Annual PRESIDENTS’ LUNCH
ARBUTUS CLUB
TUESDAY, OCTOBER 13, 2015
Speaker: Dr. Julio Montaner
Probus is very fortunate to arrange as speaker the distinguished Dr. Julio Montaner, Director of the BC Centre for Excellence in HIV/AIDS, Professor of Medicine and Chair in AIDS Research at UBC, and Past-President of the International AIDS SOCIETY. In 2010, he was chosen as the winner of the “Albert Einstein” World Award of Science and in 2014 the Order of Canada in recognition of his contributions to establishing the global standards of care for HIV/AIDS treatment and prevention and for his leadership in the international HIV/AIDS community.
Dr. Montaner’s concept has been adopted by a number of countries. It includes diagnosing HIV early and treating it aggressively with a cocktail of three drugs to suppress the virus to the point of being undetectable. This led to another significant breakthrough when researchers noticed a dramatic decrease in the likelihood that HIV patients could spread the disease, even through unprotected sex.
The approach led B.C. to a remarkable 67-per-cent decline in new diagnoses and a drop of 87 per cent in AIDS-related deaths from 1997 to 2013. Meanwhile, HIV/AIDS patients on the antiretroviral drugs now have life spans approaching those of the general population.
We should be very proud of Dr Montaner’s accomplishments, and of the contributions to disease control of the BC Centre for Excellence in HIV/AIDS. He will have a very interesting story to tell us.
Dr Montaner’s presentation will be followed by a fellowship break, with a no-host bar. Then a light and healthy Gourmet Buffet will be served, much like the one enjoyed by everyone last year. There will be soup of the day, assorted whole wheat buns and bread with various fillings, barbecued chicken and veggie wraps, vegetables and salads and finally assorted dessert squares and cookies.
Notes on presentation
This meeting was the Presidents’ Lunch at the Arbutus Club, honouring past Probus presidents. John Gunn acted as Secretary. The meeting was opened by President Jack Zaleski, who gave a delightful report on his method of maintaining good physical health involving only sacks of potatoes. President Jack then introduced the past presidents.
The chairman then introduced Peter Cooperberg who in turn introduced Dr. Montaner, our distinguished guest speaker, who arrived here from Argentina in 1981 and has been here doing his amazing work ever since. He arrived here just as a new illness was striking our population, particularly among men between 25 and 44, with a strange and fatal form of incurable pneumonia, which eventually was named HIV/AIDS (Human immunodeficiency virus infection and acquired immune deficiency syndrome).
If members of this club rewind their memory banks to the eighties and nineties, it will be surprising if a number of us will not recall friends, acquaintances or persons in the news who were taken from our midst by that tragic AIDS epidemic which was spreading everywhere. We had to witness the long and often slow decline of the lives of these people, finally ending in their death. We now realize this tragedy might still be haunting us but for the remarkable endeavours of Dr. Montaner and his colleagues along with the Sisters of Providence right here at our own St. Paul’s Hospital. At the end of his talk Dr. Montaner received a well-deserved standing ovation.
As well as 600 published scientific papers, Dr. Montaner has been awarded an Order of Canada and very many other recognitions not only in Canada but worldwide and their treatment with three special drugs, which they eventually developed, became the standard procedure throughout the world. Initially their work followed some earlier work done by the Pasteur Institute in France.
HIV, which if not treated leads to AIDS, is a “retroviral” infection. Treatment worldwide at that time was generally with two particular drugs and the results were mixed. The St Paul’s group then went on and developed a unique treatment with a difference. Initially the treatment that they brought in involved three particular drugs and their administration was very exacting. Not an insignificant problem was the cost – about $15,000 a year for each patient. Initially the team had to do a so-called ‘double blind’ test on a group of patients in order to be certain that the application of these drugs was really the reason for the remarkable rate of improvement.
In due course the team was able to obtain a single pill incorporating the powers of the original three effective drugs, and there now exists a single pill to be taken once a day for the rest of life and this allows the patient to live out a totally normal life. Without the treatment, the patient would die. Keep in mind that over 30 million people have already died of AIDS worldwide.
A peripheral benefit of their treatment, which had not been expected, was that those who had the treatment were not only out of danger themselves from AIDS but, as well, they were no longer a threat to others in that they might pass it along, and so as a result, the rate of new infections went down dramatically. So dramatic was this outcome that a move was started to try and test everyone, that’s everybody, in order to cut down the spread of the scourge. Note that even pregnant women with HIV who had been treated did not pass it on to their child. One of Dr. Montaner’s exciting moments took place when he showed Premier Gordon Campbell some of his results. Apparently Campbell grabbed his arm and said “What are we waiting for. With your brains and our money we can make this happen.” Incidentally the cost of treatment has now come down to around $75 per year and if taken always, a normal life can ensue. Of course the long term hope is that an actual vaccine would be discovered which would alleviate the need for life-long medication but this is not coming soon. Currently they are working on a program called 90 90 90 by 2030 which requires that 90% of people will have been tested, 90% of those infected are treated and 90% of those treated are living normally. The program received much support from many sources – except from our Mr. Harper who suggested that this work would encourage prostitution!
It goes without saying, that Dr. Montaner is a strong supporter of safe injection sites which can remove the danger of HIV transmission among drug users resulting from shared needles, in spite of Ottawa’s view that such things encourage bad behaviour!
Question: What is the situation in South Africa?
Answer: In this respect it is doubly tragic to recall that in South Africa the then president of the country Thabo Mbeki was convinced that AIDS was not a result of HIV infection and he prohibited the use of anti-retroviral drugs and the ban was not lifted until 2003. Not surprisingly South Africa suffered an appalling spread of AIDS in that period. The great regret is that Mandela could probably have changed this course of events but was too busy with other momentous changes in the country.
Question: Where did HIV/AIDS come from and are we likely to see similar new diseases like this?
Answer: AIDS has been traced to a remote group of monkeys in Gabon. The monkeys were being used for food by a small tribe, and in handling the raw meat a virus leap was made. With better transportation from a new highway through Gabon, truck drivers stopping in Gabon for “comfort” readily picked up the virus, and in due course it spread from there around the world.
Yes, more outbreaks of diseases like AIDS, SARS and avian flu will probably be caught from other species. This can be expected.
Question: In the well-known gay communities of San Francisco and New York has your kind of treatment been adopted?
Answer: Yes, it is widely used. The trouble with controlling the spread of HIV is that testosterone is such a powerful drive and people are going to have sex in one form or another so widespread education in this matter is essential.
Question: Which is most frustrating to you – the disease or the government?
Answer: This question prompted an extensive description of Government penny pinching at all levels of government and in summary he suggested that the health system does not serve the people but simply serves the bureaucrats and politicians.
Question: Who should be tested?
Answer: We try to test everyone who comes in the door at St Paul’s, VGH and St. Joseph’s and we find that about one in a thousand have totally unexpected HIV. This is progress in that it stops the spread from these sources. These are the most dangerous people because they don’t know they have it and so take no precautions to protect their partners.
Question: People get prescriptions and don’t fill them or don’t take their meds. What to do?
Answer: There is no clear answer – but it seems to be a social problem in that some patients have “more pressing” problems such as food, shelter, other comforts, and medications are not a priority – very difficult to change these habits.
Don Newman graciously thanked the speaker.
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