St. Paul’s Persistent Hero

By John Thomson

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Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS at St. Paul’s Hospital in downtown Vancouver is adamant he can rid the province of HIV/ AIDS within a generation.

Internationally recognized as a leader in his field, he’s already saved thousands of lives by creating the world’s first anti-HIV cocktail, a treatment known as Highly Active Retroviral Therapy or HAART for short. HAART is recognized around the world as the go-to solution in turning a deadly epidemic into a chronic but manageable condition.

“It stops the replication of the virus,” says Montaner. “The day I give you HAART, the HIV virus stops multiplying. It allows your immunity to come back and you live a near-normal life as long as you take the medication.”

Born in Buenos Aires in 1956, Montaner didn’t set out to be a medical hero. He wanted to be a clinical researcher specializing in chest medicine like his father, a distinguished respiratory clinician in Argentina, but independent of him too. Montaner arrived in Vancouver in 1981 after attending a medical conference in Ecuador.

“I was at a workshop and there were two guys explaining stuff I always had trouble understanding and it made perfect sense to me,” says Montaner. “I understood everything.”

The topic was lung injury and the clarity with which the two physicians expressed themselves impressed the young student. Self-conscious about his limited command of English, he approached the one with the “easy accent.”

“I was the one with the easy accent,” laughs Dr. James Hogg, currently an Emeritus Professor of Pathology at UBC, and the head of respiratory research at St. Paul’s Hospital at the time.

“So I approached him during the coffee break,” continues Montaner “and I said ‘this experiment that you’re talking about; if you were to do it the other way around... and he said ‘that’s an interesting proposition. Why don’t you come to my lab and we’ll do that together in Canada.’”

“I was impressed with him because of his persistent nature,” says Hogg. “Six months later, he showed up at my office door.”

Montaner joined St. Paul’s as a resident. Two years later, he was assigned to a unit specializing in HIV.

“Pneumonia was the number one killer of people with HIV,” says Montaner “and my boss said ‘pneumonia cannot be fixed without fixing HIV.’ So I said, ‘Okay, let’s try it.’ I started doing work on pneumonia and HIV.”

He applied his knowledge of respiratory diseases, particularly tuberculosis, to the task.
“One drug didn’t do very well so we tried two drugs and the next thing I did was I started copying the TB model, which was my dad’s specialty. I said, ‘Look, let’s try three drugs.’”

The result was HAART and its impact was immediate. The British Columbia death rate from AIDS was almost cut in half when HAART was first introduced in 1996.

“Within five days my viral load dropped 90 per cent,” says Vancouver artist Tiko Kerr referring to the number of pills he had to take before HAART. “Within a month, I was stabilized. The same thing happened for the other four in the group. Julio was our champion. If I hadn’t been with Julio, I’d be dead.”

HAART works but it’s not a cure; it’s a respite. Now Montaner’s obsessed with getting HAART to the people who need it the most, those folks who can’t get to the doctor’s office. The solution, he says, is to send nurses into the city’s shelters and rooming house, to test people on their own turf and follow up with therapy if necessary.

The theory? Getting to people infected with HIV early and quickly will stop it from spreading. It’s an idea Montaner pitched to the provincial government in 2010, and which the government agreed to explore in a four-year pilot program centered in Vancouver and Prince George. The program is halfway through its term, and the results are so impressive, the province wants to take it to other cities, making BC the first jurisdiction in the world to implement treatment as prevention.

Montaner would like to see the concept expanded across the country but, so far, Health Canada is unresponsive.

“This is stigma and discrimination at its utmost,” he says. “It’s a blame-the-victim kind of mentality. The only issue they’re willing to talk about is a vaccine. Why? Because a vaccine, in my opinion, addresses the needs of those that are not affected – the good people – as opposed to those infected with HIV, which is not their constituency.”

A vaccine, if one is to be found, is many years away and as Montaner points out, controlling the spread of AIDS by addressing the needs of those at risk is a strategy that has been tested and proven.

“Canada could be leading the world in the elimination of HIV, but the federal government isn’t interested.”

Frustrated over what he perceives as a lack of political will at the federal level, Montaner doesn’t flinch from his goal.

“At first, my goals were modest,” Montaner admits. “I wanted to make it better one day at a time. Today, my goal is to see how far we can go in terms of eliminating HIV from British Columbia and hopefully elsewhere in the world. This is what’s right for the patients, what is right for the public health effort and what is right for the public purse. Make no mistake. We’re going to win this fight.”

His father would be proud.



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HAART = Highly Active *Anti*retroviral Therapy

Posted by James | September 14, 2012 Report Violation

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