Treatment as Prevention: Building on the HIV experience to promote healthcare sustainability

published on May 8, 2015 in CDRD

CDRD Seminar featuring Dr. Julio S G Montaner, OC, OBC, MD, DSc (Hon), FRCPC, FCCP, FACP, FRSC, Director, BC-Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Providence Health Care, Professor and Head of Division of AIDS, University of British Columbia, UBC and St. Paul’s Hospital Foundation Chair in AIDS Research, UNAIDS Special Advisor, HIV Therapeutics.

Abstract:
Following the discovery of triple therapy for HIV and AIDS, partly at St. Paul’s Hospital and the University of British Columbia, we implemented this with remarkable success. Within a matter of months, morbidity and mortality were decreasing significantly, however at the same time it became apparent that HIV new infections were also declining concomitantly at a time where syphilis rates in the province of British Columbia were increasing. This led us to conclude that treatment could have a secondary preventive role. We coined the term “Treatment as Prevention” to characterize the impact of the emerging new cocktail, also know as highly active antiretroviral therapy or HAART, on decreasing morbidity, mortality, and secondarily HIV transmission. We were ultimately able to show that the impact of treatment of HIV transmission was in the order of a 90% decrease and, as such, we postulated that in a pivotal article in The Lancet in August 2006 a new strategy for the control of HIV/AIDS burden based on the expansion of the access to HAART under the banner of Treatment as Prevention. Eventually, this was proven to be a successful strategy in pilot studies in British Columbia funded by the National Institute of Drug Abuse, and in a randomized controlled trial, HPTN 052, published in 2011. Having spent the last several years disseminating this information in key countries around the world, and with the collaboration of the United Nations AIDS Programme, we were able to secure endorsement by the United Nations Secretary General, Mr. Ban Ki-Moon, for the strategy of Treatment as Prevention to become the cornerstone of the global control of HIV/AIDS as part of the post-2015 Millennium Development Goals. More recently, it has become apparent that the strategy of Treatment as Prevention could be of value if applied to other contagious diseases, whether infectious or not. Our next immediate target is to export this strategy to the area of hepatitis C infection where this is particularly attractive given the emergence of the novel direct-acting agents, which makes treatment highly viable and extremely successful. We are currently finalizing the details regarding the implementation of such a program, on a pilot basis, in the Downtown Eastside of Vancouver with the Ministry of Health.

Perhaps more importantly, the Treatment as Prevention strategy has not just been shown to be able to prevent morbidity and prevent pre-mature mortality, but also transmission and, in doing so, has proven cost-saving. This has opened the door for us to conceive a new strategy of targeted disease elimination based on the selective use of Treatment as Prevention to markedly reduce the disease burden of specific targeted diseases with the aim to enhancing healthcare sustainability.

Bio:

Dr. Montaner received his MD with Honours in 1979 at the University of Buenos Aires, Argentina. In 1981, he joined the University of British Columbia as a post-doctoral fellow, completed a residency in Internal Medicine and Respiratory Medicine and was Chief Resident for the Department of Medicine in 1986/1987. In 1987 Dr. Montaner joined the Faculty at St. Paul’s Hospital/University of British Columbia as the Director of the AIDS Research Program and the Infectious Disease Clinic. He held a National Health Research Scholar of Health Canada (NHRDP) for a period of 10 years starting in 1988. He is a founding co-Director of the Canadian HIV Trials Network. He has held the Endowed Chair on AIDS Research at SPH/UBC since 1996. In 1997, he was appointed Professor of Medicine at UBC. He is the Director of the BC Centre for Excellence in HIV/AIDS. He was the President of the International AIDS Society from 2008-2010 and currently is the Local Co-Chair of the 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention which will be held in Vancouver July 19-22, 2015. Recently, he has been assigned the position of Global Advisor on HIV Therapeutics to the Executive Director of the United Nations AIDS Programme.

Dr. Montaner has authored over 650 scientific publications on HIV/AIDS. He has focused his research in the development of antiretroviral therapies and management strategies. In the mid 90’s, as the PI of the INCAS Trial, he played a key role in establishing the efficacy of NNRTI based highly active antiretroviral therapy (HAART), which emerged as the new global Standard of Care at the 1996 Vancouver International AIDS Conference, of which he was a co-organizer. He then focused his attention to HAART access to hard to reach populations, including injection drug users, and the treatment of multiple drug resistant HIV infection with great success. Since the late 90’s he also pioneered the concept of Treatment as Prevention® (TasP). He was the first to advocate for the expansion of HAART coverage to curb the impact of the HIV/AIDS pandemic, in terms of decreasing progression to AIDS and death, as well as decreasing HIV transmission. Largely through his efforts, TasP has now been implemented with great success in BC, and progressively embraced by UNAIDS, China, PEPfAR, the US Government, and France, among others. In 2013 TasP was fully incorporated in the WHO Consolidated ARV Guidelines.

Dr. Montaner has received numerous awards and distinctions for his research work, among them the Knowledge Translation Award from the Canadian Institutes of Health (CIHR), Prix Galien Award, Albert Einstein World of Science Award, Hope is a Vaccine Award from the Global Alliance to Immunize against AIDS, and the David Barry DART Achievement Award that is given in recognition of invaluable contributions to the field of HIV drug discovery. He has received the Grand Decoration of Honour for Services to Austria, The Queen Elizabeth II Diamond Jubilee Medal for contributions to the field of HIV/AIDS, “Senador Domingo Faustino Sarmiento” from the Argentina Senate of the Nation presented to him by the Honorable Amado Boudou, Vice President of Argentina, and the Honorable Maria Laura Leguizamon, Senator of Buenos Aires, three Doctor of Science honoris causa degrees from Simon Fraser University, Cordoba University and the University of Buenos Aires, and an honorary fellow at Douglas College. He is a Member of the Order of British Columbia and an Officer of the Order of Canada. He has been inducted into the Royal Society of Canada-The Academies of Arts, Humanities and Sciences (RSC) and into the Canadian Medical Hall of Fame.

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