Saturday, May 14, 2011

Reflections on 30 years of HIV - Lessons Learned - Allan Ronald MD -CMDS 2011

I was fortunate to have Dr. Ronald as my teacher in medical school.  He was one of the most favourite teachers then.  I remember the fear in the first days of HIV when it was an unknown disease and transmission uncertain.  Dr. Ronald was always courageous.  It's now so apparent that his Christian faith and walk were so much a part of his character and excellence.. It was a priviledge to hear Dr. Ronald again.  "I"m an internist, " he said. "All an internist has is pills and love." Dr. Ronald is a very humble man. In addition to the Order of Canada, this last week he received four awards of medical  excellence. CMDS awared him and his wife Myrna, the Doeksen award for Distinguished Christian Service for a Doctor and his or her partner. He seemed glad at last to share an award with his wife, Myrna. In accepting he didn't talk about himself but rather told a story of how Myrna had brought faith to a grieving scientist.
These are some of the notes I took from his slide and talk.  As one of the speakers said, there are medical 'giants' in the rooms of CMDS.  I so enjoy the annual meeting for the high calibre of CME that comes as part of the package. Working with infectious diseases and HIV in the addicted populations I treat I was thankful for this update.

Prostitutes rapidly infected (70% by 1986)  with subsequent spread to clients, wives, infants, - core populations hypothesis  (we have serum from prostitutes prior to 1980 and there is no HIV)
Not terribly infectious - 50% of couples where one is infected - haven’t transmitted after 12 months of marriage with unprotected sex
Concurrent STI’s particularly chancroid and HSV2 increase transmission by 3-8x (we published this in Lancet in late 80’s)  Epidemic can spread so quickly with chancroid.
Foreskin doubled chance of HIV.  50% uncircumcised with same risk behaviour
Recognition of 10% of prostitutes were ‘resistant’ to HIV despite long term sex with infected partners - began the major ongoing studies of a HIV vaccine led by Dr. Plummer.  (?If these sex workers leave and then some time later reenter sex trade a third of them develop the disease suggests  immune phenomena?)
Role of breast feeding in transmission  20% transmission.  (at least 50 to 55% don’t get infected )  We are treating these mothers during pregnancy and delivery so there is no detectable virus in breast milk.
Role of concurrency (15-25%) of men in transmission
Education, more income doesn’t reduce HIV - 9% of top quartile vers. 4% of lowest in Uganda  (this shows in Africa - AIDS makes people poor, poverty doesn’t make AIDS)
Training of 70 Kenyans with Masters or PHD
HIV Facts
HIV due to a virus that actually isn’t very infectious .3% chance of transmission penile vaginal sex act
2011 No Vaccine. No cure
An average of 8-9 years from infection until illness - then death for 80% within 2 years without HAART
HIV destroys the immune system; death occurs with TB, unusual infections , unusual tumors, HIV itself.
Since 1997 antiretroviarl treatmnet (can be one pill day) sustains life shortened by 10 years in Canada
Still expensive $15,000 a year, $500,000 a life time
Our Sexuality
Wonderful gift
Often not ‘logical’
Important but poorly understood biological drive
Rarely addressed effectively and Biblically within our Christian community
There is greater need for open discussion of sex

There was much more in the lecture. The question and answer period was especially helpful.  This is just a glimpse. Dr. Ronald said there are 50 things we know we should be doing about HIV.  We should always look to see if we're doing these 50 things and rate each item from A-F.
Asked by a colleague why he had done so much for the poor in Africa, he said, he thought about it and could only respond, "It was the right thing to do."
IMG 1877

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