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HIV drug prescribing

Changes to HIV drug prescribing in London

HIV treatment is very effective. By keeping people well, it is also very cost effective, as it reduces the burden on health services.

However, the cost of providing HIV treatment to everyone in the UK who needs it is considerable. Treatment guidelines recognise that the National Health Service (NHS) needs to take cost into account when prescribing anti-HIV drugs. However, the most important factor in choosing treatment is still which drug will work best for that person.

How is HIV treatment prescribed?

The British HIV Association (BHIVA, the organisation for specialist HIV doctors in the UK) makes recommendations on which anti-HIV drugs should be prescribed for people at different stages of their HIV journey. These guidelines emphasise the importance of choosing the drugs that will be most effective for the person taking them.

However, the most recent BHIVA treatment guidelines also recognise that the cost of HIV treatment is considerable for the NHS, and continues to rise. The guidelines state that cost can be taken into account when choosing a treatment combination, as long as the treatment outcomes are the same.

This could mean that, if two drugs have the same outcomes, it is acceptable for the cheaper drug to be prescribed. Where a generic version of a drug is available, that may be prescribed rather than the branded version, as this will be cheaper for the NHS to purchase. This can mean that you may be prescribed individual tablets rather than one of the branded fixed-dose combinations. The NHS can also make additional cost savings by greater use of 'home' delivery of anti-HIV drugs.

In 2011, prescribing guidelines for London changed, to allow the NHS in London to save money on HIV treatment. The NHS in London outlined these new treatment guidelines in 2011 when tasked with making savings of around £10 million over two years. Making these savings in their drug budget would allow HIV clinics to continue providing frontline services.

This prescribing change has now been made in other parts of England and will be introduced more widely as time goes on.

The recommended drug combination for people starting treatment for HIV in regions where this change has been made is now Kivexa (abacavir and lamivudine), with efavirenz as the first-line option. Kivexa replaces tenofovir and emtricitabine (used in Atripla and Truvada) as the first-line option. Atazanavir/ritonavir or nevirapine are listed as alternatives to efavirenz. The new first-choice drugs are all drugs recommended for first-line treatment in the BHIVA guidelines.

These changes mean that people will most likely start treatment with a combination of two pills rather than one pill once a day (Atripla) and that some people currently on treatment may be asked to change to the new alternative if there are particular issues with their current treatment.

People who need to change to a second-line protease inhibitor-based regimen or those already taking a protease inhibitor other than atazanavir may be reviewed to see whether they can be switched to atazanavir.

There will still be a range and choice of other HIV drugs for people with individual requirements according to their medical needs. People will not be forced to take HIV medication that causes significant side-effects for them or if there is a clinical reason not to prescribe it.

For most people, this change will not be a problem but your doctor should always discuss it with you first, and take your preferences into account. If you feel you are being pushed to change treatment when you do not want to, please call THT Direct on 0808 802 1221.

There was some controversy with these proposals as abacavir has previously been associated with an increased risk of heart disease in some studies but a combined evaluation of randomised controlled trials found no increased risk with the drug.

Further information on these prescribing changes can be found on the National AIDS Trust website.

Since October 2012, all HIV treatment has been free to all who need it, regardless of your immigration status, in England. You can read more about this in our section on Immigration and healthcare.

 

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The Information Standard: Certified member

This article was last reviewed on 4/7/2014 by R. Bignami

Date due for the next review: 1/7/2016

Content Author: S. Corkery (NAM)

Current Owner: G. Hughson (NAM)

More information:

Williams I et al. BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012 (Updated November 2013)

http://bhiva.org/documents/Guidelines/Treatment/2012/hiv1029_2.pdf


National AIDS Trust How does the NHS buy drugs? March 2012

http://www.nat.org.uk/media/Files/Policy/2012/April-2012-Briefing-drugs-prescribing.pdf


Ding X et al. No association of myocardial infarction with ABC use: an FDA meta-analysis (open in new window). 18th Conference on Retroviruses and Opportunistic Infections, Boston, abstract 808, 2011.

http://www.retroconference.org/2011/Abstracts/42436.htm 


London Specialised Commissioning Group Improving the cost of antiretrovirals (ARVs) in London Summary of ARV prescribing messages for London October 2011

http://www.londonspecialisedcommissioning.nhs.uk/documents/721.pdf