Researchers continue to uncover gaps in treatment
While there’s no question that World AIDS Day marks an opportunity to celebrate huge strides in fighting the HIV epidemic over the last three decades, complex questions remain about gaps in treatment access along lines of gender, race, geographic region, drug behaviour and age.
The Canadian Observational Cohort (CANOC) collaboration is an elite team of Canadian scientists exploring Canada’s largest database of HIV-positive individuals on modern antiretroviral therapy, led by Dr. Robert Hogg of the BC Centre for Excellence in HIV/AIDS (BC-CfE). The findings from one of the collaboration’s latest studies led by Dr. Hasina Samji has found gaps remaining in access to treatment for a number of groups in Canada.
Initiated in 2008 and headquartered at the BC-CfE, the CANOC study includes anonymized, encrypted health information on approximately 10,000 HIV-positive individuals over the age of 18 in BC, Ontario and Quebec.
The Canadian Observational Cohort (CANOC) research team’s most recent findings, published in the journal of HIV Medicine, found many groups had interruptions in treatment, including women, young people, those with Aboriginal ancestry, and drug and injection drug users. Other affected groups within the 7,633 Canadians living with HIV surveyed over an 11-year period for the study were those with less advanced disease and people living in the province of B.C.
The study found that, since 2006 research emerged showing grave health detriments of skipping HIV meds, much fewer patients now take “drug holidays” in the interest of possibly saving money or giving their bodies a break. Armed with new information, most HIV positive patients studied avoided stopping treatment. But some groups still face difficulty in keeping on treatment consistently. Understanding why that is and how their challenges can be addressed are essential tools to the fight against HIV.
“These findings bring to light patient groups that may be in need of extra support to stay on treatment.” said Dr. Hasina Samji, who led the CANOC study. “If we are to address the spread of HIV in an inclusive and far-reaching manner, we need to consider the treatment needs of all.”
Still other CANOC-based studies have highlighted gaps in HIV care and groups requiring special attention. Women were found to experience poorer responses to the treatment – measured by how quickly they suppress the virus or whether they have a viral rebound. There are also hurdles to overcome when it comes to treating youth in Canada with HIV. Although since 2000 fewer people are now starting therapy later than recommended by clinical guidelines, a high number of young adults (aged 18-30) in Canada are still starting treatment later than medically advised.
Such stoppages or delays in treatment are significant factors in the health of patients, but also in the spread of HIV. The BC-CfE, under the direction of Dr. Julio Montaner, has pioneered a Treatment as Prevention (TasP) strategy that has been implemented province-wide in B.C. The strategy is based on the notion that patients with HIV should as soon as possible be placed on highly active antiretroviral therapy, the game-changing drug cocktail now known as HAART. With early and consistent treatment, patients’ viral loads decrease dramatically – hugely mitigating the likelihood that they will spread the disease. The UN is now aiming to reduce the global AIDS pandemic by at least 90% of its 2010 rate by 2030 in a strategy based on TasP principles.
As we look forward to the future of HIV research and the goal of ending AIDS, research into treatment remains imperative. In the next five-year phase of the study, supported by the Canadian Institutes of Health Research (CIHR) and the CIHR Canadian HIV Trials Network, CANOC is looking to add participant data from clinics in Saskatchewan and Newfoundland to better reflect the epidemiology of Canada’s HIV epidemic from coast to coast. By bringing together frontline HIV physicians, epidemiologists, community organizations and investigators, decision makers, statisticians, graduate students, and data analysts, the CANOC study continues to unearth knowledge of great value to the national and worldwide battle against HIV.