Highly active antiretroviral therapy (HAART), currently known for its therapeutic benefits against HIV, also reduced the spread of the virus among people with a history of injection drug use, according to a population-based study funded by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health. The study was published today in the Lancet.
HAART, a combination of drugs that target HIV at different points in its lifecycle, stops the HIV virus from replicating. Though not a cure, HAART suppresses the virus, stopping disease progression and prolonging survival in people diagnosed with HIV/AIDS. In this study, Canadian researchers found that increasing levels of HAART coverage in British Columbia were strongly associated with decreases in viral load in the population and new HIV diagnoses.
Previous research had suggested that increased HAART coverage reduced the spread of HIV in the general population. The findings in this study applied not only to the general population, but also to the subset of individuals with a history of injection drug use.
"This study strengthens the evidence that maximizing HAART coverage within current medical guidelines will help to curb the spread of HIV," said NIDA Director Dr. Nora D. Volkow. "These findings are especially important since new HIV cases have remained stubbornly steady in the United States at a rate of about 56,000 per year for the past 10 years."
Researchers analyzed information from two databases that provide information on HAART use, looking at viral load, new HIV diagnoses, and HIV and viral load testing information in British Columbia, where residents are provided free access to HIV care. During three distinct time periods, researchers saw that the number of individuals actively receiving HAART had a strong impact on viral load and new diagnoses in the community. As HAART coverage increased sharply, new HIV diagnoses decreased sharply. As HAART coverage stabilized, so did viral load and new HIV diagnoses.
"Our results clearly demonstrate that there is a connection between treatment and prevention not just among the general population, but among injection drug users as well," said Dr. Julio Montaner, the study's lead author and director of the BC Centre for Excellence in HIV/AIDS. "Expanding HAART coverage within current medical guidelines will prevent disease progression and decrease new HIV infections."
Worldwide, there were 2.7 million new HIV infections in 2008. In the United States, more than 1 million people live with diagnosed or undiagnosed HIV/AIDS. Statistics on the prevalence of HIV/AIDS in the United States can be found on the Centers for Disease Control and Prevention website: http://www.cdc.gov/hiv/surveillance/resources/reports/2008report/index.htm.
The research was supported by NIDA's annual Avant-Garde Award to Dr. Montaner. The award was intended to stimulate high-impact research that may lead to groundbreaking opportunities for the prevention and treatment of HIV/AIDS in drug abusers. Information on NIDA's Avant-Garde program can be found at http://www.drugabuse.gov/about/organization/arp/avgp.htm.
- Julio SG Montaner, Viviane D Lima, Rolando Barrios, Benita Yip, Evan Wood, Thomas Kerr, Kate Shannon, P Richard Harrigan, Robert S Hogg, Patricia Daly, Perry Kendall. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. The Lancet, 2010; DOI: 10.1016/S0140-6736(10)60936-1
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