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CATIE - www.catie.ca

Canada’s progress towards global HIV testing, care and treatment goals

6 December 2016 - Studies have found that initiating combination anti-HIV therapy (ART) and continuing to take it every day exactly as prescribed and directed can reduce the amount of HIV in the blood (viral load) to such a low level that it cannot be accurately counted with conventional tests. Such a low level is commonly called “undetectable.” Once one's viral load has reached this point and stays there, an important milestone has been reached: Not only does it mean that a person's health continues to improve, it also means that the risk of a person sexually transmitting HIV is now negligible. Thus, initiating ART soon after diagnosis carries both personal benefits (the immune system becomes stronger) and societal benefits (the spread of HIV is greatly reduced).

These effects of ART are so tremendous that in 2014 the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) have established measureable goals which all countries should aspire to achieve by the year 2020. These goals have been given the shorthand term 90-90-90 and are as follows:

  • 90% of people living with HIV are aware of their infection
  • 90% of people diagnosed with HIV are taking ART
  • 90% of people taking ART have an undetectable viral load

By committing to and implementing the steps necessary to achieve these goals, cities, regions and countries have the ability to greatly reduce the spread of HIV and improve the health of people living with HIV.

Canada supports 90-90-90

The Public Health Agency of Canada (PHAC) has embraced the 90-90-90 targets set by UNAIDS. To help Canadians be aware of the progress that has been made in the effort to reach the UNAIDS goals, scientists at PHAC, in cooperation with Provincial and Territorial Ministries and Departments of Health, have developed a report, released on World AIDS Day (December 1) 2016. Here are some key points from the report:

PHAC estimates there were 65,000 HIV-positive people in Canada in 2014. (This is revised from a previous estimate of 75,500 as a result of more robust data). Their distribution at different points in the cascade of care is as follows:

  • 80% of people with HIV know their infection status
  • 76% of people diagnosed with HIV are taking ART
  • 89% of people taking ART have an undetectable viral load

As a result, it is estimated that 54% of all people living with HIV have an undetectable viral load. These figures indicate that great progress has been made in meeting the 90-90-90 goals.

However, the figures also show that there is still much work to be done. For instance, researchers at PHAC estimate that about 20% of people with HIV in Canada are not aware of their infection. Furthermore, 24% of people who are aware that they have HIV are not taking ART. Leading international HIV treatment guidelines strongly encourage that an offer of initiation of ART be made shortly after the diagnosis of HIV.

For the future

In the months and years ahead, Canada's provinces and territories need to continue intensifying efforts to make further opportunities available for confidential HIV testing and counselling following a positive test result. In Canada, further study of all the steps involved in HIV testing, care and treatment needs to done so that the barriers delaying accession to the next step are understood and plans can be made to overcome such barriers.

Resources

HIV in Canada — Infographics from The Public Health Agency of Canada

—Sean R. Hosein

REFERENCES:

  1. Summary: Measuring Canada's progress on the 90-90-90 HIV targets. Government of Canada. 1 December 2016. Available at: http://www.healthycanadians.gc.ca/publications/diseases-conditions-maladies-affections/hiv-90-90-90-vih/index-eng.php
  2. Philpott J. World AIDS Day. Ministerial Message . 1 December 2016. Available at: http://news.gc.ca/web/article-en.do?nid=1163399&tp=980
  3. Rodger AJ, Cambiano V, Bruun T, et al. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA. Jul 12;316(2):171-81.
  4. Daar ES, Corado K. Condomless sex with virologically suppressed HIV-infected individuals: How safe is it? JAMA. 2016 Jul 12;316(2):149-51.
  5. Cohen MS, Chen YQ, McCauley M, et al. Antiretroviral therapy for the prevention of HIV-1 transmission. New England Journal of Medicine . 2016 Sep 1;375(9):830-9.
  6. INSIGHT START Study Group, Lundgren JD, Babiker AG, Gordin F, et al. Initiation of antiretroviral therapy in early asymptomatic HIV infection. New England Journal of Medicine . 2015 Aug 27;373(9):795-807.

From Canadian AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca

Source: CATIE: CANADIAN AIDS TREATMENT INFORMATION EXCHANGE


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