London prescription changes

Patients in London who are starting HIV treatment for the first time and do not have drug resistance will now be prescribed a combination of drugs based on Kivexa (abacavir/3TC), unless there is a clinical reason not to prescribe it.

Reasons not to prescribe Kivexa include:

• having a viral load over 100,000 copies/ml
• a positive genetic test for hypersensitivity to abacavir
• being at high risk of a heart attack in the next ten years.

Therapy based on Truvada (tenofovir/FTC) will generally be prescribed for these people. Truvada will also be given to people with hepatitis B, and those being treated for hepatitis C.

People starting therapy with a protease inhibitor will now normally be given atazanavir (Reyataz) boosted by ritonavir (Norvir). Patients already taking a protease inhibitor may be assessed to see if they can change to atazanavir.

Atazanavir is easy to take (one capsule, once a day) and, unlike some other protease inhibitors, does not cause increases in blood fats (lipids). A small number of patients develop a non-dangerous yellowing of the skin and the whites of the eyes.

Ritonavir-boosted darunavir (Prezista) is recommended for patients who cannot tolerate atazanavir.

The guidelines were developed by leading HIV doctors and are in line with the BHIVA treatment guidelines. If there are clinical reasons to use different treatments, all the currently available anti-HIV drugs are still an option, including newer and more expensive drugs.

One reason the change is controversial is the preference for abacavir. This drug has been linked with an increased risk of heart attack in some studies. However, other studies' findings have contradicted this.