Professor Julio Montaner

Intersection between Faith and Science

Transcript

1. Julio Montaner, MD Professor  of  Medicine,  and  Head,  Div.  of  AIDS,  University  of  Bri:sh  Columbia   Director,  BC-­‐Centre  for  Excellence  in  HIV/AIDS  -­‐  Providence  Health  Care   UNAIDS  Special  Advisor  on  HIV  Therapeu:cs   Treatment as Prevention or HAART as the Key to End HIV and AIDS AU EDITED FINAL: 03-18-13 CATHOLIC HIV AND AIDS PRE-CONFERENCE 2014 18-20 July 2014
2. 0 5 10 15 20 25 30 35 40 82 84 86 88 90 92 94 Year Deaths per 100,000 Population Unintentional injury Cancer Heart disease Suicide HIV infection Homicide Chronic liver disease Stroke Diabetes USA - Trends in Annual Rates of Death Ages 25 to 44
3. Vancouver 1996 “One World One Hope”
4. Impact of HAART in BC-CfE 0 20 40 60 80 100 120 140 1993-94 1995-96 1997-98 1999-00 2001-02 2003-04 Death Rate per 1000 0 5 10 15 20 25 30 35 1993-94 1995-96 1997-98 1999-00 2001-02 2003-04 Life Expectancy at age 20 Modified from Hogg et al, Lancet. 2009
6. HAART stops HIV replication ↓ HIV load falls to undetectable levels in plasma as well as in sexual fluids ↓ Sharp reduction in HIV transmission
7. January 2004 Summer of 1996 Year Summer of 2000 Phase I Phase II Phase III Montaner et al, Lancet, 2010 Increasing HAART Coverage within Evolving Guidelines in BC
8. 0   100   200   300   400   500   600   700   800   Year    of      AIDS    Defining      Illness         Poten=ally  ADD  (ABOVE  +   Diagn  found  in  Causes  of   Deaths)   Current  Repor=ng  Process   Poten=ally  ADD  (ABOVE+   Diagn  with    Ambiguous   Descriptn)   Montaner et al, 2014 New AIDS Cases Diagnosed by Year British Columbia - 1983 to 2013
9. BC: All Cause Mortality (#) All  Cause  Mortality  in  BC 0 50 100 150 200 250 300 350 400 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Years Frequency Montaner et al, PLOS One, Feb 12th 2014
10. 1 1 HIV+  Birth   VERTICAL TRANSMISSION - BC
11.  HIV  New  Cases  &  HAART  Use  in  BC   Montaner  et  al,  Interna:onal  AIDS  Conference,  2014,  Poster  #  TUPE203  
12. HR = 96.3% reduction in transmission No difference whether index pt was M or F Deferred Immediate % HPTN 052: Immediate vs Delayed ART in Sero-discordant Couples Cohen MS, et al. IAS 2011. Abst MOAX0102 Cohen MS, et al. N Engl J Med. 2011
14. Year  over  year   reduc:on  associated   with  every  10%   increase  in  coverage   Mills  et  al.  TasP  Workshop,   Vancouver  2014   Na:on-­‐wide   evalua:on  of   ART  Impact  in   Rwanda  
15. Granich et al Lives Saved (x 1,000) U$A Billions
16. When to start: Potential scenarios     Recommended Since 2002 CD4  ≤  200         CD4  ≤  350   +         CD4  ≤  350   +     Expanded  CD4   independent   condi6ons               CD4  ≤  500                        Test                          &                    Treat   All  HIV+   Estimated millions of people eligible for ART in lower & middle-income countries in 2011 11 15 23 >25 32 1 2 3 4 5   ART  regardless  of   CD4s  for:   •  HIV-­‐SD    couples   •  TB/HIV     •  HBV/HIV   •  Pregnant  women   •  Children  ≤  5yo     Modified  from  Meg  Doherty,  et  al.  3rd  Interna:onal  TasP  Workshop,  Vancouver  2013  
17. Doherty et al. Curr Opin HIV AIDS, 2013, 8: 528-534
18. Treatment 2.0: A new prevention- treatment paradigm in the global response to HIV/AIDS - UNGASS New York - 9 June 2010
19. Few could have imagined that we’d be talking about the real possibility of an AIDS-free generation. But that’s what we’re talking about…make no mistake, we are going to win this fight. President Obama, December 1, 2011 PS: By the end of 2013, PEPFAR will directly support more than 6 M people on HAART– 2M more than previously targeted.
20.   B.C.’s  Treatment  as  Preven:on  strategy     adopted  as  na:onal  HIV/AIDS  policy     February  2010:  UNAIDS   February  2011:  China   Dec  2011:  USA   October  2013:  France   October  2013:  Brazil   February  2014:  Spain   February  2014:  Panama   March  2014:  Sierra  Leone     25
22. AIDS  2015  -­‐  The  8TH  IAS  Conference  on  HIV  Pathogenesis,   Treatment  and  Preven=on  -­‐  Vancouver,  July  2015  
23. Thank  You