BIV Magazines: LifeSciences 2008

12 years ago, Julio Montaner was one of the B.C. researchers whose drug cocktail helped slash the number of new AIDS cases. Now they’re working on new standards to treat and eradicate the virus

By Baila Lazarus

While political pundits at the municipal, provincial and federal levels in Canada debate between themselves the efficacy of Vancouver’s safe injection site, people around the world are taking note; and using Vancouver’s initiatives as an example of how to tackle their own downtown dilemmas.

In October 2007, as just one example, the San Francisco Public Health Department, along with several other local health and social-welfare organizations, called on city hall to follow Vancouver’s three-year-old InSite program as a means of controlling drug use and reducing the spread of HIV/AIDS.

The move does not surprise Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS, located in St. Paul’s Hospital in Vancouver. Ever since the Centre for Excellence started studying the retrovirus in the early 1980s, governments and health organizations around the world have been looking to B.C. for leadership.

The success of the InSite program is just one reason why British Columbia is maintaining its position on the world stage when it comes to AIDS prevention, identification and therapeutics – the three pillars of reducing incidences of AIDS worldwide. It’s a culmination of almost 25 years of experience.

“We were ideally positioned to tackle the epidemic because St. Paul’s was at the epicentre,” said Montaner. “Very quickly, we realized we know as much about AIDS as anyone else out there because of the strength of the research we had done to date, and decided to mount a research effort at St. Paul’s. It grew quickly, and became the centre.”

Just over a decade later, in 1996, B.C. took centre stage at the XI International Conference on AIDS in Vancouver, presenting its drug cocktail to the world – a treatment that would set the benchmark and “altered the landscape of opportunities,” according to Montaner.

In only three years after the release of the cocktail, Montaner said, the number of new AIDS cases in the province decreased by 50%.

Since then, the Centre for Excellence has consistently been seen around the world as a focal point of AIDS research. Montaner himself is currently president-elect for the International AIDS Society (IAS), and will become president in August 2008.

The IAS has has more than 10,000 individual members – scientists and health-care professionals – from more than 172 countries.

“This is not just a recognition of my work, but really it’s a recognition of the collective work of the group that has been done here,” said Montaner.

While the AIDS cocktail addresses the issue of therapeutics, there are B.C. companies that are setting a new standard in the second pillar of AIDS eradication – identification of those with the disease – or what Montaner refers to as “seek and treat.”

It is estimated that more than 33 million people are infected with HIV worldwide and there are approximately 16,000 new infections a day. The faster one can identify if an individual has the virus, the faster they can be treated and educated on how not to spread the disease.

Montaner estimates that, within Canada, about 35% of those infected are unaware of the fact, and should be on treatment.

Richmond’s bioLytical Laboratories Inc. has tackled this issue with a ground-breaking 60-second test kit.

“You use our test to screen the population, to identify people who are positive,” explained CEO Carl Roy. “If someone is interested in having an HIV test, they’ve likely been involved in some sort of high-risk behaviours. The counsellors who administer the test can begin to educate the individuals about managing their behaviour and reducing their risk profile.”

Currently, even in developed countries, HIV testing can be a barrier to identification of cases because many people may not want to take the time to go to a doctor, who then sends them to a blood clinic. Test results may take several weeks, and many patients never even check back once the results are in.

BioLytical’s test can be administered in a walk-in clinic, with immediate results, said Roy. The product has been given approval by Health Canada, and provinces are beginning to use it in their health systems.

In additon, last December, bioLytical finished U.S. FDA clinical trials, and it’s currently incorporating a company there. It’s also expecting Chinese regulatory approval by the spring of 2008.

Roy said the leadership and expertise exhibited in B.C. has facilitated the province to become a focal point for the rest of the world.

“We have an amazing critical mass in terms of structural enablers, we have excellent clinicians, ... in terms of research, how to identify people who are HIV positive and manage the disease properly.

“We’re certainly a world leader in how we do public screening and enhance and grow those programs as opposed to sitting back on our laurels and waiting for the rest of the world to catch up.”

B.C.’s structure around health research has played a big part in keeping the province at the forefront of HIV/AIDS research, according to Patrick Lauzon, the medical science liaison, HIV/AIDS, and manager of policy for B.C. with Merck Frosst Canada Ltd.

“With a province-wide mandate, all of the treatment data, outcome data, all of the individual data is collected in a centralized source, which allows for better management and allows for broader care, and you can use that data to improve outcomes in the future,” said Lauzon. “It’s a very cohesive group working toward the prevention and management of HIV/AIDS care.”

Within that group, B.C.’s universities are consistently making news around the world for their research and collaborative efforts. Since 1990, the Canadian HIV Trials Network, a partnership of medical personnel, people living with HIV/AIDS and pharmaceutical manufacturers, funded by the Canadian Institutes of Health Research and sponsored by UBC and St. Paul’s, has been conducting clinical trials for AIDS research. From 2000 to 2005, more than $100 million dollars were granted to UBC research projects in infectious diseases alone.

Now B.C.’s leadership is shining in the first pillar of HIV/AIDS reduction – prevention. While a vaccine is not around the corner, use of HAART (highly active anti-retroviral therapy) may help by reducing the spread of the disease.

“There is enthusiasm that if we maximize our use of HAART among those who need HIV treatment, we will see further reductions in HIV infection,” said Montaner. “This is not only good for B.C. but this is ultimately the way forward for the world.” •

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