Sept/Oct 2015: Volume 16 Number 9/10

This issue of HTB includes the last conference reports from IAS 2015 and the 16th PK workshop together with conference news from the 55th ICAAC.

We also report on newly released treatment guidelines from both BHIVA and WHO, most significantly recommending universal ART irrespective of CD4 count based on results from the START study.

BHIVA also notably drop efavirenz as a preferred drug for first-line ART and WHO recommends broader use of PrEP. Both these evidence-based guidelines will advance the standard of care but challenge financially constrained health systems.

Issues of treatment access are covered in other articles include concerns over the Transatlantic Trade and Investment Partnership (TTIP) proposals. This protracted trade proposal (currently in the 11th round of negotiations) is designed to extend the power of large multinational companies. TTIP is being discussed/negotiated/imposed in secret but potentially threatens to extend patent restrictions on medicines.

We include an example of the excesses of monopoly drug licensing with the example of price increases for pyrimethamine in the US and a new report on the TTIP threat for global access to treatment.

Related to access to drugs in the UK, we include several articles about buying generic medications online for personal use. Awareness that this is both legal and cost effective makes this an option that many people in the UK might have to consider for prompt access to new hepatitis C drugs and for generic tenofovir/FTC for PrEP.

The support by an Australian medical association for people to access generic versions of new hepatitis C drugs is based on both their high efficacy and safety data but extremely limited access due to out-of-reach prices of the originator versions. We include the guidance in full because this is just a important for people in the UK.

Other PrEP news includes the launch of the first NHS clinic to offer monitoring services needed by people who are already independently sourcing PrEP online. Also, that two new community websites include excellent information on how to do this.

The team at 56 Dean Street should be commended for this service, which developed from an private PrEP clinic launched in August. A revison to the initial pricing means that routine monitoring and advice is now available as a free NHS service.

The NHS now needs to rapidly decide for criteria on how and when PrEP will be prescribed: currently the Dean Street clinic can only provide private prescriptions for medication and drug level testing to confirm that generic PrEP includes active tenofovir DF.

Supplements to this issue of HTB

Two supplements are included with this issue of HTB. Both resources are updated to include the recommendations from the 2015 BHIVA guidelines.

Introduction to ART (16th edition)

The 2015 update to the i-Base guide to combination therapy – now in its 16th edition – has been retitled Introduction to ART.

This 48-page A5 booklet includes essential information for anyone starting treatment (or already on treatment), especially if they are recently diagnosed.

New pocket guide to ART

The second supplement – Pocket ART – is a new small concertina folding A7 leaflet that is designed to be an even simpler and more direct introduction to ART.

The leaflet uses simple statements and quotes about ART, with short URL links to web pages that have additional information in a similar easy format.

All with all i-Base publications, both resources are free in the UK. Please order online or use the fax-back form on the back cover of HTB.