B.C. research spurs UN to focus on treatment of HIV

published on July 19, 2010 in The Province

Study shows antiretroviral therapy really working

By Andy Ivens

Researchers from B.C. are the toast of the 18th International AIDS Society Conference in Vienna this week.

Since 1996, Dr. Julio Montaner and his team have found that increasing the number of HIV patients who receive highly active antiretroviral therapy (HAART) leads to a dramatic decline in the spread of the virus that causes AIDS.

Montaner presented the study to the conference on Sunday and praised the B.C. government for helping fund his research.

“It’s a great day for British Columbia,” said Montaner, president of the International AIDS Society and director of the B.C. Centre for Excellence in HIV/AIDS in Vancouver.

“It’s an initiative that we undertook with the personal support of the premier [Gordon Campbell],” he said in a phone interview from Vienna.

“We expanded the use of antiretroviral therapy coverage because we had some preliminary evidence that this is not just good for the patient, but it’s also able to decrease the likelihood of people transmitting HIV.”

Montaner said B.C. “is the first jurisdiction in the world that has done this kind of work.”

The study began in 1996. Up until 2009, the number of individuals receiving HAART increased from 837 to 5,413, a 547-per-cent increase.

Over that period the number of new HIV diagnoses fell from 702 per year to 338, a 52-per-cent decrease.

The study was published Sunday in The Lancet, the world’s leading medical journal.

The decrease in new HIV cases in recent years was largely achieved in the category of injection drug users, as the incidence of other sexually transmitted diseases increased.

“Our report in The Lancet today shows that the more you treat, of course you save lives and make people healthier, but actually the more you treat the more you prevent,” said Montaner.

“So, while treatment is highly cost-effective on its own merits because it is a life-saving, diseasepreventing intervention, it has a multiplier effect on the prevention axis, which makes this a very attractive investment.

“It’s good for the patient, it’s good for public health and it’s good for the public purse,” he said.

While hailing Campbell and Health Minister Kevin Falcon for their vision in funding the research, Montaner had no kind words for the federal government’s lack of support.

“We certainly have had no support from the federal government,” said Montaner.

“We approached [Prime Minister] Stephen Harper, [federal Health Minister] Leona Aglukkaq,” he said. “We begged, asked and implored for [HIV/AIDS] issues to be made part of the agenda for the G8 [conference last month].

“We were met with total silence on their part. They haven’t been able to find the time to meet with us,” he said.

“This is sad. We cannot have British Columbia leading the world and Canada watching from the side.”

The reaction to the article from some of the 20,000 people attending the conference in Vienna from 185 countries was instantaneous, said Montaner.

“The article was released in front of the people attending the conference, including royalty, presidents, ministers of health,” he said.

“The executive director of the United Nations AIDS program stood up as part of his opening address and publicly acknowledged the support of Premier Campbell and the province of British Columbia on supporting our work, which has actually provided the fundamental bricks to build the new UN AIDS initiative that was announced [Sunday].”

That initiative calls for “a prevention revolution,” said Montaner.

“The essence of this is that by treating more people all over the world, we have an opportunity to curb the growth of the epidemic to control HIV and AIDS and to bring the growth curve for HIV and AIDS down while we wait for an effective cure and a vaccine.”

More than 33 million people are infected with HIV. Although there are 2.7 million new infections worldwide each year, the number of deaths from HIV declined from 2.2 million in 2004 to two million in 2008.

Montaner said the health of his thousands of HIV patients is paramount in his work.

“At a time of official [financial] constraints, it has been incredibly gratifying for me to be able show that doing the right thing for my patients is not only the right thing for my patients but also a wise investment for the people,” he said.

“The game-changer here is . . . the treatment is highly cost-effective . . . but you need to move beyond being cost-effective.

“Because the multiplier benefit in prevention is many times greater, we are able to reset HIV treatment in the priority scale at a much higher priority.”

Montaner said it costs about $1,500 a month per patient for the cost of HAART drugs and treatment in B.C. but only $1 a day for subsidized drugs for the millions of HIV/ AIDS sufferers in Africa.

Reprinted under license from The Province.

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