After 30 years, HIV fight goes on
Canadians have played key roles in battling the infection that causes AIDS
Paul Volberding was treating his first patient on his first day as an oncologist in San Francisco when he got a glimpse of what would quickly become the world's HIV epidemic.
It was July 1, 1981. Volberding was 31 and had just completed his training in cancer medicine. His patient was a 22-year-old man with Kaposi's sarcoma, an obscure skin cancer that covers its victims in splotches of red lesions.
"I had never seen a case like this. He was a striking case in being so wasted away and really very sick," Volberding recounted.
The patient died weeks later. Meanwhile, other cases of typically healthy, young men with rare pneumonias and infections started to pour into hospitals, pushing baffled doctors to return to an article published a month earlier on the first cases of what was later named human immunodeficiency virus - or HIV.
"We were completely mystified at first. We knew it was bad; there was really nothing we could do to reverse the course of the disease," said Volberding, a University of California medical professor and former AIDS International president. "There was a lot of fear, especially when it became clear that this must be a new infection and we didn't know how it was transmitted, what the incubation time was and who might be at risk," he said.
Today marks the 30th anniversary of the first documented cases of HIV, an infection that quickly grew into a devastating pandemic that brought the international medical community to its knees.
Thirty years after the discovery, the landscape of HIV/AIDS has changed dramatically. Cases have plummeted in British Columbia, where antiretroviral therapy is free. In contrast, they've climbed in the Prairies due to lack of access to treatment in First Nations regions, according to Julio Montaner, the director of the BC Centre for Excellence in HIV/AIDS, who is internationally recognized for his HIV treatments.
On June 5, 1981, researchers at the United States' Centers for Disease Control reported the first cases of what was later named HIV in five young homosexual men who had pneumocystis pneumonia, a lung infection associated with the virus; two of the men had already died.
The disease trickled into Canada by 1983 and quickly became an "explosion," according to Mark Wainberg, a McGill University biologist and the first scientist in the country to run an HIV lab. There were at least 10,000 cases in Canada by 1990 and more than 75 per cent of those infected died, he said.
"We were talking about a virus that was spreading like wildfire," he said, noting that the epidemic devastated the country's gay community.
Montaner said the epidemic was disproportionately represented in Toronto, Vancouver and Montreal although it appeared across the country.
Volberding said he remembers patients coming into the hospital with tumours coating their skin. Healthy men were suddenly blinded. Others had parasitic infections, chronic fevers or fungal infections in their mouths as their immune systems deteriorated.
"There was no test at the time. These were young men who tended to stay home to consider it the flu or something until they couldn't stand it any longer," he explained. "They looked like they were starving to death. Everybody died."
Experts carried on with their research to help their dying patients, even though critics suggested their efforts were pointless.
"There was a lot of stigma, a lot of frustration, a lot of isolation. Things were pretty dark in those days," said Montaner, whose work was applauded by the United Nations last year.
Today there are 75,000 Canadians living with the virus with another 3,300 people infected annually. Based on current trends, the number is expected to double by 2025.
More than 33 million people - roughly Canada's entire population - are infected with HIV worldwide, at least 7,700 people become infected with HIV each day and nearly 5,500 die daily from an AIDS-related illness. Two-thirds of the world's HIV and AIDS patients live in subSaharan Africa. AIDS has claimed 30 million lives.
Still, today is a milestone for celebrating the dramatic progress the country has made in pioneering a treatment for the disease, the experts say.
Researchers in the field have advanced in understanding a virus that had once delivered an automatic death sentence to what is now considered a chronic condition because of madeinCanada medical therapy.
At July 2010's International AIDS Society conference in Vienna, Montaner's anti-HIV treatment was hailed by the United Nations' AIDS panel as the fundamental prevention strategy to fight the pandemic.
Montaner led research that was first in the world to confirm that highly active antiretroviral therapy, or HAART, led to a significant decrease in diagnoses of HIV. HAART, a cocktail of three drugs taken daily, was first implemented in 1996 to stop HIV from progressing into AIDS, to extend life expectancy and to reduce HIV-related deaths.
Emerging from the results was also a reduction in the emergence of new cases because the cocktail lowers the viral load of those who are HIV positive to the point where they are less likely to transmit the virus to their partners.
For every 100 patients using HAART, scientists recorded a three per cent decrease in HIV diagnoses in B.C., according to Montaner's work. His findings were recently supported by the National Institutes of Health, whose own evaluation confirmed that HAART decreased HIV transmission by over 90 per cent.
"Today, you can tell a woman infected with HIV that if she joins the treatment program and she takes the medicine appropriately, the longevity of her life will be assured, the quality of her life will be protected ... her child will not be affected and she will be around to see that child graduate university," Montaner said. "You'd never see this kind of progress in medicine ever in a century, let alone in three decades. [Canadian] fingerprints are all over this development and we should be proud of it," he said.
Vancouver resident Tiko Kerr is one of the Canadians who was diagnosed at the onset of HIV and has lived through the epidemic.He tested positive in Sydney, Australia, in 1985 when he was 32 years old. He said his doctor told him to return to Canada to "sort out his affairs."
"Everybody I knew was dropping like flies. I would see them on the street one day and you'd hear that they'd passed away literally two weeks later," he said.
Still, Kerr tried each new treatment available with some that were effective and others that left him with painful side effects. At 58, he is healthy and takes half a dozen drugs administered every 12 hours but still fresh in his memory are the decades of bouncing in and out of hospitals for bouts of pneumonia, skin infections and problems with his liver.
"There was a period of time where I was taking 80 to 90 pills a day and barely hanging on," he recounted.
HIV is still most common in Ontario, Quebec and BC but the fastest growing epidemic is in Saskatchewan, where about 200 people are diagnosed each year.
HAART is used across the country, and also in parts of the US, including San Francisco, New York and Washington, DC. In February, China adopted the BC Centre for Excellence in HIV/AIDS' "treatment as prevention strategy" to help its 740,000 people infected with HIV.
Watching the first generation of those on HAART therapy hit a decade of healthy living, Montaner is convinced international officials should provide global access to the medication. It is available worldwide but only 30 to 40 per cent of patients receive it.
"The next decade is going to be about implementing what we know so that we can fulfil our dream of having an HIV/AIDSfree generation, hopefully in my lifetime," Montaner said. "Because the truth is, we can do it."