Julio Montaner

Julio S. González Montaner (born April 13, 1956) is an Argentine-Canadian physician, professor and researcher. He is the director of the British Columbia Centre for Excellence in HIV/AIDS, the chair in AIDS Research and head of the Division of AIDS in the Faculty of Medicine at the University of British Columbia and the past-president of the International AIDS Society. His father initially doubted that Montaner would follow in his footsteps, but after entering medical school, he developed a passion for medicine. His initial research focused on animal models of acute lung injury. Montaner initially planned on returning to Argentina after completing his fellowship.

Research Respiratory medicine research

As a post-doctoral fellow and resident, Montaner's research was initially focused on respiratory medicine. Montaner and his colleagues found that oral corticosteroid treatment administered early to AIDS patients experiencing their first moderate to severe P. carinii pneumonia episode prevented early deterioration and improved oxygen saturation, a key indicator of survival in PCP patients. Montaner and the study's co-authors found that only 5.6% of the patients given Prednisone (a corticosteroid) reached the study-end point of a 10% decrease in oxygen saturation compared to 42.1% of the patients on the placebo drug. At the XI International AIDS Society-USA (IAS-USA) Conference in 1996, Montaner presented the findings of the INCAS group, which consisted of HIV-positive cohorts in Italy, Netherlands, Canada, Australia and the United States. Montaner said about the discovery: "The sense of excitement was absolutely palpable. It was incredible. Within months, mortality, death rates and progression to AIDS among people taking triple therapy was down to nothing. This happened in Vancouver." The paper demonstrated their findings of a greater decrease in plasma HIV-1 RNA (an indicator of HIV viral load) in patients treated with the combination of the three drugs as opposed to patients treated with a regimen of only two of the drugs, which was the standard of care in the mid 1990s. The results indicated that a high baseline plasma viral load, poor adherence and the inclusion of non-nucleoside reverse-transcriptase inhibitors (NNRTIs) in the initial drug cocktail were all predictors of development of antiretroviral resistance. Montaner and the BC-CfE continue to focus research efforts on multi-drug resistance and its predictors. In 2006, Montaner, Robert Hogg, and colleagues at the B.C. Centre for Excellence in HIV/AIDS published an article in The Lancet promoting early and global access to HAART treatment as a strategy not just to decrease mortality and progression to AIDS, but also as a method of reducing HIV transmission. HAART treatment has been found to reduce viral load to undetectable levels in the female genital tract, semen and blood. This suggested that Treatment as Prevention was a cost-effective strategy, based on an estimated lifetime treatment cost of $241 000 in 2001 in the United States for a new HIV infection. Montaner and his colleagues created a hypothetical population-based model that demonstrated that with worldwide access to HAART, the short-term cost would be much less compared to the long-term cost of treating new infections as a result of the decrease in transmission rate. In a 2011 article published in Lancet, Montaner stated that "The evidence is in: treatment is prevention. Treatment dramatically prevents morbidity and mortality, HIV transmission, and tuberculosis. Furthermore, treatment prevents HIV transmission in vertical, sexual, and injection drug use settings; indeed, a very welcome double hat-trick. The challenge remains to optimise the impact of this valuable intervention. Failure to do so is not an option." Montaner cited the findings of the landmark study HPTN 052, that HAART use can reduce HIV transmission by 96% in sero-discordant heterosexual couples, as compelling evidence for implementing the "Treatment as Prevention" Strategy. These findings supported the BC-CfE's finding of a negative correlation between an increased number of HIV positive individuals on HAART and new cases of HIV. The 2010 Lancet study demonstrated a population-level association between increased HAART coverage and decreased viral load and new HIV infections, which supported the idea of decreased HIV transmission as a secondary benefit of expanding HAART coverage. This program is based on Cohen's HPTN 052 research supporting Treatment as Prevention and aims to expand access to HAART among hard-to-reach and vulnerable populations in the Downtown East-Side area of Vancouver. Montaner has co-authored many studies on the effect of safe injection facilities on drug overdoses and deaths, HIV and Hepatitis C infections and the spread of other blood-borne pathogens. The research of Montaner and his colleagues was instrumental in the Supreme Court of Canada's 2011 ruling in Canada (AG) v PHS Community Services Society, which allowed Insite's exemption status to continue.

Current research interests

Montaner's current major research interests are harm reduction (including safe injection sites and needle exchange programs), treating hard-to-reach HIV-positive populations, and developing new antiretrovirals. Kerr was diagnosed with HIV in the 1980s and over time, had developed resistance to every HIV drug on the market due to being treated with single-drug therapy in the early 1990s before the discovery of triple-drug therapy. Montaner pressured Health Canada to allow Kerr and five other patients with drug-resistant HIV to receive two experimental HIV drugs, TMC114 and TMC125.28 The drugs had not yet been released to market in Canada due to concerns about drug toxicity.

Controversy surrounding the treatment as prevention strategy Under Montaner's leadership, the Center for Disease Control and Prevention in China and the B.C. Centre for Excellence in HIV/AIDS created a new Fellowship program in 2013 to help incorporate the "Treatment as Prevention Strategy" as China's national response to HIV/AIDS. Brazil, Australia, the United States and France have also implemented "Treatment as Prevention" as a strategy for fighting HIV/AIDS. The World Health Organization has also incorporated the strategy into its Global HIV Treatment Guidelines.

This followed after years of frustrated advocacy by Montaner who stated his belief in 2012 that the stigmas associated with the transmission routes of HIV are responsible for the Canadian government's hesitancy to embrace the strategy in an interview with the Globe and Mail.

Honours and recognition 2009 – inducted in the Royal Society of Canada – The Academies of Arts, Humanities and Sciences (RSC). 2010 – Order of British Columbia in part for his work developing the Treatment as Prevention strategy, resulting in a decrease in HIV/AIDS infections and mortality. 2010 – Doctor of Science Honoris causa from Simon Fraser University. 2010 – Albert Einstein World Award of Science, awarded as "means of recognition to those persons who have accomplished scientific and technological achievements which have brought progress to science and benefit to mankind" for his leadership and development of novel HIV treatment strategies with worldwide impact. 2010 – Inaugural Aubrey J. Tingle Prize from the Michael Smith Foundation for Health Research for his contributions to advances in treatment and care of people living with HIV. 2010 – Prix Galien Research Award for his role in altering the management of HIV positive patients and for his discovery leading to the introduction of HAART triple therapy as the standard of care for HIV/AIDS. 2011 – UBC Jacob Biely Prize awarded "yearly to an active faculty member for a distinguished record of research publication" for his extensive research in HIV/AIDS. 2012 – Grand Decoration of Honour for Services to the Republic of Austria from the president of Austria for his HIV/AIDS research and development of novel treatment strategies. 2012 – Queen Elizabeth II Diamond Jubilee Medal for his work in groundbreaking HIV Research and as "recognition for his outstanding commitment and contributions to end the epidemic and to improve the lives of people living with and affected by HIV, both in Canada and internationally." (Albert McNutt, chair of the Canadian AIDS Society board of directors). 2013 – HRF Medal of Honour for his leadership and commitment to advancing HIV/AIDS treatment worldwide and improving the lives of HIV positive individuals. 2013 – Frederic Newton Gibson (F.N.G.) Star presented annually by the Canadian Medical Association to "individuals who have made outstanding contributions to science, the fine arts or literature, or by achievements in serving humanity under conditions calling for courage or the endurance of hardship in the promotion of health or the saving of life, in advancing the humanitarian or cultural life of his or her community or in improving medical service in Canada" for creating a global prototype for HIV/AIDS control. 2015 – Canadian Medical Hall of Fame