The Impact of Treatment as Prevention on the HIV Epidemic in British Columbia, Canada

Curr HIV/AIDS Rep. 2020 Apr;17(2):77-87. doi: 10.1007/s11904-020-00482-6.

Abstract

Purpose of review: This study proposes to describe the impact of a publicly funded Treatment as Prevention (TasP) strategy in British Columbia (BC), Canada, in decreasing the individual and public health impact of the HIV/AIDS Epidemic.

Recent findings: In BC, TasP has been associated with a steady decline in HIV-related morbidity and mortality. At the same time, a demographic transition was observed among people living with HIV (PLWH), with the majority of those on antiretroviral treatment (ART) now ≥ 50 years of age, living with at least one comorbidity, and dying from age-associated comorbidities. We also documented a progressive increase in the proportion of viral load suppression as a result of ART expansion. While the pre-ART CD4 T cell count has increased steadily in recent years, there is still a large proportion of PLWH being diagnosed in later stages of HIV infection. New HIV diagnoses have been rapidly declining, however to a lesser extent among men who have sex with men (MSM), and BC is currently experiencing an increase in infectious syphilis cases in this population. These facts reinforce the effectiveness of TasP in decreasing HIV transmission, but at the same time, it highlights the need for further innovation to enhance the control of HIV and syphilis among MSM. This study supports the development of new approaches that address existing gaps in the TasP strategy in BC, and the future health needs of PLWH.

Keywords: British Columbia; Canada; HIV epidemic; TasP; Treatment as prevention.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acquired Immunodeficiency Syndrome / diagnosis
  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Acquired Immunodeficiency Syndrome / epidemiology
  • Acquired Immunodeficiency Syndrome / prevention & control*
  • Adult
  • Anti-Retroviral Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / methods*
  • British Columbia / epidemiology
  • CD4 Lymphocyte Count
  • Female
  • Government Programs / methods
  • Homosexuality, Male / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Preventive Health Services / methods*
  • Sexual and Gender Minorities / statistics & numerical data
  • Viral Load / drug effects

Substances

  • Anti-Retroviral Agents