BC Health Minister Terry Lake (left) with Dr. Julio Montaner, director of the BC-CfE.

Controlling Outcomes in the Next Lethal Health Crisis

Promise Magazine: Fall/Winter 2016
by Melissa Edwards

Nearly three decades ago when HIV first rocked BC, the Ministry of Health took action, founding the BC Centre for Excellence (BC-CfE) in HIV/AIDS at St. Paul’s. The BC-CfE, with Dr. Julio Montaner as the director of clinical activities, pioneered triple drug therapy, introduced viral load testing and monitoring, and simplified and supervised therapy programs, all to promote and facilitate access to life-saving therapy for those in need.

In 2004, Dr. Julio Montaner became the director at the BC-CfE, and he expanded the centre’s focus to explore the possibility of treatment as a means of preventing HIV transmission. In 2006, based on work done in BC, Dr. Montaner formally proposed a new global strategy for the control of HIV and AIDS: Treatment as Prevention® (TasP®).

The model maximizes patient access to immediate treatment, care and support – to reduce HIV-related morbidity and AIDS mortality – and prevents the spread of HIV. The World Health Organization and the United Nations have formally endorsed TasP® as the new global standard under the related UN 90-90-90 target, which, if implemented successfully, would bring about the end of the AIDS pandemic by 2030.

And now a new health crisis is looming – a dangerous virus called hepatitis C. Armed with $5 million in new provincial funding, the BC-CfE is once against stepping up to stem the tide.

Hepatitis C is a potentially fatal blood-borne illness that slowly attacks the liver, leading to cirrhosis, liver cancer or total liver failure if left untreated. It has already infected more than 60,000 British Columbians, many of whom don’t even know they have it. The virus is transmitted through blood-to-blood or sexual contact, and those infected can pass it along unknowingly for up to 30 years before symptoms even appear.

Dr. Montaner calls hepatitis C “a perfect storm heading our way.” In BC alone, about 2,500 new cases of hepatitis C are diagnosed every year – the highest rate of infection in Canada. Transmission of the disease spiked from the 1950s to ’70s, so those born between 1946 and 1964 are at particular risk – which is why testing is important.

“Now is the time to act if we want to prevent late stage liver disease and further spread of hepatitis C infection in the province,” says Dr. Montaner. It’s also why he’s made hepatitis C infection as the next focus of the TasP® model as part of a Targeted Disease Elimination strategy that has proven so effective in controlling HIV in BC and around the world.

The good news in this battle is that, unlike with HIV, once hepatitis C is diagnosed it can be cured within a few weeks. However, treatment doesn’t protect against reinfection after its completion, so it’s critical to understand how to optimize the long-term response.

Preventing re-infection among people with addictions or mental health disorders who have already been treated for hepatitis C – and cured – is a critical aspect of the cascade of care.

“We’ve learned a great deal,” says Dr. Mark Hull, a clinician researcher at the HIV-Hepatitis Co-Infection Clinic at the BC-CfE. “We know the importance of a team approach, the role of high-risk groups and harm reduction behaviour and the importance of outreach. It’s a very exciting time to be treating hepatitis C.”

To learn more about how you can support St. Paul’s effort to eradicate hepatitis C, visit helpstpauls.com.

St. Paul's Foundation