Vancouver, BC [October 5, 2015] HIV testing in parts of Canada remains based on “perceived risk” and could be keeping people living with the disease from discovering their status. A new study, based on the largest Canadian database of people living with HIV, finds nearly half of those surveyed started antiretroviral treatment (ART) when they had already reached an AIDS-defining illness or a weakened immune system.
The study found that:
- From 2000 to 2012, 48% started ART with low CD4 counts, the indicator of a weakened immune system.
- Focusing on the time period between 2008 and 2012, 68% of participants initiated ART when the immune system was already weakened.
- Women, older adults, and individuals who inject drugs are among those more likely to start treatment late.
- Over the study period, there was a shift towards earlier treatment initiation, reflective of more modern treatment guidelines and better treatment options.
“CD4 counts at ART initiation remain below treatment guidelines,” said Angela Cescon, a researcher with the BC Centre for Excellence in HIV/AIDS (BC-CfE), medical student and lead author of the study. “Diagnosing patients at the earliest possible stage of HIV infection is critical to optimizing the benefits of HIV treatment.”
Early initiation of ART is essential to lowering the risk of HIV-associated illnesses, extending life expectancy and reducing onward HIV transmission. Under the Treatment as Prevention® strategy, pioneered at the BC-CfE, an individual will be offered HIV treatment immediately upon diagnosis. In September, the World Health Organization released new guidelines calling for the immediate treatment of all individuals diagnosed with HIV, regardless of CD4 count.
Widespread testing is vital to reaching and treating groups experiencing more recent surges in HIV rates. Canadian women accounted for 24% of new HIV positive tests among adults in 2011, double the proportion between 1985 and 1998. A previous BC-CfE study, based on the CANOC cohort, found young adults also had relatively high rates of late ART initiation, and were less likely than older adults to be retained in care and achieve viral suppression.
“Our study shows we still have much further to go to end the AIDS epidemic in Canada,” said Dr. Julio Montaner, Director of the BC-CfE and senior author of the study. “Stereotypical assumptions about who is at risk of becoming HIV positive are now dangerously out of date. In order to ensure the health of all individuals, universal testing should be adopted.
The researchers advocate for the development of Canadian consensus guidelines calling for earlier testing and treatment, based on the UNAIDS 90-90-90 Target. This new global target calls for 90% of all those living with HIV to be diagnosed, 90% of those diagnosed to access treatment, and 90% of those on treatment to achieve a sustained undetectable viral load by 2020.
“Meeting the 90-90-90 target by 2020 will make it possible to end AIDS by 2030, as called for by the UN Sustainable Development Goals approved at the 2015 UN General Assembly in September,” said Dr. Robert Hogg, a Senior Research Scientist with the BC Centre for Excellence in HIV/AIDS (BC-CfE) and Professor at Simon Fraser University, an author on the study and Principal Investigator of the CANOC Collaboration. “Removing barriers to HIV testing is the first step to reaching the ambitious new target.”
The study, published in the Journal of the International AIDS Society, uses data from the Canadian HIV Observational Cohort (CANOC) Collaboration, a multi-centre cohort of adults initiating ART after January 1, 2000 at clinic sites across three provinces. CANOC represents nearly half of the estimated 20,500 people on HIV treatment in BC, Ontario and Quebec. However, provincial differences in rates are not reflective of provincial trends as only BC captures everyone on ART in the province during this time period.
CANOC is funded by the Canadian Institutes of Health Research and the CIHR Canadian HIV Trials Network.