appeared to have cured a baby of the HIV virus, headlines roared that it could be a major discovery. However, Dr. Julio Montaner, the Director of the British Columbia Centre for Excellence in HIV/AIDS, said in an interview with Yahoo! Canada News that it’s too soon to declare the baby cured of the virus and there isn’t enough research to call the case a breakthrough.When a U.S. doctor at the University of Mississippi Medical Centre announced she
He says the story could still be valuable in that it illustrates a lesson he’s been trying to teach for years: early treatment drastically improves the lives of HIV patients. A study published in the journal PLoS Pathogens on Thursday supports his point and takes it further, saying early HIV treatment could functionally cure the virus.
[ Related: Doctor's 'gutsy' move led to baby's cure from HIV ]
Montaner says we need a national strategy to reach more of these patients and get them treatment, so their babies are never born with HIV in the first place. But with sex and drugs at its core, HIV is a political loser for our federal government, Dr. Montaner says – and our politicians are ignoring an epidemic.
Here are some excerpts from the interview.
Yahoo! Canada News: Can you tell me about the strategy you developed for HIV – Treatment as Prevention?
Dr. Julio Montaner: Our group, myself and others, we were involved in the original clinical trials that demonstrated an established efficacy of triple drug therapy. ... British Columbia was among the first jurisdictions that embraced triple therapy. ... We set up our program to monitor the impact that triple therapy had on our community and lo and behold, by three years later, 1999 to the year 2000, somewhere thereabouts, we were able to show that morbidity and mortality related to HIV had decreased markedly. In addition to that, life expectancy was steadily improving among people infected with HIV.
At the same time, the other phenomenon that we identified was that for the first time, pretty much in over a decade, the number of new cases diagnosed with HIV was also falling. ... The number of HIV cases among children born to HIV infected women was also markedly declining. ... For us, at that time, this became a clear signal that the use of treatment was contributing not just to prevention of morbidity and mortality but also prevention of HIV transmission.
What was your first reaction when you heard about a child effectively having been cured of HIV?
At any time, hearing of an episode of a potential cure becomes quite exciting. These things happen very rarely, as you know there’s only one case of documented cure in an adult person who was chronically infected of HIV and that required a bone marrow transplantation, which is something that is very problematic because by itself it can be life threatening.
This second instance of a pediatric case being reported where a kid who started treatment very soon after birth, within a day and a half of birth, was really compelling. Now, there are a number of caveats. ... In the last seven years there have been two children born with HIV in British Columbia, out of many children who were born to mothers infected with HIV. Because first and foremost, treatment of the mother infected with HIV, nearly all of the time, prevents the infection from being passed to the kid. We need to recognize that we have a strategy that is actually highly effective to prevent this from happening. In the event that this happens — and obviously this happens very often in areas of the world where treatment is not readily available — the recommendation is that the kid be offered treatment as soon as possible.
The truth is that we yet don’t have a clear understanding why this kid behaved in such an exceptional way. Was it because the treatment was started very early after the infection occurred? Before, perhaps, the virus was entrenched in that particular individual? Is there any other particular feature of this kid, genetic or otherwise, that allowed this to happen? Really, there are more questions than answers at the present time. There is also the issue that genetic material pertaining to the virus is still present in this kid. We cannot be sure that sometime down the road the infection may not reactivate.
How will this affect your work, if at all?
If a clue was to emerge, it would be entirely consistent with our entire proposal to proactively and enthusiastically engage individuals on normal HIV testing and early initiating of anti-retroviral therapy. As you can see, this kid illustrates both of those points.
What's interesting about what you're saying is it sounds like effective HIV treatment is more about implementation than it is about medical or scientific discovery. What is Canada lacking in implementation?
I would say that you're absolutely correct. That's basically the essence of our message. We have the tools to dramatically change the course of the epidemic in Canada, in North America and in the rest of the world.
And yet, while we spend a lot of time talking about it, not the same amount of effort is being put on actually implementing the strategy. Unfortunately, we are lacking, in my opinion, federal focus on trying to stop HIV. While British Columbia has been incredibly supportive of this work and as a result of that we can show marked improvements on outcomes, I cannot say the same thing about the rest of Canada.
Both Manitoba and Saskatchewan continue to see increasing rates of HIV, new cases. Many areas in other jurisdictions across the country, including Ottawa, for example, are seeing increasing rates of HIV transmission. Our epidemic among young men who have sex with men is rampant across the country. Our epidemic in First Nations is out of proportion as well. All of this indicates that there is an urgent need for a concerted national strategy. Unfortunately, the federal government, both the ministers and the Prime Minister, continue to wash their hands when it comes to this issue, pretending that this is a provincial matter that needs to be addressed at the provincial level.
If this was H1N1, if this was Avian Flu, if this was anything else — breast cancer epidemic, prostate cancer epidemic — you would have a national strategy. We don't, simply because this is HIV and our federal government is not interested. It doesn't want to get involved. This is all sex and drugs as far as they're concerned. And it's not being handled with the seriousness and the urgency that the issue requires.
[ More Brew: Winnipeg judge ‘conscripted’ mid-day shoppers into jury duty ]
At the international level, unfortunately, people are looking at this as a cost issue. They're saying ‘well, thank you, Dr. Montaner, very good idea. We admit the fact that you've been right all along. However, the amount of money that would be needed to implement this strategy is significant and we have other priorities,’ without recognizing that the AIDS mortgage continues to grow at the global level and it's not going to go away. Sooner or later, either our generation or the next generation will have to foot the bill for it. But if we do it now, the amount of suffering and devastation that AIDS will lead to will be substantially less than if we continue to procrastinate. As I said, It's a matter of political will, which, unfortunately, is simply not there.