“It’s no longer a death sentence” – Advances in treating HIV/AIDS have saved lives
Dr. Gary Rubin has worked with HIV/AIDS patients in Canada for more than 25 years — and his job is a lot easier than it used to be. “In my time as a physician, a disease that previously didn’t exist emerged, and was almost universally fatal,” Dr. Rubin says. “We found the cause, we found an effective treatment, we learned how to prevent it and we completely turned it around so that it’s no longer a death sentence. thanks to the diligent work of physicians, scientists, pharmaceutical companies and the community, there are few diseases I can think of where any physician could say that.”
today, most of the people he sees with HIV/ AIDS are put on a singledose, daily medication and return to his toronto clinic for regular check-ups and tests. If they follow that protocol, he says, they can usually have a good quality of life, and around the same life expectancy as the general population.
But back in the 1980s and early 1990s, an HIV-positive diagnosis was effectively a death sentence. “My colleagues and I always had blank death certificates in the trunks of our cars,” says Dr. Rubin. those infected often developed chronic infections and had visible cancers on their faces and bodies and, as the number of new cases increased, so did the stigma around being labelled HIVpositive.
It was a time when AIDS provoked widespread terror. those diagnosed often had a very poor quality of life, with no treatment options and no hope for recovery. “Often when we were asked to make a house call it was because another patient had died,” Dr. Rubin recalls. “It was just that bad.”
Dr. Stephen Shafran, an infectious disease expert at the University of Alberta, has similar recollections of his time as a doctor on the front-lines of the HIV/ AIDS epidemic.
“People were dying all the time in their thirties and forties. they would develop a complication for which there were no effective treatments,” he says, adding it was probably well into 1984 before the scientific community was convinced they had found the virus responsible for the disease. “that’s when scientists in academia and in pharma came up with strategies to find out what the essential proteins necessary for the virus’s replication were, and whether we could come up with inhibitors for the essential proteins the virus needed to reproduce itself.”
Dr. Shafran was in iew Orleans in 1986 when data on the first AIDS therapy AZt was presented to the world. the antiretroviral medication was introduced at a time when there was an urgent call for an answer to the AIDS epidemic. With so much at stake, and millions of people infected with the HIV virus around the world, AZt was approved for use by public health officials in record time.
“It was the first therapy, and it wasn’t a very good therapy, but it did buy patients some time,” Dr. Shafran notes. “Up until then we could only treat the treatable complications.”
AZt was hailed as a major leap forward in the battle against HIV/AIDS, but there were serious side effects and limits to its effectiveness. taking just one drug wasn’t enough. In some patients the virus mutated so that the AZt therapy was powerless to stop the disease. A major breakthrough came in 1996, at an HIV/AIDS congress held in Vancouver. the conference, recalls Dr. Gary Rubin, introduced a new treatment called HAARt (highly active antiretroviral therapy).
“Hit the virus early, hit the virus hard. Don’t use one drug, use three drugs and different classes of drugs,” Rubin says. the breakthrough reduced the risk of the virus mutating and developing resistance and led to plummeting death rates. In 1995, 1,764 people died from HIV/ AIDS in Canada. After the introduction of the combination antiretroviral therapy, the mortality rate dropped by 83 per cent to 303 deaths in 2011.
the new treatments discovered in the mid1990s set the stage for more advances, and the current phase of therapy with single-tablet regimens. A young person diagnosed with HIV today, who starts treatment shortly after being infected, can expect to live into their 70s and longer.
there remain important challenges for doctors. Rates of new HIV infections haven’t dropped in Canada, despite decades of public health campaigns. Canada’s Indigenous communities are overrepresented in terms of incidence of infections, especially in Manitoba and Saskatchewan. An effective vaccine, and cure, are still a long way off. Still, new discoveries have revolutionized treatment for HIV/AIDS. Once a lethal disease with a nightmarish impact, the HIV virus is now handled as a chronic condition, similar to diabetes. In fact, Dr. Shafran says that diabetes is actually more difficult to manage on a day-to-day basis than being HIV-positive.
“Where we are now is just stunning,” he says. “We can basically suppress the virus in almost everybody with one pill a day. [these therapies have] an incredibly good safety profile and it’s an incredible story.”