Doctor who pioneered HIV treatment hopes to stop new cases by 2030
PUBLISHED: 17:19 14 August 2019
"If truth be known, I think my patients can be quite routine and boring now."
Dr Gary Brook, who works at the London North West NHS Trust - including at Northwick Park Hospital - is a consultant who has been on the front line of the fight against HIV since 1985.
Back then, the disease was an unknown terror, now, thankfully, he told the Times things are quite different.
"I have been looking after people with it from the very beginning of the epidemic," he said.
"I had my first patient in 1985 and there have been enormous changes since then.
"Back then, HIV was difficult to diagnose and difficult to treat. There was some treatment that came along - AZT - in the late 1980s but that wasn't widely available until about 1993."
"That's the big way it's changed, it became a treatable condition, and now it's a routinely treatable condition.
"If truth be known, I think my patients can be quite routine and boring now - in the majority of cases."
Last year in Britain, a remarkable target, known as 90-90-90, was achieved - that means more than 90 per cent of people were diagnosed with HIV, of those people more than 90 pc were on treatment, and of those on treatment, more than 90pc were "virally suppressed" (so had an undetectable viral load).
The next aim is a simple one, to cut new HIV diagnosises to zero by 2030.
Dr Brook explained the hard path to get to this point.
He said: "The work to achieve that has been staggering.
"When I was looking after patients in the 1980s, pretty much for every person newly diagnosed you had another person who was dying.
"Our job was to try and keep people comfortable for as long as possible and to prolong their life.
"Now, I say to patients: 'look - as long as you attend clinic regularly and take the treatments you will probably have a normal length of life'.
"You might die with HIV, but you probably won't die of it."
Before his time as a HIV doctor, Dr Brook was one of two medical officers assigned to the British Territory of Anguilla in the Caribbean.
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Being a doctor for all-seasons on the island was helpful training for taking on the Aids crisis.
When it first began, there was no way of treating the disease itself. Instead, doctors were forced to confront each associated disease - such as pneumonia or tuberculosis - as it appeared. They were firefighting, and it took until the late 1990s until an antibody test was available to confirm an Aids diagnosis."
Dr Brook told the Brent & Kilburn Times that he worries allowing people to choose to have HIV tests or not was a mistake.
"I think we maybe did a disservice to the patients," he said.
"The bottom line is they went away still not knowing if they were HIV positive.
"I personally feel the whole issue of pre-test concern turned out to be detrimental.
"Particularly as time went on - it set in stone this thing about HIV being special and therefore the test being special. We have had to work very hard to normalise HIV testing."
What are the issues in 2019, then?
Dr Brook said one is the stigma, which he said contributes to late diagnosis.
"Many people presenting with late stage HIV have had three or four opportunities for testing that have been missed."
Dr Brook has also always been involved in the research aimed at first dealing with HIV, and now curing it.
He said: "I have been involved in some of the largest multi-area, multi-clinic trials - such as one where we looked at if it was good to stop and start treatment."
He's now working to improve HIV care in the developing world, and has helped to come up with a HIV testing machine "the size of a coffee machine" he soon hopes will be able to tackle HIV in sub-Saharan Africa.
"This could be massive." he said.
"That's still where most cases of HIV are. At the moment we can only have testing in large cities, and even then there are big issues with fixing machines when they break.
"The machine could be put on the back of a van."
Dr Brook is excited about progress also desperate to be put out work.
He added: "I would dearly dearly love for someone to come along, say HIV's cured, you're out of a job.
"There are millions of pounds being put into a cure, I live in hope that someone will get there soon."