Dr. Julio Montaner: more aggressive AIDS treatment needed for those in helpless situations - photo by Brian Smith
UBC Reports | Vol. 54 | No. 2 | Feb. 7, 2008
Conquering AIDS — if We Have a HAART
By Julie-Ann Backhouse
One of the world’s leading researchers in HIV/AIDS,
Dr. Julio Montaner, believes it is possible to completely eliminate the transmission of HIV in Canada, starting in British Columbia.
“We have come a long way in two decades of treating HIV/AIDS,” says Montaner, Director of the BC Centre for Excellence in HIV/AIDS. “I really believe by expanding HAART (highly active anti-retroviral therapy), a therapy proven to work, we can finally control this epidemic.”
There are 12,000 people in British Columbia who are HIV positive. The B.C. Centre for Excellence in HIV/AIDS estimates that 2,000 are not receiving treatment even though most have access to free therapy.
HAART treats HIV with a combination of drugs (anti-retrovirals) that blocks HIV replication at different stages of its life cycle. As a result, HAART dramatically reduces the amount of HIV in the blood, known as viral load, and this in turn helps to decrease the risk of HIV transmission.
“We have proven that among those who engage in care, 90 per cent show a vast improvement and transmission almost disappears,” says Montaner. “But this benefit is restricted to those who initiate and adhere to HAART treatment.”
The benefits of HAART are major and long lasting – life expectancy increases and quality of life improves. Further, transmission is greatly reduced. This means that HIV-infected women can give birth without transmitting the virus to their babies, as long as they are on HAART.
“The reality for the more vulnerable members of our community is that seeking treatment for HIV does not rank high enough to make it a priority,” says Montaner. “This creates completely unnecessary pain and suffering for people and generates futile health care expenses.”
Most Canadians, if given a HIV-positive verdict, would seek treatment without delay. This is not the case, however, for many people who are homeless, mentally ill, substance abusers or all of the above.
Montaner believes that it’s possible to improve the situation. He believes that it requires rethinking the current passive approach to treatment and creating a more aggressive method of providing care for HIV sufferers in helpless situations. Montaner calls this approach “seek and treat.”
“It is not unlike what we did for tuberculosis in the past,” says Montaner. “We need to go out there, find the cases, and engage them in comprehensive education, prevention and care programs. We need a dynamic outreach program that will allow us to find, through trial and error, effective ways to engage these hard to reach populations in care. Only then we will be able to stop HIV in BC.”
As Professor of Medicine and Chair of the AIDS Research Division at UBC and also President-Elect of the International AIDS Society, Dr. Montaner has worked on treating HIV/AIDS since 1981.
He was the lead investigator of a seminal clinical trial that demonstrated that non-nucleoside reverse transcriptase inhibitor (NNRTI) – based HAART could render HIV plasma levels undetectable and lead to full remission of the disease. Montaner unveiled this groundbreaking research at the International AIDS Conference held in Vancouver in 1996.
“Clearly HIV is readily preventable,” says Montaner. Still, HIV/AIDS is ranked fourth on the Top 20 Causes of Death Worldwide list created by the World Health Organization. Traditional prevention strategies (including safer sex, harm reduction, etc) are the number one priority. But when prevention fails, treatment can be lifesaving. HAART treatment of those in medical need is the next priority.
“When HAART was introduced as a treatment, the incidence of HIV was reduced by 50 per cent. But since 1998 these figures have reached a plateau,” explains Montaner. “When you put all the facts together a new model for prevention and treatment is required.”