NRM caught up with Dr Julio
Montaner, director of the BC Centre for Excellence in
HIV/AIDS, shortly after the International AIDS Conference
and asked him to give us his thoughts on the science
— and the politics — of the meeting.
NRM: What were
this year's conference highlights for you?
Dr Montaner: The sheer wealth of
information coming out of the sessions. No single individual
can really honour the depth and breadth of the presentations,
but I can say the science in the area I'm involved with
— new drug development and clinical trials —
was plentiful. For instance there was sufficient data
on Merck's new protease inhibitor, integrase, as well
as maturation inhibitors and a number of other compounds
affecting new targets. There was also a lot of attention
to the area of prevention — there's a huge gap
there.
NRM: HIV rates
are still on the rise in Canada — what do you think
needs to be done?
Dr Montaner: I am terribly dumbfounded
by those statistics. The most dangerous thing is to
be HIV positive and not to know it, yet the most recent
statistics argue that about a third of people infected
in this country aren't aware of it. The current policy
surrounding HIV testing was drafted in the first years
of epidemic. We now have the technology to get test
results in one minute — but we don't do it. I would
like to see a revision of our policy and campaigns where
testing is being offered all the time.
NRM: You presented
data at the conference suggesting that starting treatment
earlier would dramatically reduce transmission rates.
Can you tell us about that?
Dr Montaner: We looked at the data
and demonstrated that treatment has already led to a
decrease in HIV transmission. If you treat people appropriately,
their viral load drops and they're less likely to transmit
the virus. In our study's utopian, unrealistic, improbable
model — not a recommendation — we argue that
if one day we chose to treat everyone with HIV at once,
you could see a situation where HIV could eradicate
itself over 30-50 years. You need to know that in order
to understand the impact of antiretrovirals and prevention.
What we're asking is that since we know it works and
that it's cost effective and that the UN strongly argues
for treatment of 100% of patients who need it, why the
hell aren't we doing it?
NRM: Do you think
there's sufficient access to treatment for Canadian
AIDS patients?
Dr Montaner: No. In BC, around
30% of people who should be on treatment (and that's
a low estimate) aren't. And the system isn't aggressively
pursuing them. You set up a system, but if the patient
doesn't come, it's too bad. The ones who aren't coming
are the ones who are more trouble because of addiction,
mental health, homelessness, or they're single mothers
with no babysitting, or they live in a reserve or other
institutional environment. They're likely contributing
in a disproportionate way to spread of disease. Those
individuals have more difficulty accessing the treatment.
We have to get it to them. We currently have a proposal
in front of the government of BC to try to develop a
plan to capture 100% of individuals that should be getting
treatment.
NRM: What did
you make of Prime Minister Harper's no-show at the conference?
Dr Montaner: I'm honestly ashamed.
We hosted the largest conference on HIV and AIDS and
our political leadership didn't bother to show up. It's
true that Tony Clement was there, but only as a matter
of protocol — no one dealt with the issues. And
when it comes to HIV, a missed opportunity is actually
an act of criminal negligence.
NRM: What can
Canadian GPs do to fight HIV/AIDS?
Dr Montaner: The first is that
they be aware of the issues. Aiming towards appropriate
HIV testing should be a priority in every practice.
Second, they should ensure that all their clients are
appropriately counselled regarding safe sex, and that
those found to be HIV positive are referred for appropriate
care. We would also welcome their help in supporting
the leadership role Canada should be playing. We have
to be leaders, and we're not. That is not acceptable.
NRM: What do you
hope to achieve as president of the International AIDS
Society?
Dr Montaner: To overcome everything
I've just told you.
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