ARCHIVED - Your Health Research Dollars at Work 2005-2006

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HIV/AIDS

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The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. Through CIHR, the Government of Canada invested approximately $36 million in 2005-06 in research on HIV/AIDS across Canada.

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The Facts

• Human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). The virus mutates rapidly, creating new strains that make it hard to detect, prevent and treat. While treatments exist, they are costly and not readily available in developing countries. There is no cure for AIDS.
• The HIV virus is transmitted by the transfer of blood and semen through such activities as sexual intercourse and the sharing of needles. It can also be transmitted by infected mothers who breastfeed their infants.
• The first case of AIDS in Canada was reported in 1982. By December 31, 2005, there were a total of 60,160 positive HIV test reports in Canada.
• In 2005, around four million adults and children became infected with HIV worldwide. By the end of the year, an estimated 38.6 million people were living with HIV/AIDS. The year also saw almost three million deaths from AIDS. More than 95% of new HIV infections were in low- and middle-income countries.
• Women accounted for half of all new HIV infections among adults over the age of 15 worldwide in 2005. In Canada, women accounted for one quarter of positive HIV test reports, an increase from the period before 1996, when they accounted for just 10% of such tests.
• In 2003, 14.4% of Canadian AIDS cases with known ethnicity were Aboriginal people. Compared to the general population, Aboriginal people who test positive for HIV are more likely to be female, under 30 and have been infected through injection drug use. A high proportion of HIV-infected pregnant women are Aboriginal.

Research Finding Solutions to HIV/AIDS

• CIHR-funded researchers at Toronto's Hospital for Sick Children, University of Toronto, led by Dr. Clifford Lingwood, have found a novel molecule that prevents many types of HIV, even drug-resistant strains, from infecting different kinds of cells. The molecule binds to the virus and prevents it from fusing with the host cell. The molecule is soluble, making it particularly promising for use in a topical microbicide that women can apply before intercourse to prevent transmission of the virus.

• A CIHR-funded researcher from the Université de Montréal, Dr. Louis de Repentigny has identified defects in immune cells that give rise to a fungal infection commonly found in HIV patients called candidiasis. The infection can limit food consumption, leading to weight loss, which threatens patients' general health and well-being. The infection is often resistant to conventional antifungal treatments. The new knowledge will help in the development of more powerful and effective treatments for the fungal infection.

• CIHR-funded researcher Dr. Mario Ostrowski at the University of Toronto is using state-of-the-art techniques in immunology and virology to design a new, improved version of an HIV vaccine made from the canarypox virus. Clinical testing of an earlier version of the vaccine found it did not create a strong enough immune response to be effective. Once the new vaccine is developed, it will be tested in mice and monkeys and, if successful, it will move on to clinical testing in humans.

• For many HIV patients, staying healthy means adhering to one's drug treatment therapy. A positive attitude toward taking medication and a strong sense of self-efficacy were the most significant predictors of adherence to antiretroviral therapy, according to a study out of Université Laval. Led by CIHR-funded researcher Dr. Gaston Godin the study also found that not living alone and being a male were other predictors of success. Information such as this is important in designing programs that can be used to improve adherence to treatment programs.

• Working with a group of HIV-resistant female commercial sex workers in Nairobi, Kenya, CIHR-funded researcher Dr. Keith Fowke of the University of Manitoba was part of a team that has found that women who are resistant to HIV respond differently to a peptide called p24, which could result in a longer lifespan for a group of immune response cells known as CD4+T cells. This information will be valuable in designing and developing an effective HIV vaccine.

• People who are exposed to HIV without becoming infected are more likely to have immune responses to HIV than those who are at low risk for exposure, according to research by CIHR-funded researcher Dr. Nicole Bernard of McGill University. These immune responses appeared to protect the uninfected people exposed to HIV from infection, regardless of whether their exposure to the virus came through injection drug use or sexual behaviour.

In the Pipeline...
Getting the Needed Treatment

Anyone in British Columbia infected with HIV can receive medication at no cost - but many people aren't getting the drugs they need to stay alive. In 2003, one third of people who died of HIV-related causes did not receive treatment - many of them residents of Vancouver's Downtown Eastside, known for its high population of injection drug users (IDUs). The lowest life expectancy for HIV-positive individuals in the province is among IDUs not receiving anti-HIV treatment. It is believed that 35% of the city's estimated 15,000 IDUs are currently infected with HIV.

Dr. Thomas Kerr of the B.C. Centre for Excellence in HIV/AIDS wants to improve access to HIV treatment for these people, by examining the barriers they face to gaining access to treatment. He will examine the influence of law enforcement, addiction treatment levels and psychological variables, as well as socio-economic issues such as unstable housing, on access and adherence to treatment. His work could lead to the development of more effective interventions targeting this high-risk population.

The Researchers...
Dr. Julio Montaner - Exemplifying Excellence

Twenty years ago, men started showing up at St. Paul's Hospital emergency room in Vancouver with fatal pneumonia. No one knew what it was. All that was known was that the men were young, previously healthy - and gay.

These were among the earliest victims of AIDS. In the past 20 years, AIDS has dramatically been transformed from a lethal epidemic into a chronic and manageable condition with highly active antiretroviral therapy (HAART).

Dr. Julio Montaner was at the forefront of that transformation. He has been involved with HIV/AIDS clinical trials for more than 20 years. He is widely acknowledged as one of the fathers of modern HAART. He has also published hundreds of research papers and was the first to report that antiretroviral therapy can be started later than previously believed without adverse effects on the patient. His current research focuses on developing and testing new treatments for people who are not responding to the standard antiretroviral therapy and new strategies to curb the growth of the epidemic. And now he is poised to become President-Elect of the International AIDS Society in August 2006.

Dr. Montaner received his training in Argentina, coming to Canada in 1981 as a postdoctoral fellow at St. Paul's Hospital and the University of British Columbia. The benefits of conducting research in Canada keep him here. Among them is Canada's public healthcare system, which means that there is a standard of care to which all people with HIV/AIDS have access. As a result, he can focus on the more difficult questions, such as why some patients don't respond to antiretroviral therapy and how to reduce its side effects. Another pressing issue involves how to reach populations, such as Aboriginal injection drug users, who do not tend to receive treatment to the same degree as others infected with HIV. The Canadian HIV Trials Network provides an integrated approach that reinforces Canada's strengths in HIV/AIDS clinical trials.

Dr. Montaner is a fierce advocate for his patients, recently expressing his "moral outrage" that Health Canada had approved more than 21,000 requests for banned silicone breast implants while continuing to deny patients with advanced HIV access to potentially live-saving drugs.

Now, Dr. Montaner would like to see Canada take its leadership role in preventing, treating and managing HIV/AIDS into the international arena. Canadian researchers, he says, can help to translate our achievements into global advances, and help end the devastation that HIV/AIDS is causing throughout so much of the world.

The CIHR Institute

CIHR's Institute of Infection and Immunity leads CIHR's efforts in the fight against HIV/AIDS. It manages the research arm of the Federal Initiative to Address HIV/AIDS in Canada. With the assistance of the CIHR HIV/AIDS Research Advisory Committee, the Institute is identifying research priorities and undertaking collaborative research initiatives to reduce the burden of HIV/AIDS domestically and internationally.

About CIHR

The Canadian Institutes of Health Research (CIHR) is the Government of Canada's agency for health research. CIHR's mission is to create new scientific knowledge and to catalyze its translation into improved health, more effective health services and products, and a strengthened Canadian healthcare system. Composed of 13 Institutes, CIHR provides leadership and support to more than 10,000 health researchers and trainees across Canada.

Canadian Institutes of Health Research
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http://www.cihr-irsc.gc.ca/