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the innovative mind

Julio Montaner followed his physician father’s golden rule – that a combination of drugs can be more effective than one alone in treating infections – as he pushed AIDS treatment forward.Darryl Dyck/The Globe and Mail

Julio Montaner's medical breakthroughs have helped save millions of lives. Many were inspired by one simple piece of advice from his father.

Dr. Montaner's dad was a noted pulmonary specialist and expert on tuberculosis, which was a problem in their native Argentina. Julio Gonzalez Montaner told his son to treat the stubborn respiratory disease with a combination of drugs – one alone was not enough.

The younger Dr. Montaner leveraged this concept in the mid-1980s when, as a pulmonary specialist himself, working at St. Paul's Hospital in Vancouver, he kept encountering patients suffering from a previously rare form of pneumonia.

He hypothesized that while these patients seemed to have suppressed immune systems, their immunity was also acting erratically – they had inflammation, too. He treated them with steroids to curb the inflammation, then antibiotics to zap the pneumonia infection. It worked.

As it became clear that these patients were also suffering from an underlying new disease that would eventually be labelled HIV/AIDS, Dr. Montaner went to a conference in California and shared his discovery. His approach quickly became the standard of care for pneumocystis pneumonia, which often affected people with HIV/AIDS.

Years later, as head of the hospital's AIDS clinic and research program (launched in the late 1980s with Dr. Montaner as the only devoted employee, plus a half-time secretary), he realized his father's golden rule might work again.

Dr. Montaner was treating his patients with azidothymidine (AZT), but it wasn't slowing the disease enough, and the drug kept becoming resistant to the powerful virus. "Using the combination model, I started shopping around for another drug," says Dr. Montaner. He began testing his patients with a combination of AZT and didanosine (DDI). Better, but not good enough.

In 1994, he got his hands on nevirapine, a drug developed in the United States that was seeing mixed results. He led an international trial and found the three drugs worked together – so well, in fact, that Dr. Montaner had to use a new test his colleagues were developing to even detect the virus in his samples.

He presented the findings at a 1996 AIDS conference held in Vancouver. A U.S. team showed up with similar results, also using three drugs. Before either paper was even published, triple therapy (dubbed highly active antiretroviral therapy or HAART) became the standard of care around the world and deaths from the disease plummeted by 90 per cent.

Dr. Montaner noticed something else from those staggering statistics. "Infections were also going down. This is not what we expected. It seemed the regime was powerful enough to render the HIV-positive person non-infectious."

And thus began his next mission: treatment as prevention (TasP). As the head of the International AIDS Society from 2008 through 2010 and now juggling numerous other high-profile positions, including director of the British Columbia Centre for Excellence in HIV/AIDS and special adviser to the United Nations, he advocates for treating all people diagnosed with HIV to lower the spread of the disease (which still infects about two million a year globally).

Since 2008, 58-year-old Dr. Montaner has devoted himself full-time to this work. Before that, he would put in four days a week at the AIDS clinic, seeing patients for 12 hours a day – their treatment regimes were complex, plus he kept extensive records on all his patients, as their health informed his research. He crammed his paperwork and research into one office day, and evenings and weekends. "It was more than a full-time job. No time for lunch. It was a nightmare."

Dr. Montaner still travels extensively, puts in the occasional 12-hour day at the hospital or at the University of British Columbia, where he's head of the division of AIDS in the medical school, works during family vacations (his wife, an X-ray technician whom he met at St. Paul's, and four now-adult children are used to it), and skips lunch.

For him, hard work and killer hours have been a small sacrifice for building a medical career that has made a difference to one disease, just like his father – who died this year – did. "He was a tremendous influence on my life."

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