Jan/Feb 2016: Volume 17 Number 1/2

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With barely a nod since the New Year, this issue of HTB is especially sparky with international and UK news that affects important aspects of both current and future HIV care.

Reports from the 44th World Lung Conference include a promising nine-month regimen for MDR-TB and PK data for children.

And reports from BHIVA include the political issue of the gap between best clinical evidence (in NICE accredited BHIVA guidelines) and current commissioning guidelines (based on recommendations from 2012). This threatens to make early access to care in England the worst in the world, with little indication there is any urgency for change before 2018.

Luckily the disparity can be easily covered by wider use of Treatment as Prevention (TasP) for people with CD4 counts above the current threshold of 350 cells/mm3 being used by NHS England.

TasP has been commissioned in England since July 2015 and as ART at any CD4 count is already included for clinical reasons in UK, US, European and WHO guidelines, we hope TasP prescribing will enable everyone in the UK to access ART.

Global ART is highlighted relating to WHO guidelines and new generic drugs – most importantly the prospect that dolutegravir could cost as little as US$ 44 a year.

Other reports on reduced ART – either dolutegravir monotherapy or dolutegravir plus 3TC – are covered in additional articles from the perspective of global access. Studies to evaluate these strategies are an urgent priority.

And prevention news includes that tenofovir/FTC has at last been filed in the EU for a PrEP indication. We also report a caution that dual therapy is likely to be essential for optimal protection, rather than simply tenofovir alone (although this still recommended for programmatic reasons in WHO guidelines).

With UK access to PrEP largely dependent on people importing generic medicines for personal use – nicely summarised in one of the talks at BHIVA – it is right that NHS clinics provide the minimal additional monitoring (“it costs pence”) in order to ensure these medicines are used safely. VAT however may be payable.

Plus other news on NICE approval of new HCV drugs, promising strategies for a cure, and a warning from Public Health England about microbial-resistant Shigella.

Happy reading for the start of 2016… Our next issue will bring reports from the Conference on Retroviruses and OIs (CROI) being held this year in Boston in a few weeks time.

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