) could reduce HIV transmission. We aimed to estimate the association between plasma HIV-1 viral load, HAART coverage, and number of new cases of HIV in the population of a Canadian province. METHODS: We undertook a population-based study of HAART coverage and HIV transmission in British Columbia, Canada. Data for number of HIV tests done and new HIV diagnoses were obtained from the British Columbia Centre for Disease Control. Data for viral load, CD4 cell count, and HAART use were extracted from the British Columbia Centre for Excellence in HIV/AIDS population-based registries. We modelled trends of new HIV-positive tests and number of individuals on HAART using generalised additive models. Poisson log-linear regression models were used to estimate the association between new HIV diagnoses and viral load, year, and number of individuals on HAART. FINDINGS: Between 1996 and 2009, the number of individuals actively receiving HAART increased from 837 to 5413 (547% increase; p=0.002), and the number of new HIV diagnoses fell from 702 to 338 per year (52% decrease; p=0.001). 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). For every 100 additional individuals on HAART, the number of new HIV cases decreased by a factor of 0.97 (95% CI 0.96-0.98), and per 1 log(10) decrease in viral load, the number of new HIV cases decreased by a factor of 0.86 (0.75-0.98). INTERPRETATION: We have shown a strong population-level association between increasing HAART coverage, decreased viral load, and decreased number of new HIV diagnoses per year. Our results support the proposed secondary benefit of HAART used within existing medical guidelines to reduce HIV transmission. FUNDING: Ministry of Health Services and Ministry of Healthy Living and Sport, Province of British Columbia; US National Institute on Drug Abuse; US National Institutes of Health; Canadian Institutes of Health Research. Copyright 2010 Elsevier Ltd. All rights reserved.
BACKGROUND: Results of cohort studies and mathematical models have suggested that increased coverage with highly active antiretroviral therapy (HAART) could reduce HIV transmission. We aimed to estimate the association between plasma HIV-1 viral load, HAART coverage, and number of new cases of HIV in the population of a Canadian province. METHODS: We undertook a population-based study of HAART coverage and HIV transmission in British Columbia, Canada. Data for number of HIV tests done and new HIV diagnoses were obtained from the British Columbia Centre for Disease Control. Data for viral load, CD4 cell count, and HAART use were extracted from the British Columbia Centre for Excellence in HIV/AIDS population-based registries. We modelled trends of new HIV-positive tests and number of individuals on HAART using generalised additive models. Poisson log-linear regression models were used to estimate the association between new HIV diagnoses and viral load, year, and number of individuals on HAART. FINDINGS: Between 1996 and 2009, the number of individuals actively receiving HAART increased from 837 to 5413 (547% increase; p=0.002), and the number of new HIV diagnoses fell from 702 to 338 per year (52% decrease; p=0.001). 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). For every 100 additional individuals on HAART, the number of new HIV cases decreased by a factor of 0.97 (95% CI 0.96-0.98), and per 1 log(10) decrease in viral load, the number of new HIV cases decreased by a factor of 0.86 (0.75-0.98). INTERPRETATION: We have shown a strong population-level association between increasing HAART coverage, decreased viral load, and decreased number of new HIV diagnoses per year. Our results support the proposed secondary benefit of HAART used within existing medical guidelines to reduce HIV transmission. FUNDING: Ministry of Health Services and Ministry of Healthy Living and Sport, Province of British Columbia; US National Institute on Drug Abuse; US National Institutes of Health; Canadian Institutes of Health Research. Copyright 2010 Elsevier Ltd. All rights reserved.
Authors: S Cu-Uvin; A M Caliendo; S Reinert; A Chang; C Juliano-Remollino; T P Flanigan; K H Mayer; C C Carpenter Journal: AIDS Date: 2000-03-10 Impact factor: 4.177
Authors: E Wood; P Braitstein; J S Montaner; M T Schechter; M W Tyndall; M V O'Shaughnessy; R S Hogg Journal: Lancet Date: 2000-06-17 Impact factor: 79.321
Authors: Julio S G Montaner; Robert Hogg; Evan Wood; Thomas Kerr; Mark Tyndall; Adrian R Levy; P Richard Harrigan Journal: Lancet Date: 2006-08-05 Impact factor: 79.321
Authors: Jennifer N Sayles; Jacqueline Rurangirwa; Min Kim; Janni Kinsler; Rangell Oruga; Mike Janson Journal: AIDS Patient Care STDS Date: 2012-07-09 Impact factor: 5.078
Authors: Vladimir Novitsky; Melanie Prague; Sikhulile Moyo; Tendani Gaolathe; Mompati Mmalane; Etienne Kadima Yankinda; Unoda Chakalisa; Refeletswe Lebelonyane; Nealia Khan; Kathleen M Powis; Erik Widenfelt; Simani Gaseitsiwe; Scott L Dryden-Peterson; Molly Pretorius Holme; Victor De Gruttola; Pam Bachanas; Joseph Makhema; Shahin Lockman; M Essex Journal: AIDS Res Hum Retroviruses Date: 2018-01-17 Impact factor: 2.205
Authors: Sarah Ickowicz; Evan Wood; Huiru Dong; Paul Nguyen; Will Small; Thomas Kerr; Julio S G Montaner; M-J Milloy Journal: Drug Alcohol Depend Date: 2017-08-10 Impact factor: 4.492
Authors: Adam W Carrico; Peter W Hunt; Torsten B Neilands; Samantha E Dilworth; Jeffrey N Martin; Steven G Deeks; Elise D Riley Journal: J Acquir Immune Defic Syndr Date: 2019-01-01 Impact factor: 3.731
Authors: Bohdan Nosyk; Jeong E Min; Guillaume Colley; Viviane D Lima; Benita Yip; M-J S Milloy; Evan Wood; Julio S G Montaner Journal: AIDS Date: 2015-05-15 Impact factor: 4.177