Hope Grows for HAART as HIV Preventive

Since its introduction in 1996, highly active antiretroviral therapy (HAART) has proven to be a godsend for HIV-infected individuals, reducing HIV viral load in their bodies and leading to long-term disease remission.

Now a new study suggests that HAART might be able to achieve a feat at least as impressive—preventing the spread of HIV. It found that in the Canadian province of British Columbia, newly diagnosed cases of HIV have been more than halved since the introduction of HAART in 1996.

The study was headed by Julio Montaner, M.D., director of the British Columbia Center of Excellence in HIV/AIDS, and colleagues. Results appeared in The Lancet on July 18. Results were also reported at the International AIDS Society Conference in Vienna, Austria, in July.

“This is a very important paper, published in a top journal by one of the leading HIV/AIDS scientists,” Francine Cournos, M.D., a professor of clinical psychiatry at Columbia University and a HIV expert, told Psychiatric News.

“Although this study does not establish a causal relationship between maximizing HAART coverage and decreased HIV infection incidence, it does show a strong link between increasing HAART treatment rates, decreased viral load, and reduced new HIV diagnoses per year,” Antoine Douaihy, M.D., an associate professor of psychiatry at the University of Pittsburgh who has conducted HIV prevention research, added. “This view of HAART has a significant public-health implication in that HAART may serve not only as a treatment for HIV infection, but also as a preventive measure in its transmission.”

Several studies have found that HAART can decrease HIV viral load in semen and in vaginal secretions, and several cohort studies have suggested that HAART treatment can prevent HIV transmission. Montaner and his group decided to undertake a population-based study to explore this possibility.

British Columbia was ideal terrain for such an investigation, they believed, since it has universal health insurance, and thus any resident could have an HIV evaluation or receive treatment for HIV free of charge. The study period they used was 1996 (when HAART became available) to 2009.

They used two separate databases for their study. Data for the number of HIV tests done and new HIV diagnoses in British Columbia from 1996 to 2009 were obtained from the British Columbia Center for Disease Control. That agency centralizes HIV surveillance data for the province. It has access to HIV testing data from the provincial public health reference laboratory, which performs more than 90 percent of HIV testing in British Columbia.