BY ADELLE LARMOUR

The human immune-deficiency virus (HIV), once considered a deadly disease, is being tamed at Sudbury Regional Hospital’s Haven Clinic.

Located at the hospital’s Laurentian site, this Ministry funded clinic is one of 15 that are part of the Ontario HIV Outpatient Clinic Network.
A multi-disciplinary team of 10 health-care providers works with 200 clients in northeastern Ontario, an increase from its early days when it treated approximately 65 people annually.

The clinic opened in 1992 and, since that time, more than 700 infected HIV/AIDS outpatients have been treated. In its first year of operation, the clinic received 117 referrals. Since then, there are approximately 50 referrals annually.

“It is a real team effort,” said Dr. Roger Sandre, infectious disease specialist and medical director of the clinic. “We provide the same level of care found in the larger urban centres.”

The team is comprised of one medical doctor, one full-time and two part-time nurses and secretaries, a nurse co-ordinator and a social worker. Also available are a pharmacist and dietitian, access to specialized lab testing and opportunities to participate in clinical trials. The clinic is open five days a week, offering patient care such as counselling, nursing and instruction on how to use the medications. Two morning clinics are hosted weekly, at which patients are seen by Dr. Sandre.

Education also plays a significant role.

“There is a lot of teaching done with patients, families, and within the community, including medical students and local and area physicians,” said Judy Latendre-Paquette, nurse co-ordinator for the clinic.

HIV is a virus that attacks the immune system. If left untreated, it will develop into AIDS (Acquired Immune Deficiency Syndrome). Although there is no cure, treatment for people infected with HIV/AIDS has progressed significantly over the past 12 years.

“Up until 1995-1996, patients often went on to develop AIDS,” said Sandre. “Now, that is not the case. Patients are doing exceptionally well. Most of them who are on good treatment are not going on to develop AIDS and they are not dying of HIV-related or AIDS complications.”

The 1996 International AIDS Conference in Vancouver was one of the turning points in treatment. It was shown that triple therapy, three drugs administered at the same time to treat HIV, was very effective.

Success story
“It’s really a success story,” Sandre said. “Treatment initially started with one antiretroviral drug – AZT (Zidovudine). Now it has advanced to five drug classes with more than 20 different drugs, and treatment is a combination of at least three antiretroviral agents at one time.”

As well, the medication is now in one pill, taken once a day, a significant change from taking as many as seven to 10 pills three to four times daily.

Improved treatments have resulted in people living longer, thus creating a longer patient list and possibly more financial strain on the government’s purse. The cost for treatment ranges between $1,000 and $1,500 a month. Payment can be made through a private carrier, the province’s disability fund or Ontario Works. The working poor can apply through the Trillium program and Aboriginals can obtain coverage through the First Nations and Inuit Health Branch, Health Canada.

Regardless of advancements in medications, HIV treatment is complex, technical and requires specialized clinics to manage it, Sandre emphasized. “A team approach is necessary because our patients are complex with a lot of medical, social and psychological problems, making care challenging.”

He added that Hepatitus C infection remains a major issue for many of his patients. “We are witnessing a marked increase in Hepatitus C-related cirrhosis of the liver.”

Approximately 60 per cent of the clinic’s patients are intravenous drug users. Of the total patients, 25 per cent are Aboriginal and 25 per cent are women. The average age ranges between 35 and 45.

“The number of Aboriginals and women who are acquiring HIV related illnesses is increasing,” said Linda Mansfield-Smith, the clinic’s counsellor. She believes it is due to increased injection drug use and undiagnosed disease with ongoing transmission. Other factors for acquiring HIV related illnesses are poverty, housing, addictions (alcohol/drug), depression and mental illnesses.

Interestingly, of the seven or eight HIV-positive pregnant women who were treated over the last 10 years, none of the infants were HIV infected.

“Women are treated after 14 weeks gestation,” Sandre said. “If they go on treatment, the risk of transmitting it to the infant is one per cent or less with proper prenatal care.”

All patients arrive at the clinic with a diagnosis of HIV. They may be referred by a family physician, emergency room doctor, a walk-in clinic, methadone clinic or by public health. A patient’s first-time visit requires a medical, social and hemographic history. They are assigned a nurse throughout their visits. Afterwards, Sandre performs a medical history and orders two blood tests to determine the stage of the disease.

Blood tests
One blood test, called the CD4 cell count, determines the status of their immune system. “CD4 cells are special white blood cells in your blood,” Sandre explained. “A normal count is around 800. Since HIV kills these cells, once the count is down to 350, treatment is recommended. It takes a number of years to get down to that count.”
Another initial test measures how much virus is present in the person’s blood. This test is sent to Toronto for analysis and provides information that determines the type of treatment most likely to succeed.

Once patients are placed on treatment, they are monitored every three to four months unless there are complications or they have chosen to go on a clinical trial, both of which may require more visits.

The program has been hailed as a success, according to the Haven Clinic’s staff. Patients are grateful, appreciative and pleased with the care provided. But challenges still exist.

Travel distance for many patients is one of the biggest barriers for patients accessing proper care, said Latendre-Paquette.

Due to the nature of the population and their socioeconomic situations, not all patients adhere to the medication regimen. “Sometimes, HIV is not their first concern”.

The lack of primary care physicians and psychiatric care is another challenge. “We have a good working relationship with the mental health services within the hospital, but most of our patients aren’t hospitalized,” Sandre said. As well, many of the patients have other illnesses like Hepatitus C, diabetes or hypertension.

Lastly, many of the outlying communities are not aware of the Haven Clinic’s services.
Although some hurdles exist, the team remains strong, the work interesting and new information abundant and evolving.

“There have been such remarkable changes in treatments,” Sandre said. “It is rewarding to treat and manage patients and see their health restored.”