Dr Montaner first began seeing patients with HIV in the early 80s — "before we even knew what HIV was," he says. As understanding of the disease grew, Dr Montaner, who was then specializing in internal and respiratory medicine at St Paul's Hospital in Vancouver, began focusing on clinical research into the respiratory complications of HIV. He soon became interested in investigating the disease on a broader scale.

CANADA LEADS RESEARCH
Today Dr Montaner's work as Clinical Director of the British Columbia Centre for Excellence in HIV/AIDS, based at St Paul's Hospital, has helped catapult Canada into the limelight as a leader in the fight against the deadly virus.

Founded in 1992, the centre brings HIV testing, outreach work, in-patient/out-patient treatment and research together under one umbrella with the mandate to continuously deliver more effective treatment.

The centre is now a key provincial resource serving each and every health authority, region and citizen of BC. Its major scientific breakthroughs include being involved in the mid-90s discovery of a drug cocktail called highly active antiretroviral therapy (HAART) that could bring a patient's viral load to undetectable levels.(For more on HAART, please see "HAART hinders HIV progression to AIDS — and here's how").

"We first put people on these treatments experimentally in 1994," recalls Dr Montaner. "When we reported in 1996 at the International AIDS Conference in Vancouver that we found a treatment that could actually suppress the virus, nobody was more surprised than us."

Since this early success, the centre has never been happy to rest on its laurels. Dr Montaner's current focus is on moderating the drug regimens to help patients adhere to treatment programs which many find difficult.

"When AZT [Azidothymidine] started, we were asking people to take one dose every four hours, including one in the night.... This year, we're going to start treatments that involve the whole cocktail in one pill to be taken once a day." Adherence, he adds, is absolutely critical as missed doses can result in the virus developing resistance to entire classes of drugs.

LOCAL AND GLOBAL VISION
The centre divides its energies between local and global work. Locally, it's focused on addressing the needs of HIV positive intravenous drug users and Aboriginal people (groups, the centre's research has found, which have a much higher rate of infection than the general population). Internationally, the centre does outreach work in developing countries, assisting them with diagnosis and treatment. The centre collaborates with groups in Asia, Africa and Latin America, helping with virus testing and clinical trials.

"We offer support to people who want to copy us," explains Dr Montaner. "Ultimately, if we go there and do their stuff, the effort is non-sustainable. But if they're doing it and we support them, then they are getting better at doing what they need to do."

As for the fate of developing countries struck with an AIDS epidemic, Dr Montaner is a little less optimistic. "This is a huge problem, and if nothing is done about it, the social unrest emerging from Africa, Asia and Latin America is going to be a total disaster. And nobody will be able to tell me they didn't know about it, because they do."

When faced with such odds, lesser mortals might turn away in defeat, but Dr Montaner takes a more sanguine approach. "Because I do a lot of clinical research, I understand perfectly well where we're at, and look at my life as a sequence of successes. I don't spend time crying over the fact that people die.... The question is, what am I going to do to make it better?"

For more information about the BC Centre for Excellence in HIV/AIDS, visit www.cfenet.ubc.ca.