February 25, 2015
Deaths from AIDS-related causes have been falling since 1994 in B.C. In that year the rate of such deaths was 19 per 100 people. By 2013 the rate had fallen to three per 100 people. The CfE researchers noted that there were two periods when deaths due to AIDS-related complications were relatively high:
The researchers explained that during the first period, deaths likely peaked because people did not have access to ART or were taking weak regimens.
In the second period, they argue that the reason for the increase in deaths may have been due to the following two factors:
The BC researchers made the following statement:
"Our results strengthen the evidence that programmes that aggressively distribute free ART to infected individuals have great potential to decrease [illness and death] caused by AIDS."
Furthermore, they added:
"Our data support the proposition that expanded access to ART, in the presence of evidence-based guidelines and systems to ensure early HIV diagnosis, timely ART initiation and sustained virological response, can transform AIDS from an epidemic to an endemic disease, and eventually might lead to the elimination of AIDS. However, as no curative therapy exists and lifelong suppressive ART needs high adherence for this effect to be sustained, treatment programmes and related support must be strengthened on a long-term basis."
The continuum between the offer of an HIV test to a person receiving care and treatment and having a continuously low viral load thanks to ART is a long one. This continuum is called the "cascade of care" by researchers. Here are some of the steps in a simplified version of the cascade:
The CfE team, in a separate study, has explored the cascade of HIV care in its province and found that gaps exist. We should point out to readers that, to some degree, such gaps likely exist in other parts of Canada and in other high-income countries. Indeed, the U.S. Centers for Disease Control and Prevention (CDC) has found gaps in the U.S. cascade of HIV care.
The study by the CfE shows that tremendous progress against AIDS has been made but there is still room for improvement. As the researchers stated: "... the number of [new] AIDS cases is still not zero."
The CfE researchers note that there is increasing optimism by policy planners that it may be possible to bring about the "end of AIDS" -- a phrase that has been heard at AIDS conferences in recent years. The researchers made an important statement that clarifies what is possible at least over the next several years:
"Ending AIDS and ending HIV are two different issues, with substantially different levels of complexity. Our report specifically analysed [new cases of AIDS] rather than HIV. Ending AIDS could be achieved with the identification of all HIV-infected individuals in a given jurisdiction before they develop AIDS and intervening with effective treatment on a sustained basis. Ending HIV would imply stopping HIV transmission, which in all likelihood would not be feasible without a cure, a vaccine, or both."
In a commentary to accompany the report from the CfE in the Lancet HIV, former International AIDS Society president Professor Stefano Vella, MD, acknowledges the tremendous progress made against AIDS. He notes that gaining a similar magnitude of progress against the global spread of HIV will be challenging but outlines how such progress against HIV might be achieved. Importantly, he ends his call with these words: "... the HIV epidemic is definitely not over. Let's not leave the job half-done."
Interactive graphics from B.C. Centre for Excellence in HIV/AIDS (scroll down page to view)
Changing the Narrative: Why HIV prevention work in Canada needs to embrace HIV treatment -- Prevention in Focus
Gaps in British Columbia's HIV treatment cascade -- CATIE News
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