Health

IN THE TRENCHES

For nearly 20 years, Dr. Philip Berger has been at the forefront of HIV and AIDS treatment

July 9 2001
Health

IN THE TRENCHES

For nearly 20 years, Dr. Philip Berger has been at the forefront of HIV and AIDS treatment

July 9 2001

IN THE TRENCHES

Health

For nearly 20 years, Dr. Philip Berger has been at the forefront of HIV and AIDS treatment

AIDS=death. For 22 million people around the globe, this simple equation has become a reality. While modem treatments have prolonged and improved the lives of many of the 36 million people currently living with HIV/AIDS worldwide, victims in developing countries remain defenceless—lacking the adequate funding, education and medication needed to stop the deadly disease. In Canada, new therapies have lowered death rates dramatically in recent years, but new cases are on the rise. Dr. Philip Berger, who is the chief of the department of family and community medicine at St. Michael’s Hospital in downtown Toronto, has been on the front lines of the war against the disease for nearly two decades, treating patients ever since AIDS was first identified. Berger, 50, spoke with researcher-reporter John Intini.

Maclean’s: How has the publics perception of AIDS changed over the years?

Berger: The initial perception was one of terror. There were many irrational reactions. People thought the disease was limited to homosexual men, drug users and hemophiliacs. Some people thought it could be transmitted by bed bugs, through the air, touching doorknobs, in swimming pools or by being served in a restaurant by someone with AIDS. I think the message has finally gotten through. But now many view HIV/AIDS as no longer a terminal disease, which is very wrong. It still kills. Maclean’s: How have treatment and survival rates changed?

Berger: In the early years, there really was no treatment other than traditional pain control and treatment of infections that AIDS patients acquire. I had a patient in the 1980s who showed the symptoms but figured, why get tested? He was practising safe sex and there were no drugs available to help him anyway. I agreed with him because that was a time when public-health authorities demanded the identities of people who tested positive. There was no good reason for that. The first real breakthrough was in the late ’80s with the treatment to prevent a life-threatening pneumonia. HIV monitoring tests also came along, which showed how suppressed people’s immune systems were, even though there was no good treatment for that. Other drugs were introduced and patients began combining them, even though it had not been recommended. Finally, triple therapy and different classes of drugs [were introduced] in 1995. At that point, the incidence of people with HIV developing AIDS began plummeting, as did death rates. I have one patient who was diagnosed with AIDS in 1992 and has been relatively healthy for nine years. The patient was lucky not to get sick before effective drugs became available. Ten to 15 years ago, it would have been unimaginable for someone to live with AIDS for five or six years. Now, it’s not unusual.

Maclean’s: How is the quality of life for those on the medication?

Berger: The drugs are not fun to take. They have terrible side-effects. There is often a change in body image. A person’s face may become gaunt, people may develop a pad of fat behind their necks. Their arms and legs may thin or they may develop big bellies and larger breasts in women. It is important to watch how anti-HIV drugs interact with each other and with other medications. The number of pills depends on the combinations one takes. In a lot of cases, patients now take fewer pills but the same amount of chemicals. People can be on five types of anti-HIV drugs a day and others can be on a lot more. It depends on the combination. There are always problems with timing and whether to take them with lots of fluids, on an empty stomach or a full stomach. Maclean’s: Since AIDS treatments help people live longer, have they also resulted in a more laissez-faire attitude towards risky sex? Berger: I’m not sure. Statistics show new cases of HIV are creeping up. The reason is complex, but drugs that can prolong lives may be part of the equation, since people don’t view AIDS as a death sentence.

Maclean’s: Do you think people still view AIDS as a gay disease ?

Bergen I hope not. The statistics show it isn’t. According to some estimates, onequarter of new infections in Canada are found to be heterosexuals. In the developing world, almost all cases are heterosexuals. The number of women is also increasing. Maclean’s: Is AIDS getting its fair share of research money?

Berger: No disease gets the funding the people who suffer from the disease think it should. The research into AIDS benefits all other sexually transmitted diseases as well as research of other diseases. It

does not help to compare diseases since it results in patient groups competing for money.

Maclean’s: What is the best possible result of current research efforts, and how likely is that to happen?

Berger: Several new classes of therapy are being studied. The hope is they will help people live a more normal and longer life, even if a cure is never found. People have not been on the newly developed drugs long enough to know how long this will take. Only time will tell.

Maclean’s: How big a role should Canada be playing in finding a cure when primarily this is a major problem only in the developing world?

Beigen Since Canada is a country of relative wealth, we have a major role to play. Recently, I proposed the “95-per-cent rule.” Since 95 per cent of HIV infections occur in developing countries, 95 per cent of the proceeds from fancy gala events used to raise money should go to credible programs in developing nations. It would be a symbolic gesture of solidarity, but was not well received.

Maclean’s: What were the worst times in your own medical practice?

Beigen During some really rough years in the 1980s, I had about 250 to 275 patients. Now, I have about 120. I used to keep a list of the people I had treated who died, but, a long time ago, I stopped counting. It was around 300. Most of those were prior to 1996.

Maclean’s: Were there days you thought it was hopeless? Bergen I’ve never felt entirely hopeless. I’ve always had what is maybe a naïve confidence that scientists and researchers would find a therapy to slow or stop the disease. Despair for sure. Sometimes even rage. Rage at colleagues who dumped patients out of their practices. Rage at the government who failed to respond appropriately and adequately. Rage with the public-health system that was obsessed with collecting names of people even though they couldn’t tell you why they needed them. Rage with hospitals where food trays were left at the doors of patients because food handlers didn’t want to touch patients. Rage with employers who fired employees. Rage with landlords who kicked HIV-infected people out of their apartments. But especially rage with families who rejected their children or relatives who had HIV. It’s the bad stories I remember, but there were some inspirational people. Two young surgeons who operated on HIV patients during the 1980s, without question, and also some amazing parents who loved their children unconditionally. I have always tried to give patients hope. In the mid-’80s it was more an illusion of hope. Now it’s real. E3