An update on HIV research and care, nearly two years into the COVID-19 pandemic
On the occasion of World AIDS Day, we spoke with Dr. Jean-Pierre Routy, Clinical Director of the Chronic Viral Illness Service at the MUHC, Senior Scientist in the Infectious Diseases and Immunity in Global Health Program at the Research Institute of the MUHC and Director of the FRQS AIDS and Infectious Diseases Network. Dr. Routy is also the co-chair of the International AIDS Conference 2022, which will be held from July 29 to August 2, 2022, in Montreal.
Dr. Jean-Pierre Routy
To mark World AIDS Day, you have organized an event to pay tribute to the pioneers of Quebec’s HIV-AIDS response.
Yes. We want to pay tribute to the doctors and field workers who initiated the fight against AIDS in Quebec 40 years ago, to talk about the progress that was made and commemorate HIV victims. Hosted by Yanick Villedieu, science journalist at Radio-Canada, the evening will include testimonies from some of the pioneers, as well as literary reading selected by author Catherine Mavrikakis, and read by Jean Marchand.
You talk about progress… What is the status of HIV/AIDS research today?
After 40 years of research, there is still no effective HIV vaccine. The challenge is to develop an HIV vaccine that does not create inflammation, and so far, this has not been successful.
In fact, the “superpower” of HIV is that it infects cells when they enter an inflammatory phase to fight an enemy. The cells “cry wolf” and the wolf—in this case HIV—infects them more easily because it knows where they are. This mode of action is unique to HIV, which infects CD4 lymphocytes that are central to the coordination of the immune response. Moreover, we know that the colon has more CD4 cells and therefore more HIV, because the cells are more inflamed.
For this reason, recent scientific developments about the gut microbiome is of particular interest to HIV research. Every day, immune cells in the digestive system must stop microbes while allowing nutrient absorption. Alteration of these immune cells contributes to an inflammatory syndrome related to a greater passage of microbial particles into the blood. This regulatory process could be modified by drugs that act in the digestive tract, as suggested in a recent study that we published in PNAS.
On the other hand, where we have failed with vaccines, we have prevailed with antiretroviral drugs, which are now incredibly powerful. These treatments make it possible to achieve and maintain an undetectable viral load and thus to stop sexual transmission—hence the equation undetectable = untransmissible (u=u). People living with HIV, and who follow treatment, no longer transmit the virus. For people who engage in risky behaviours, taking daily medication protects them from acquiring the virus, but not from other sexually transmitted infections.
In both types of treatment, people must take daily medication, which is sometimes difficult. As a result, what is being developed now is a long-acting injectable drug that could protect an individual for six months. A two-month version is already on the market in Canada; its development was delayed by the COVID-19 pandemic. The 6-month version should have a greater impact.
How has the COVID-19 pandemic affected research and care?
Like other diseases, AIDS has been overshadowed by COVID-19. A lot of research money was invested in COVID-19. In many cases, the same doctors who were working on HIV started working on SARS-Cov-2. So obviously, research has slowed down a bit.
On the care and prevention side, the pandemic has affected the follow-up of some patients. Approximately 10 per cent of patients stopped their treatment or interrupted their medical follow-up, which led, for some, to hospitalizations. Some patients lost their jobs and stopped taking their medication due to a drop in income. There has also been a decrease in the number of tests performed, following temporary closure of testing centres. We do not have precise figures yet, but this has certainly had an impact on health and the transmission of HIV.
What are your hopes for the future?
COVID-19 has had dramatic effects around the world but remains benign in the majority of cases. HIV, on the other hand, affects people for life and remains a major source of stigma.
It is important to re-engage and follow the science—the theme of the upcoming International AIDS Conference 2022, to be held in Montreal next summer. We need to re-engage patients, prevention, vaccine research, and the pharmaceutical industry. All of this must be based on science, and that involves fighting anti-immigrant, anti-LGBTQ2+ rhetoric. When it comes to communicable diseases, we must never let our guard down.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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