Joep Lange, a Dutch physician and professor of medicine at the University of Amsterdam, had been studying HIV since the discovery of the virus 30 years ago, rising to international prominence in a sometimes fractious field in part for his prescient and impassioned activism on everything from treatment regimes to health policy.
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"Everything he was advocating, from my recollection, he ended up being right," said Jean-Pierre Routy, an HIV vaccine researcher and professor of medicine at McGill University in Montreal who met Lange numerous times at conferences over the years, including several in Canada.
Lange, 59, was among what is thought to be dozens of AIDS researchers, consultants and policy experts headed from the Netherlands to Malaysia and onward to an international AIDS conference in Australia when their Boeing 777 plane appeared to have been blown out of the sky Thursday over the battlefields of eastern Ukraine's separatist insurgency.
His scientific contributions included partnering with top Canadian AIDS researchers on a watershed 1998 study that helped usher in a drug treatment known as a "triple cocktail," which became today's mainstay therapy for people with HIV. The then-controversial treatment involved a combination of three or four different types of antiviral medications, up to 20 pills a day in its early years. But it has effectively tempered the virus from a degenerative, fatal infection to a chronic and manageable ailment.
Initial results from that study were presented at an international AIDS conference in Vancouver in 1996.
"It was a pioneer work in the field of HIV therapeutics," said Stefano Vella, an HIV specialist and head of drug evaluation at Italy's National Institute of Health, who co-authored the study. "It proved that triple therapy was very effective and could control the infection."
Later research showed that the combination drug therapy also hugely curtails HIV transmission from an infected person to their sexual partners. That has resulted in a rewriting of the guidelines on when to commence drug treatment for HIV patients, favouring early intervention in many cases instead of waiting for the virus to take hold and manifest itself.
Lange, typically, had been at the forefront of advocating for early treatment, as part of a once-contentious policy known as "treatment as prevention" — or attacking the virus with medication on as wide a scale as possible to control its spread.
One of the pioneers of that policy, and a collaborator on the 1998 triple therapy study, is Vancouver physician Julio Montaner, who said yesterday he is devastated by the death of a dear colleague and friend.
"This is a horrendous loss," said Montaner, who is also chair of AIDS research at the University of British Columbia and director of B.C.'s Centre for Excellence in HIV/AIDS.
"This is a huge blow to the whole enterprise, and losing somebody like Joep Lange and any of his colleagues would be heartbreaking. The Dutch group has contributed so much, and Joep has certainly been the leader of a lot of that, including the establishment of triple therapy."
Fought for access to medicine
But just as important as his clinical trials, his colleagues say, were Lange's contributions to health policy. He fought for drug companies to provide their antiretroviral medications to developing countries, and for those countries to furnish them to HIV patients of all stripes, no matter how they became infected.
"He was also a political activist, fighting against certain pharmaceutical companies who wanted to only use their medications, where was he was saying you need triple therapy, not just these companies' one drug," Routy recalled.
Developing-world politicians understandably often balked at the expense of triple therapy —a year's supply of just one medication could run to $25,000 per person — but Lange kept up the pressure on them, on Western countries, and on the drugmakers, stressing that the HIV epidemic could be fought and tens of thousands of deaths prevented.
Routy said one of Lange's early successes was in Thailand, where the government had at first resisted providing costly pills to HIV patients, favouring much cheaper distribution of condoms and other safe-sex tools. But Lange prevailed.
Battling against the global divide of rich countries that could afford the medicines and developing nations that couldn't, Lange campaigned in sub-Saharan Africa as well. There, in the early 2000s, the World Health Organization estimated that less than one per cent of those who needed it were getting access to anti-HIV medications.
"These drugs have saved hundreds of thousands of lives in Europe and the United States. They could do the same for millions more in developing countries," Lange said in 2002. "If we can get cold Coca–Cola and beer to every remote corner of Africa, it should not be impossible to do the same with drugs."
Vella said that kind of activism is the norm among many AIDS researchers, who work in a domain where inequalities in wealth are one of the biggest constraints on anti-epidemic efforts.
"That's the difference, in a sense, that differentiates a lot of AIDS researchers from a lot of other fields," Vella said. "We were able to show that there were two worlds in the health world — and that that was not acceptable. And actually this battle of which Joep Lange was a pioneer brought millions onto HIV treatment now in Africa."
Lange served as president of the International AIDS Society from 2002 to 2004. His predecessors and successors included UBC's Montaner, Vella from Italy and their research collaborator Mark Wainberg, a professor of medicine and head of the AIDS centre at McGill University in Montreal.
Though Lange's death will hang over the AIDS conference in Melbourne as it gets underway on Sunday, Montaner said the Dutchman wouldn't want his colleagues to waver in the least.
"I can only imagine Joep standing up in front of us and telling us that he doesn't want us to waste one moment from doing what is right, what he would have done. And that is redoubling our effort to conquer AIDS."Suggest a correction