The HIV/AIDS epidemic continues to grow rapidly, throughout the world. This is likely to remain so because i) HIV cannot be cured, ii) prevention is neglected and iii) a preventive vaccine remains elusive. In contrast, on the therapeutics front there has been tremendous progress. Since 1996, highly active antiretroviral therapy (HAART) has transformed AIDS into a chronic manageable illness. HAART stops HIV replication, therefore turning plasma viral levels to undetectable levels (<50 c/mL). This leads to a sustained immune recovery and near normal health. HAART has also been shown to decrease HIV levels in semen and vaginal secretions. As a result there has been growing interest regarding the possible role of HAART in directly preventing HIV transmission by decreasing infectiveness of those on treatment. Supportive evidence for """"""""HAART as Prevention"""""""" first emerged in vertical transmission studies where, ultimately, HIV transmission from the infected mother to her child has become exceedingly rare if HAART is in place. A possible effect of HAART on decreasing HIV transmission has been incidentally observed in HIV serodiscordant heterosexual couples and separately in population-level studies from Taiwan, San Francisco and in our own study in British Columbia, Canada. We therefore propose to prospectively test the """"""""HAART as Prevention"""""""" hypothesis, with a special focus on IDU. Specifically we propose to test that: 1) expanded HAART coverage among IDU will lead to a decrease in the number of new HIV infections within the population, including but not restricted to IDU;and 2) expanded HAART coverage among IDU, will lead to a decrease in adverse HIV/AIDS health outcomes among IDU. This proposal, named """"""""Seek and Treat for Optimal Outcomes and Prevention in HIV &AIDS in IDU"""""""", represents both a groundbreaking and innovative research hypothesis with important consequences for the control of the global HIV epidemic.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
NIH Director’s Pioneer Award (NDPA) (DP1)
Project #
Application #
Study Section
Special Emphasis Panel (ZDA1-NXR-B (26))
Program Officer
Jenkins, Richard A
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of California San Diego
Schools of Medicine
La Jolla
United States
Zip Code
Patterson, Sophie; Kaida, Angela; Nguyen, Paul et al. (2016) Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis. CMAJ Open 4:E169-76
Duff, Putu; Goldenberg, Shira; Deering, Kathleen et al. (2016) Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics. J Acquir Immune Defic Syndr 73:83-90
Duff, Putu; Ogilvie, Gina; Shoveller, Jean et al. (2016) Barriers to Cervical Screening Among Sex Workers in Vancouver. Am J Public Health 106:366-73
Milloy, M-J; Wood, Evan; Kerr, Thomas et al. (2016) Increased Prevalence of Controlled Viremia and Decreased Rates of HIV Drug Resistance Among HIV-Positive People Who Use Illicit Drugs During a Community-wide Treatment-as-Prevention Initiative. Clin Infect Dis 62:640-7
Milloy, M-J; King, Alexandra; Kerr, Thomas et al. (2016) Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting. J Int AIDS Soc 19:20617
Richardson, Lindsey; Laing, Allison; Milloy, M-J et al. (2016) Protocol of the impact of alternative social assistance disbursement on drug-related harm (TASA) study: a randomized controlled trial to evaluate changes to payment timing and frequency among people who use illicit drugs. BMC Public Health 16:668
Joseph, Brenden; Kerr, Thomas; Puskas, Cathy M et al. (2015) Factors linked to transitions in adherence to antiretroviral therapy among HIV-infected illicit drug users in a Canadian setting. AIDS Care 27:1128-36
Nosyk, Bohdan; Min, Jeong E; Colley, Guillaume et al. (2015) The causal effect of opioid substitution treatment on HAART medication refill adherence. AIDS 29:965-73
Lourenço, L; Samji, H; Nohpal, A et al. (2015) Declines in highly active antiretroviral therapy initiation at CD4 cell counts ≤ 200 cells/μL and the contribution of diagnosis of HIV at CD4 cell counts ≤ 200 cells/μL in British Columbia, Canada. HIV Med 16:337-45
Azar, Pouya; Wood, Evan; Nguyen, Paul et al. (2015) Drug use patterns associated with risk of non-adherence to antiretroviral therapy among HIV-positive illicit drug users in a Canadian setting: a longitudinal analysis. BMC Infect Dis 15:193

Showing the most recent 10 out of 139 publications