P1. Treatment as prevention: a reality.
Hampus Nordqvist, Bernt Hildingsson Lund, Anders Blaxhult, Göran Bratt.
Affiliates: Venhälsan, Department of Infectious Diseases/Venhälsan, Stockholm South Hospital, Stockholm, Sweden
Patients on antiretroviral treatment (ART) with undetectable virus levels have extremely low risk of passing HIV on to a sexual partner. ART coverage has increased year by year among patients with known HIV infection at our clinic. We aimed to study if this increase in ART coverage was associated with lowered numbers of new HIV infections among men who have sex with men (MSM) at our clinic. The number of patients with severe HIV related immunodeficiency (AIDS or CD4 < 200 x 106 /L) and other sexually transmitted infections (STIs) among MSM were also investigated.
The study was conducted at the Venhälsan clinic, Stockholm South Hospital (Södersjukhuset). Venhälsan was established in 1982 to combat STIs among MSM. 6000 MSM are now tested for HIV/STIs every year and 1325 HIV patients of both sexes, of whom 80% (n=1059) are MSM, are cared for (own data). Information about the number of STI, HIV and AIDS diagnosis, CD4+ cell count and the percentage of HIV patients on ART at our clinic was obtained from a local registration of diagnoses and treatment.
We interpret the reduced numbers of new HIV infections acquired in Sweden and severe HIV related immunodeficiency as a success of treatment as prevention and early diagnosis through partner notification. Treatment as prevention can only be really effective if the undiagnosed HIV population is reduced. Test, treat and notify is the way to achieve this. Consistent condom use however still remains the main way of HIV/STI-prevention. ART coverage varies globally and no reduction was seen in the numbers of HIV infections acquired abroad. The significant increase in STIs shows that maintenance of “safe sex practices” will be a challenge in an era where HIV infection is no longer perceived as the same threat.