At the University of British Columbia, Montaner was just finishing up his residency in internal and respiratory medicine when the HIV epidemic exploded onto the world stage. When he was asked to oversee the new HIV unit at St. Paul’s Hospital in 1987, he rolled up his sleeves and got to work. First, by figuring out a way to treat a lethal form of pneumonia that was afflicting AIDS patients. Then, by devising a combination of drugs that, when taken consistently, would render the disease undetectable — a profound advancement in world health.
The year was 1996 and things were looking bleak for people living with HIV and AIDS. Just two years earlier, AIDS had topped the lists as the number-one cause of death for American adults aged 25 to 44. Montaner, piqued by HIV’s tenaciousness and determined to understand its course of operation, led research on an international study into how the disease functions and its response to various drugs. He and his team discovered a potent combination of drugs — a high-efficiency cocktail — that wielded a truly revolutionary power: the ability to prevent HIV from developing into AIDS. Montaner brought it to the world. The discovery, now known as highly active antiretroviral therapy (HAART), has transformed HIV from a death sentence into a manageable condition.
In those early days, Montaner worked with other researchers to convince the BC government of HAART’s cost-effectiveness. The subsequent buy-in from policymakers helped realize a drop of 65 per cent in new HIV cases and a stunning reduction of 88 per cent in new AIDS cases since 1994. This put Vancouver on the map as the birthplace of modern HIV/AIDS therapy.
In 2000, Montaner’s team made another paradigm-shifting discovery: not only did HAART prevent the progression of HIV into AIDS, it also reduced the amount of the virus in the body — blood and sexual fluids alike — to undetectable levels. This decreased viral load cut transmission rates by more than 95 per cent. With this discovery, researchers had in hand a highly effective means for preventing the spread of the disease.
To further reduce transmission and harm, Montaner pushed for the creation of Insite, North America’s first legal supervised injection site where intravenous drug users could get clean needles and access staff nurses who would provide medical care. The result of developing the Vancouver site was clear: “Insite saves lives and tax dollars…benefits include increased uptake into addiction services, reduced HIV risk behaviour and improved public order,” said Montaner. The B.C. government and Canada’s leading medical and public health bodies, including the Canadian Medical Association and the Canadian Public Health Association, have all since endorsed Insite.
In 2006, at the International AIDS Society Conference in Toronto, Montaner and his team unveiled their comprehensive HAART-based strategy: Treatment as Prevention® or TasP® and what is a multi-faceted approach that includes expanded testing, compassionate care and immediate, universal access to treatment through antiretroviral medications. Between 1994 and 2013, TasP® cut the number of new AIDS cases in BC by a staggering 88 per cent. Thanks to TasP®, mother-to-child HIV transmission has been virtually eliminated in British Columbia.
The rest of the world has since come around to the idea of HIV treatment upon diagnosis. In 2015, the World Health Organization adopted this standard in its HIV treatment guidelines. Today, HAART continues to be the international gold standard in HIV treatment.
Currently, Montaner heads up UBC’s Division of AIDS and is the director of the UBC-affiliated BC Centre for Excellence (BC-CfE) in HIV/AIDS. He is a global leader in the fight to eliminate the disease and is tireless in his pursuit of improving the health of those living with HIV and AIDS. He is similarly intent on eliminating other communicable diseases that are major health burdens around the world, such as hepatitis C.
Today, an ever-increasing number of governments and medical authorities around the world — including China, Brazil, Panama, Spain, France, the state of Queensland in Australia, and major cities in the United States — have embraced TasP® as an HIV/AIDS treatment model. The BC-CfE is currently working with Indiana University to apply TasP® to a rapid outbreak of HIV in a rural region of the state, linked to expanding injection-drug use.
The United Nations is also on board. UNAIDS, the UN body tasked with addressing HIV/AIDS, has created a 90-90-90 global strategy based on the principle of TasP®. The plan is to diagnose 90 per cent of those living with HIV, treat 90 per cent of those diagnosed, and render the viral load undetectable in 90 per cent of those undergoing treatment by 2020.
The UN embraced this far-reaching objective in 2015 as one of its Sustainable Development Goals. This followed a major milestone reached that same year: the UN Millennium Development Goal of 15 million people worldwide on HAART treatment worldwide.
These positive advancements bring optimism to the mission of ending AIDS by 2030, the ultimate goal of UNAIDS’s 90-90-90 target. Montaner continues to fight for ever-wider political buy-ins in order to achieve this ambitious — but reachable — feat in BC, Canada and the world.
What can you do to help the way forward? An estimated 25 per cent of individuals living with HIV in Canada are unaware of their HIV status. Get tested and talk about HIV with those you love.