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Canadian Journal of Public Health

, Volume 104, Issue 5, pp e418–e419 | Cite as

The Holy Grail: The Search for Undiagnosed Cases Is Paramount in Improving the Cascade of Care Among People Living With HIV

  • Oghenowede Eyawo
  • Robert S. Hogg
  • Julio S. G. MontanerEmail author
Commentary
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Abstract

Highly Active Antiretroviral Therapy (HAART) has transformed the nature of HIV/AIDS from an imminent death sentence to a chronic manageable condition. There is a growing interest in the potential impact of “treatment as prevention” — a notion that expanded coverage with HAART would substantially reduce morbidity and mortality from HIV, and secondarily HIV transmission at the population level. However, undiagnosed and undocumented HIV cases cannot benefit from HAART and are more likely to experience HIV-related morbidity and untimely mortality. Late diagnosis of HIV remains prevalent and represents missed opportunities for early linkage to and engagement in care. In the absence of a vaccine and cure for HIV, undiagnosed HIV cases represent the biggest challenge yet in the fight against HIV/AIDS. As such, identifying them should be a priority of HIV prevention programs.

Key Words

HIV Acquired Immunodeficiency Syndrome undiagnosed HIV cases early HIV detection linkage to care treatment and prevention 

Résumé

La thérapie antirétrovirale hautement active (TAHA) a transformé le VIH et le sida de sentences de mort imminente en états chroniques gérables. On s’intéresse de plus en plus à l’impact potentiel du «traitement à titre préventif» — la notion voulant qu’une couverture élargie de la TAHA réduise considérablement la morbidité et la mortalité dues au VIH, et de façon secondaire la transmission du VIH dans la population. Toutefois, les cas de VIH non diagnostiqués et non documentés ne peuvent pas tirer parti de la TAHA et sont plus susceptibles de souffrir de morbidité et de mortalité prématurée liées au VIH. Le diagnostic tardif du VIH est encore prévalent et représente des occasions manquées d’aiguiller les patients et de les faire participer aux soins dès le début de la maladie. En l’absence d’un vaccin et d’un remède contre le VIH, les cas de VIH non diagnostiqués représentent le plus grand défi à ce jour dans la lutte contre le VIH et le sida. Identifier ces cas devrait donc être une priorité des programmes de prévention du VIH.

Mots Clés

VIH syndrome d’immunodéficience acquise cas de VIH non diagnostiqués détection précoce du VIH lien vers les soins traitement et prévention 

References

  1. 1.
    Nokes KM. Revisiting how the Chronic Illness Trajectory Framework can be applied for persons living with HIV/AIDS. Sch Inq Nurs Pract 1998;12(1):27–31.PubMedGoogle Scholar
  2. 2.
    World Health Organization. HIV/AIDS in Europe — Moving from death sentence to chronic disease management. Matic S, Lazarus J, Donoghoe MC (Eds.), WHO Regional Office for Europe, 2006.Google Scholar
  3. 3.
    Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d’Arminio Monforte A, et al. Decline in the AIDS and death rates in the EuroSIDA study: An observational study. Lancet 2003;362(9377):22–29.CrossRefGoogle Scholar
  4. 4.
    Palella FJ Jr, Delaney KM, Moorman AC, Loveless MO, Fuhrer J, Satten GA, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med 1998;338(13):853–60.CrossRefGoogle Scholar
  5. 5.
    Montaner JS, Hogg RS, Wood E, Kerr T, Tyndall M, Levy AR, et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet 2006;368(9534):531–36.CrossRefGoogle Scholar
  6. 6.
    Persaud D, Gay H, Ziemniak C, Chen YH, Piatek M, Chun T-W, et al. (Eds.). Functional HIV cure after very early ART on an infected infant. 20th Conference on Retroviruses and Opportunistic Infections (CROI), Abstract # 48LB. Atlanta, GA: March 4, 2013.Google Scholar
  7. 7.
    Sáez-Cirión A, Bacchus C, Hocqueloux L, Avettand-Fenoel V, Girault I, Lecuroux C, et al. Post-treatment HIV-1 controllers with a long-term virolog-ical remission after the interruption of early initiated antiretroviral therapy ANRS VISCONTI Study. PLoS Pathog 2013;9(3):e1003211.Google Scholar
  8. 8.
    Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveillance Supplemental Report 2012;17(3, part A).Google Scholar
  9. 9.
    Public Health Agency of Canada. Summary: Estimates of HIV Prevalence and Incidence in Canada, 2011. Available at: https://doi.org/www.phac-aspc.gc.ca/aids-sida/publication/survreport/estimat2011-eng.php (Accessed March 20, 2013).Google Scholar
  10. 10.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: Implications for HIV prevention programs. J Acquir Immune Defic Syndr 2005;39(4):446–53.CrossRefGoogle Scholar
  11. 11.
    Health Protection Agency. HIV in the United Kingdom: 2012 Report. Department of Health, Social Services and Public Safety, 2012. Available at: https://doi.org/www.hpa.org.uk/Publications/InfectiousDiseases/HIVAndSTIs/1211HIVintheUK2012/ (Accessed March 20, 2013).Google Scholar
  12. 12.
    Public Health Agency of Canada. Human Immunodeficiency Virus: HIV Screening and Testing Guide. 2012. Available at: https://doi.org/www.catie.ca/sites/default/files/EN_HIV-Screening-Guide-2013.pdf (Accessed September 6, 2013).Google Scholar
  13. 13.
    STOP HIV/AIDS Collaborative Pilot Project. STOP HIV/AIDS — Seek and Treat for Optimal Prevention of HIV/AIDS pilot project. 2012. Available at: https://doi.org/www.stophivaids.ca/stop-hivaids-pilot-project (Accessed March 31, 2013).Google Scholar
  14. 14.
    British Columbia Centre for Excellence in HIV/AIDS. STOP HIV/AIDS. 2012. Available at: https://doi.org/cfenet.ubc.ca/stop-hiv-aids/about (Accessed March 31, 2013).Google Scholar
  15. 15.
    Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 2011;52(6):793–800.CrossRefGoogle Scholar
  16. 16.
    Nosyk B, Montaner JS, Colley G, Lima VD, Chan K, Heath K, et al. The cascade of HIV care in British Columbia, Canada, 1996-2011: A population-based retrospective cohort study. Lancet Infect Dis 2013; doi:pii: S1473–3099(13)70254-58. [Epub ahead of print]Google Scholar

Copyright information

© The Canadian Public Health Association 2013

Authors and Affiliations

  • Oghenowede Eyawo
    • 1
    • 3
  • Robert S. Hogg
    • 1
    • 3
  • Julio S. G. Montaner
    • 3
    • 2
    Email author
  1. 1.Faculty of Health SciencesSimon Fraser UniversityVancouverCanada
  2. 2.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  3. 3.BC Centre for Excellence in HIV/AIDSVancouverCanada

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