grinsztejn b, et al, lancet infect dis, march 4 th 2014

Grinsztejn B, et al, Lancet Infect Dis, March 4th 2014

PRIMARY COMBINED M&M OUTCOME

FIRST AIDS DEFINING EVENT

FIRST TB EVENT

DEATH

Impact of ART on Life Expectancy

Bor et al, Science 2013

ART and Employment

Bor et al, Health Affairs 2012

Mortality & ART Coverage

Modified from A. Hill et al. IAS 2014 [LBPE29]

New HIV infections* & ART Coverage

Modified from A. Hill et al. IAS 2014 [LBPE29]* percentage growth

HIV Transmission According to Sexual Behavior Reported by HIV-Negative Partner

Rate of Couple Transmission (per 100 Couple-Years Follow-Up)

Heterosexual (Male)Vaginal sex with ejaculation

(192 CYFU)

Heterosexual (Female)Vaginal sex (272 CYFU)

MSM Receptive anal sex:

With ejaculation (93 CYFU)Without ejaculation (157 CYFU)

Insertive anal sex (262 CYFU)

0 1 2 3 4Rate (95% CI)

Overall risk = Zero through condomless sex with a partner on ART (HIV RNA <200

copies/mL

Rodger A, et al. 21st CROI. Boston, 2014. Abstract 153LB.

Key Messages

• TasP is primarily about Preventing Morbidity & Mortality, and as a byproduct, for virtually no additional investment and in a cost-saving fashion, Preventing HIV Transmission

• TasP vs Chemoprophylaxis• TasP works in all settings, including in MSM• TasP works in RLMS• 2013 WHO Guidelines• Need for Ambitious New ART Targets

– Proposed UNAIDS 90-90-90 Target

By 2020…

90%

of all people living with HIV will know their

HIV status

90% of all people

diagnosed with HIV will receive

sustained antiretroviral

therapy.

90%

of all people receiving

antiretroviral therapy will have

durable suppression.

The result

= a three-fold increase over current 2014 estimates

72%of all people living with HIV

will be virally suppressed

3

The new treatment paradigm

Single target → Cascade targetDeath → Death and transmission

Number → EquityIncremental funding→ Frontload Investments

90% 81% 73%

The objective

“Maximize the effectiveness of existing toolsto virtually eliminate progression to AIDS,

premature death and HIV transmission, and thereby transform the HIV/AIDS pandemic into a

low level sporadic endemic.”

For Further Information

• Invited Presentations• Workshop Proceedings• Evaluation

Please visit the website:

www.treatmentaspreventionworkshop.org