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.
People beginning treatment for HIV in London will now start with a new recommended combination of drugs with Kivexa (abacavir and 3TC) replacing tenofovir and FTC (used in Atripla and Truvada) as the first-line option.
The NHS in London has outlined these new treatment guidelines 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, is tasked with making saving of around £10 million over the next 2 years.
Those commencing treatment will still be offered efavirenz as the first option alongside two nucleoside reverse transcriptase inhibitors (NRTIs), with atazanavir/ritonavir or nevirapine as alternatives.
These changes mean that people will most likely start treatment with a combination of two pills rather than one pill once a day and that some people currently on treatment will be asked to change to the new alternative if there are particular issues with their current treatment.
The other main change will be to patients who need to change to a second-line protease inhibitor-based regimen or patients already taking a protease inhibitor other than atazanavir, who will be reviewed to see whether they can be switched to atazanavir.
For most people this change will not be a problem but you should always discuss it with your clinician first. If you feel you are being pushed to change treatment when you do not want to then please call THT Direct on 0808 802 1221.
There will still be a range and choice of other HIV drugs for people with individual requirements according to their medical needs.
The changes are in line with treatment guidelines as recommended by the British HIV Association (BHIVA) and patients will not be forced to take HIV medication that has significant side effects for them.
There is 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 published at this year’s Conference on Retroviruses found no increased risk with the drug.
Further information on these prescribing changes can be found at the following links:
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, is undertaking 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.
We are now launching the first part of this work, an online and anonymous survey, available here. Thanks for your help!