Self-testing is the key to reducing undiagnosed HIV in Australia. Your support will help Professor Mark Stoové and his team make this happen.
In acknowledgement of the International Day of Women and Girls in Science on 11 February, Professor Suzanne Crowe AM reflects on her career in HIV research, with a special focus on the early days when HIV was discovered in Australia, and the progress in HIV treatment and research over the past 30 years.
Back in 1984 when my close colleague and friend Dr Anne Mijch and I set up the first HIV clinic in Melbourne, based at Fairfield Hospital, there was a sense of frustration.
We started the clinic after Dr Ron Lucas, a senior infectious diseases physician at Fairfield Hospital and his wife Jo, a Fairfield nurse, visited the Centers for Disease Control in the USA in mid 1984. They learned about this new disease that seemed to be attacking gay men. Ron recognised similarities to hepatitis B, and being man of few words said, “This is going to be important. Contact the homosexual community and get on to it”.
As clinicians at Fairfield we had early access to an HIV test established in the Virology laboratory at Fairfield Hospital by Dr Ian Gust and his colleagues, but we didn’t know what the results meant. Would the test stay positive for life? Would all those who tested positive go on to develop AIDS? Could the body eradicate HIV? We learnt to diagnose and treat and sometimes prevent many of the unusual infections and cancers but at that stage there was no treatment for the virus.
At the clinic initially about 25 per cent of patients turned out to be HIV positive, probably because those who came to the clinic were already aware of their risk or sick. We used to go to funerals all the time. It was hard not to get involved with our patients. All young, virtually all of them grateful for the culture of care they received at Fairfield Hospital, many retaining their sense of humour and community spirit despite terrible illness.
Australia didn’t have much money to spend on HIV research in those early days and thus focused on education, prevention and care. The Grim Reaper advertisement was one particularly effective early example. It depicted a bowling alley with grandmothers, pregnant women, infants and schoolchildren all being bowled over, presumably by HIV. While it received enormous criticism for being alarmist and inaccurately portraying the general population as being at risk of infection it led to people talking about HIV.
Our success in keeping the epidemic controlled in Australia was the result of a very involved gay activist movement that quickly formed an alliance with clinicians, the government and media. This coupled with strong education campaigns and focused interventions (safe blood supply, condoms, clean needles and eventually antiviral treatments) should give us great pride. It is amazing how the landscape has changed.
Image: Dr Ron Lucas, Professor Suzanne Crowe and Associate Professor Anne Mijch at Fairfield Hospital in 1991
The HIV epidemic has been a continuum: initially no treatment with a diagnosis of HIV considered to be a death sentence then sequential development and early availability of drugs to treat HIV, with combinations proving to be effective in controlling the virus making it a chronic controllable illness.
These days in the hospital clinics most of our patients are well with very low levels of HIV in their blood and strong immune systems. Many are working, and even able to have children. There is research underway to determine whether a cure might be possible in the future.
Whilst initial efforts focused on treating HIV-positive patients in wealthy countries, there has been scaling-up of treatment in the developing world. My work has included coordination of education programs for doctors and other healthcare workers on HIV clinical management in India, Myanmar, Lao, Indonesia as well as transferring the technology to do lab tests to monitor HIV infection in these resource-limited settings.
I am very proud of the contributions my PhD students have made to understand how HIV impacts health in their countries of PNG and Malaysia. Here at Burnet I have worked with my colleague Associate Professor David Anderson and his team on a point-of-care test (Visitect® CD4) to monitor the immune system of people with HIV who live in remote parts of developing countries. This test will be used to determine when a patient needs treatment.
I have been involved in access to viral monitoring for these same healthcare sites with resultant prevention of mother-to-child transmission and better use of therapy for people with HIV in many neighbouring countries.
Whilst we less commonly see people with late stage HIV infection/AIDS we now are confronting young people with HIV infection who are prematurely developing diseases that we normally associate with the elderly. Younger HIV-positive people have an increased risk of developing heat attacks, diabetes, strokes, cancers, kidney and bone disease. It appears that HIV prematurely ages the immune system and our studies are trying to determine the precise cause and how these serious conditions can be prevented.
There is still a lot of work to be done in HIV and we can’t become complacent. I think Australia, and Burnet specifically has fantastic expertise in this area and can share it with the rest of the world to continue making headway in the fight against HIV.
(This article, co-written by Associate Professor Anne Mijch OAM, originally appeared in the Autumn 2014 edition of Impact)
Professor Crowe is Burnet’s Program Director (Healthy Ageing), an infectious diseases physician at The Alfred hospital, and Professor of Medicine and Infectious Diseases at Monash University.
Burnet Institute recognises that change is needed to achieve gender equity, and we are focused on achieving this.
Burnet is currently involved in a range of gender equity activities including participation in the Science in Australia Gender Equity (SAGE) Pilot of Athena Swan, and through our Gender Equity Committee.