Expanded HIV treatment will cut costs, prevent infections: B.C. study

For nearly 15 years, highly active antiretroviral therapy (HAART) has been the gold standard in HIV treatment, transforming the disease from a death sentence to a chronic, manageable condition for thousands of Canadians. By suppressing the virus to undetectable levels, HAART can provide decades of healthy, productive life for individuals living with HIV and AIDS.

And its benefits are not limited to improving the health of individuals, according to the findings of a new study. The first comprehensive economic evaluation of the net benefit of HAART in B.C. was recently published in AIDS, the official journal of the International AIDS Society (IAS), by researchers at the BC Centre for Excellence in HIV/AIDS (BC-CfE). The study makes a compelling case that wider use of HAART can curb the spread of the HIV epidemic and save hundreds of millions of dollars in health care costs.

The study found that expanding HAART coverage to 75 per cent of clinically eligible British Columbians would deliver a net benefit of up to $900 million over 30 years by preventing new infections and averting future treatment costs. Currently, only an estimated 50 per cent of HIV-positive individuals eligible for treatment are receiving HAART in B.C.

“The study findings make the point that expansion of HAART is not just a medical or ethical imperative, it is a very smart financial investment in terms of its potential to improve public health,” said Dr. Julio Montaner, director of the BC-CfE and one of the study’s authors.

“HIV continues to be a global health concern and the lifetime costs of treating individuals with HIV are substantial. Therefore, HAART’s potential to prevent new infections is an important element of the overall strategy to minimize the economic burden on the health care system of treating HIV.”

In assessing the economic impact of expanded treatment coverage, only direct medical costs were considered, including antiretroviral and non-antiretroviral medications, hospitalizations, physician visits, and laboratory tests. While the study was based on high-quality data from patients receiving HAART in B.C., the researchers expect the findings can be accurately applied to other regions with similar health care systems.

The study provides further evidence to support the concept of “treatment as prevention.” This novel strategy, pioneered at the BC-CfE by Dr. Montaner and his colleagues, is based on the principle that HAART disrupts viral replication and dramatically reduces viral load in patients who adhere to their drug regimens. Mathematical models have demonstrated that this concept, if broadly applied, has the potential to significantly curb new HIV infections and overall HIV prevalence.

At the recent International AIDS Conference in Vienna, treatment as prevention was applauded as a game-changing strategy to address the global AIDS pandemic and formally adopted by UNAIDS, under the title “Treatment 2.0,” as the cornerstone of its plan to prevent 10 million AIDS deaths by 2025. The concept has also garnered accolades internationally from the World Health Organization, the Clinton Global Initiative, the Global Fund, the Bill and Melinda Gates Foundation, and the IAS.

Earlier this year, B.C. became the first jurisdiction to implement treatment as prevention as part of a comprehensive approach to controlling HIV and AIDS. A four-year, $48-million pilot project called Seek and Treat has been established to expand HIV treatment and improve testing, diagnosis, and linkage to care in Vancouver’s inner city and Prince George.

Fully supported by the provincial government, the program specifically targets hard-to-reach populations, including men who have sex with men, injection drug users, sex trade workers, and Aboriginal individuals. By improving access to treatment and retention in care, Seek and Treat aims to halt the progression of HIV infection to AIDS among these individuals and decrease HIV transmission province-wide.

Similar projects based on the Seek and Treat concept have recently been launched in Washington, D.C., New York City, and San Francisco.

“In the absence of an HIV vaccine or cure, Seek and Treat provides an innovative option to help HIV-positive individuals live full and fulfilling lives, prevent HIV transmission, and curtail the human and economic costs of HIV infection,” said Dr. Montaner.

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is Canada’s largest HIV/AIDS research, treatment and education facility. Based at St. Paul’s Hospital in Vancouver, the BC-CfE is dedicated to improving the health of British Columbians with HIV through the development, monitoring and dissemination of comprehensive research and treatment programs for HIV and related diseases. For more information, please visit www.cfenet.ubc.ca.