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Thursday, 29 November 2012

HIV success stories for World AIDS Day - and a bit of statistical slight of hand

Plenty of news on HIV these days.   That World AIDS day is December 1st might be just coincidental.

Leading the headlines is the report out of BC on the success of HAART in reducing population transmission Picard story on HIV fight. This is great news.   Perhaps a bit self-serving for the 'treatment as prevention' folks that are taking credit for the reduction.  The STOP HIV program, which inherently makes a lot of sense, was only implemented in 2008 and the data on which the research they are claiming success reflects the time period of 1995-2008 (up to start of STOP HIV).  The BC reduction in incidence began in about 2003 and has been consistent over most of the last 9 years.  

They also fail to acknowledge that Canada has started trending downwards since 2008. 

Read the full article at PLOS One Burden of HIV in Canada.   The conclusion is based on data from only three provinces who had innumerable other differences in their approach to addressing HIV and not just in access to HAART.  There are other correlations that might also explain the differences noted, including political stripes of the leadership.  So while non-treatment public health efforts across the country have likely been the major initiators of the downward trend, the use of treatment will be advantageous to sustaining the decrease.   One can see a very similar trend with tuberculosis rates prior to and following the discovery off streptomycin as one of the first effective anti-TB drugs.

A more balanced discussion of the Stop HIV approach can be found in a CMAJ editorial at CMAJ on HIV seek and treat 

In honour of World AIDS day, Health Evidence has produced a list of high quality evidence reviews of practices associated with control of HIV http://health-evidence.ca/saved_searches/run_search/1134  although some are very dated. 

Also in recognition of World AIDS day is the release of an international report The beginning of the end.  Notable as well on page 11 is the incidence of HIV globally has been decreasing since 2003 – the reasons internationally are different from the Canadian experience.  

US rates are more difficult to obtain, and perhaps reflective of less positive news as well.   A detailed analysis was published at US HIV statistics 2008-2011.  A real positive is the addition to the USPTF of universal screening for HIV USTPF draft HIV screening recommendation as a Grade A recommendation.

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