Are you in London and on HIV treatment? If so, you may find that you are being encouraged to change the treatment you are on.
The recommended drug combination for people starting treatment for HIV in London is now Kivexa (abacavir and 3TC), with efavirenz as the first option. Kivexa replaces tenofovir and FTC (used in Atripla and Truvada) as the first-line option. Atazanavir/ritonavir or nevirapine are listed as alternatives to efavirenz. These are all drugs recommended for first-line treatment in the new BHIVA guidelines for HIV treatment. The NHS in London outlined these new treatment guidelines in 2011 in an attempt to meet budget proposals for HIV health care in line with Government spending cuts. The London HIV Consortium, the pan-London group responsible for commissioning HIV services, was tasked with making saving of around £10 million over 2 years.
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 at:
In response to these changes, and to get a clearer picture of how they are impacting people living with HIV, the UK Community Advisory Board (UKCAB), the network for community HIV treatment advocates, undertook a study of patients who have seen changes to their drug regimen since April and of the experiences of people accessing HIV drugs from London HIV clinics. See the results of the survey.
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by T. Kelaart
Date due for the next review: 30/9/2014
Content Author: B. Smith
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Williams I et al. BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012 http://www.bhiva.org/documents/Guidelines/Treatment/2012/120430TreatmentGuidelines.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.
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
HIV i-Base http://i-base.info/changes-to-hiv-drug-prescribing-in-london/
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