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CHANGES TO ARV PRESCRIBING IN LONDON

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Gus Cairns
Member
Posts: 257
CHANGES TO ARV PRESCRIBING IN LONDON
Posted on: June 15 2011, 03:28 pm

Dear all,

As you may be aware there have been changes to prescribing practice for some HIV drug regimes in London.

For the background to these changes and analysis by community organisations, see http://www.aidsmap.com/prescribing-in-london and http://i-base.info/htb/14803.   

For a summary for changes by the London HIV Specialist Commissioning Group, see http://www.londonspecialisedcommissioning.nhs.uk/?assetId=16#contentBox368

The primary changes are:

1) The preferred regimen for patients starting HIV therapy will consist of Kivexa (abacavir + 3TC) plus Sustiva (efavirenz) instead of Atripla or Truvada plus Sustiva.

2.) The preferred protease inhibitor (PI) for people on PI-based regimes will be Reyataz-plus-Norvir (atazanavir/ritonavir), and some patients on other PIs will be asked if they are prepared to change to Reyataz.

These changes aim to save approximately 9 million pounds a year from the London drugs budget and preserve HIV services, which would otherwise have to be cut instead. The negotiations have included patient representatives and should cause not clinical problems as long as they are done in accordance with existing clinical guidelines.

However i-Base, THT and some other organisations have received anecdotal reports from some patients that they are having their HIV drug regimens changed withuot prior warning or full discussion.

UKCAB is keen to hear about any such experiences so we can feed them back to the London HIV Consortium with the aim of maintaining good practice and good doctor/patient relationships, and so so that this strategy to save money can work without causing any clinical harm or other problems.

Experiences can be reported on this message board or to the i-Base Treatment Helpine on 0808 800 6013
(Mon, Tues, Wed 12-4).

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Simon Collins
Global Moderator
Posts: 651
Re: CHANGES TO ARV PRESCRIBING IN LONDON
Reply #1 on: June 24 2011, 07:42 am

Thanks Gus

We had a call from someone who had picked up their prescription only to find it had been changed without him knowing why or being told anything about it.

At a support group we were talking at someone said they were told that they needed to change meds because if they were on one treatment for too long then their drugs might stop working.

A third example was from advocate who had been on a study for maraviroc and had been stable on this since for over five years. This person was also told to change, but after complaining was then told he could stay on his current treatment.

These are all examples of bad and sloppy medical practice. They are not in line with the London Commissioning guidelines. The Drugs and Treatment Sub-Committee and Commissioners need to hear about these cases.

If anyone has similar examples and doesn't want to post on this list, please contact me at i-Base by phone or email.
http://i-base.info/about-us/contact/

The London guidelines are primarily focussed on people starting treatment. Only a small percentage of people need to switch their PI-based treatment and the context should be where this has a clinical benefit. There is a lot of flexibility in individual cases.
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