1. 1 st International Treatment as Prevention (TasP) Workshop Overview British Columbia Centre for Excellence in HIV/AIDS Julio Montaner MD, DSc(hon), FRCPC, FCCP, FRSC, OBC Director, BC-Centre for Excellence on HIV/AIDS, Providence Health Care Professor of Medicine and Head, Division of AIDS, University of British Columbia Past-President, International AIDS Society

2. Additional Industry Support: British Columbia Centre for Excellence in HIV/AIDS

3. Treatment as Prevention vs ARV Chemoprophylaxis

4. Integrating HIV prevention and treatment: From slogans to impact Salomon JA, Hogan DR, Stover J, Stanecki KA, Walker N, et al. (2005). PLoS Med 2(1): e16 Sub Saharan Africa

5. Treatment as Prevention Heterosexual Couples

6. HIV Incidence (per 100-person-years) 2.24 (1.84-2.72) 0.37 (0.09-2.04) HIV Partner Had Started HAART NoYes 92% Reduction Donnell D, et al. Lancet. 2010;375:2092-2098

8. HPTN 052 (www.hptn.org) HR = 0.37 or 96.3% reduction in transmission No difference whether index pt was M or F Deferred Immediate M Cohen et al, NIH Press Conference May 12 th 2011. To be presented at IAS-Rome, July 2011 %

9. HPTN 052 (www.hptn.org) Extra-Pulmonary TB Deferred : 17 cases Immediate : 3 cases 84% Reduction Deferred Immediate M Cohen et al, NIH Press Conference May 12 th 2011. To be presented at IAS-Rome, July 2011 %

10. Treatment as Prevention MSM

11. Determinants of HIV-1 Transmission in MSM: A Combined Clinical, Epidemiological and Phylogenetic Approach

12. Treatment as Prevention IDUs

14. Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.

15. Wood et al, BMJ, 2009 Whiskers represent 95% confidence intervals.

16. HAART Reduces HIV incidence in IDUs G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011 HIV Incidence Community pVL % Injecting % on HAART

17. HAART Reduces HIV incidence in IDUs G Kirk, …, D Vlahov for the Alive Cohort, CROI 2011 From 1997, HIV incidence decreased by 74% (IRR 0.26, 0.08-0.81) for each log decline in community pVL In a separate model, HIV incidence decreased by 5% (3-8%) for each 1% increase in the proportion of HAART treated patients For the entire follow up period, for each 1% decline in the proportion of HIV+ patients actively injecting, there was a 3% decline in HIV incidence. - However, this effect was largely restricted to the pre-HAART era

18. Tuesday Feb 8 th 2011

19. Treatment as Prevention Population Based Studies

21. Community Viral Load and New HIV Cases in SFco Das M, Chu PL, Santos G-M, Scheer S, Vittinghoff E, et al. Decreases in Community Viral Load Are Accompanied by Reductions in New HIV Infections in San Francisco. PLoS ONE 2010 5(6): e11068. doi:10.1371/journal.pone.0011068 n=12,512 unduplicated HIV-positive individuals.

22. Treatment as Prevention Next Steps

23. The authors estimated that only about 19% of HIV infected individuals in the USA have an undetectable HIV-1 RNA level Spectrum of Engagement in HIV Care - USA Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6): 793-800

24. Spectrum of Engagement in HIV Care - USA Gardner E, McLees M, Steiner J, del Rio C, Burman W, Clin Infect Dis. (2011) 52 (6): 793-800

26. Montaner J, The Lancet, Vol 378: July 16 th 2011, pages 208-209