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. But not any more, 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 head of UBC’s Division of AIDS and 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, or “highly active anti-retroviral therapies,” the cocktail has essentially turned HIV/AIDS from a catastrophic diagnosis into something manageable with consistent, sustained lifelong treatment. This means people living with HIV can now lead healthy, normal lives, have children and plan for a future.  

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

Many UBC researchers at the BC-CfE have supported Montaner in his work towards eliminating the spread of HIV and other related diseases, including Drs. Evan Wood, Thomas Kerr and Richard Harrigan. 

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 dramatically reducing the likelihood that they will spread the disease.

So far, TasP® has been implemented to great success in BC. Between 1994 and 2013, the number of new AIDS cases in BC decreased from 696 to 84 – a drop of 88 per cent. It has also 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 the disease—but the principles of TasP® are strengthening the global fight against it. 

The UNAIDS 90-90-90 program aims to ensure 90 per cent of people infected 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: 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.

As the leader of both the BC-CfE and the Division of AIDS at UBC, a former head of the International AIDS Society and a special advisor to the United Nations, Montaner wears many hats. They all have one thing in common: to eliminate HIV and AIDS, no matter what it takes.

 

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

 

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