From killer to chronic, epidemic to eliminated: stopping the spread of HIV+AIDS through effective, sustained treatment


Dr. Julio Montaner. 

Just two decades ago, an HIV diagnosis brought with it stigma and suffering and eventually, death. End of story. Today, while stigma remains an issue, individuals with HIV are living longer and healthier lives. This is thanks in large part to ongoing work pioneered in the 1990s and continuing to this day at the BC Centre for Excellence in HIV/AIDS.

Dr. Julio Montaner is the determined and much-decorated Director of the BC Centre for Excellence in HIV/AIDS (BC-CfE), a UBC-affiliated centre based at Providence Health Care’s St. Paul’s Hospital.

Dr. Montaner was the principal investigator of an international 1996 study that showed a cocktail combination of drugs to be the most effective way to prevent HIV turning into AIDS. Known as HAART (highly active anti-retroviral therapies), the cocktail has transformed HIV from a catastrophic diagnosis into something manageable with consistent, sustained lifelong treatment. This means people living with HIV can now plan for a future, have children and live healthier lives. 

HAART was just the first step however in a battle that continues to this day in Canada and around the world to eliminate HIV. That is why Montaner developed a program he calls “Treatment as Prevention®,” or TasP®.

On a global scale, TasP®  has been embraced by the United Nations in its plan to end the AIDS epidemic. By expanding testing and access to anti-retrovirals following a diagnosis, people living with HIV can receive effective, sustained treatment that improves their health and longevity, while curbing the spread of HIV. Through treatment, an individual can achieve a level of virus that is undetectable by standard blood tests. At this point, the chances they will transmit the virus to others drop to zero.

So far, TasP® has been implemented to great success in BC. Between 1994 and 2013, the number of new AIDS cases in BC decreased dropped by 88 per cent. New HIV cases have consistently declined in the province, from a yearly high of close to 900 at the peak of the epidemic to approximately 200 today. The proven effective strategy has been embraced by China, Brazil, Spain, France, major U.S. cities, and Queensland, Australia – among many others.  



That is not to say the battle against HIV and AIDS has yet been won—there are still many barriers to accessing sustained treatment for some living with the disease—but the principles of TasP® are strengthening the global fight against it. 

The UNAIDS 90-90-90 program aims to ensure that, by 2020, 90 per cent of people living with HIV are tested; 90 percent of those diagnosed are on sustained antiretroviral treatment; and 90 per cent of those on treatment have undetectable viral loads. The goal is to virtually eliminate progression to AIDS, premature death and HIV transmission by 2020.

By 2030, the worldwide HIV/AIDS pandemic could be transformed into a low-level sporadic endemic.

“We turned what was a crazy idea into a sound public policy,” says Montaner.

TasP® has also been shown to save money in health care costs due to avoided cases of disease. The BC-CfE is now applying TasP’s winning principles towards a Targeted Disease Elimination® strategy for other contagious and socially contagious diseases (such as hepatitis C and type 2 diabetes).  

Dr. Montaner is a world-renowned leader in the field of HIV research who has dedicated his career to improving the lives of those affected by the epidemic. His focus remains steadfast on the global elimination of HIV and AIDS, and how the lessons he has learned in his career can help ease the burden of other modern-day epidemics.

Listen to Dr. Montaner's Killam Lecture: "Has Preventing HIV/AIDs Provided a Key to Sustainable Healthcare?"