Quality of life
With research interests in epidemiology, vulnerable populations, and infectious diseases, Leah Martin found the mentorship she needed in the supervisors for her Ph.D. thesis at the University of Alberta. Dr. Duncan Saunders, current chair of the Department of Public Health Sciences, is an epidemiologist who studies HIV infection in Africa. Dr. Stan Houston is an infectious-disease specialist and director of the Northern Alberta HIV Program. Together these three researchers developed a project to look at the effect of drug therapies on the quality of life of HIV-infected patients in both Northern Alberta and Uganda.
For the Alberta-based part of the research, Martin is studying patients in Edmonton HIV clinics who started "highly active antiretroviral therapy" (HAART) between 1997 and 2005. Martin is assessing three possible outcomes: mortality, treatment failure, and health-related quality of life. Her particular interest is Aboriginal people who are infected with HIV.
"There's evidence from the literature that the outcomes for Aboriginal people on antiretroviral therapy are not as good as for non-Aboriginals," notes Martin. "In general, Aboriginal people have poorer health and lower socioeconomic status compared to the rest of the Canadian population, and these factors may lead to the poorer treatment outcomes. To be successful, antiretroviral treatments require a very high level of adherence [to the treatment regimen], and this can be extremely difficult for people who lead unstable lifestyles, as many injection-drug users do. A large number of the Aboriginal patients in our study have a history of injecting drugs. By looking more carefully at patients' treatment outcomes, we aim to find ways to improve their success on therapy."
For the Uganda-based part of the project, Martin is studying data from a rural HIV clinic where antiretroviral therapy has only recently become available. The objective is similar to her work in Alberta: get a better handle on what factors predict successful outcomes. Martin hopes to finish her thesis later this year.
"My Ph.D. research will quantify some important outcomes; for example, we have found that Aboriginal people have higher rates of HIV-related mortality after starting treatment. But there's a lot more qualitative work that needs to be done, too, especially in terms of understanding the treatment experience of Aboriginal people receiving antiretroviral therapy. This understanding will help clinicians improve treatment experiences for these patients and contribute to better outcomes. We need to address these issues if we're going to be successful with antiretroviral therapy in these vulnerable populations."
That is music to Dr. Houston's ears. "Increasingly, AIDS is the disease of poverty and marginalization and disadvantage, both at the international and local level," he says. "In Canada, HIV infection hits certain groups the hardest-the poorest people and people with social problems such as homelessness and addiction, or clinical problems such as psychiatric illness. We see these people every day in HIV clinics in Alberta: people who are really struggling, not only with HIV but also with poverty, psychiatric illness, homelessness, and drug addiction."
In 1987 Dr. Houston went to Africa to work in the field of tropical diseases; he arrived just as the AIDS epidemic was exploding. Since then, he has devoted his career to caring for AIDS patients and doing HIV research. "Looking after AIDS patients, especially in 2008, is incredibly rewarding. Not only is there potential for spectacular medical benefit with the newer treatments, but often people with really serious personal and lifestyle problems are able to move their lives forward in dramatic ways. You see these changes and it's rewarding to have played a small part in them."
HIV, AIDS, and HAART
HIV (human immunodeficiency virus) is the virus that causes the disease we call AIDS (acquired immune deficiency syndrome). HIV weakens the immune system by attacking certain white blood cells called T-helper cells. These cells play a central and crucial role in the immune response, and without them the body can't fight off disease. If the numbers of T-helper cells fall below a certain level, the result is AIDS: a chronic, progressive illness that leaves infected people vulnerable to opportunistic infections and cancers. There is no cure for AIDS.
There is, however, effective treatment for HIV infection-in the form of a regimen of three or more drugs, known as HAART (highly active antiretroviral therapy). HAART has significantly decreased the number of AIDS-related deaths. Although it isn't a cure for AIDS, it reduces the amount of virus circulating in the blood to nearly undetectable levels. However, make no mistake: HIV will always be present in the body, and people must stay on HAART for the rest of their lives.
Sources: Health Canada, National Institutes of Health (US), Centres for Disease Control