Question

Options for starting treatment in the UK if newly diagnosed

23 September 2014. Related: Access to treatment, All topics, Newly diagnosed, Starting treatment.

I was diagnosed a few weeks ago and I have not started treatment yet. I live in London and I went to see a specialist HIV nurse yesterday who took my baseline bloods. I asked about regimens they prescribed and he said they would normally prescribe Sustiva plus Kivexa or Truvada.

I have researched this and I do not think I am a good candidate for efavirenz due to its nervous system side effects. So, that rules outs Atripla. Similarly, I can’t take Eviplera because I take omeprazole every day. So that leaves me with Stribild as the only one pill regimen I could do.

The nurse made me feel that Stribild is such a prestigious pill that no one gets it (is it because it’s expensive?). Do they really not prescribe it in London? From what I know it has a very favourable side effects profile and would suit me very well.

I will see the consultant in two weeks time. I don’t think my VL will be that high as it is a very recent infection (CD4 650). Why would they not prescribe it to me? It doesn’t feel fair. The pill is there, available and approved.

Answer

Answer: Simon Collins

Hi

Thanks for your questions and the chance to post the answers online.

If you were calling the phoneline here I would first be interested first in how you were doing generally. Also whether you had some support. Learning you are positive is still tough but it does slowly get easier.

It is great that you are finding out about treatment. There are lots of interesting reasons why starting treatment in early infection should be your choice

Treatment in the UK is very individualised. Your doctor will work with you to talk about different choices and the advantages and disadvantage of each one. If efavirenz in not appropriate you would not be given this. The discussion with your doctor will include the chance for you to decide this.

Although there are now three options for single-pill combinations, these are not always the best options for every person. This will depend on your full medical history and your doctor will have the full picture. Sometimes combinations that involve either two or three pills a day can be safer or more effective.

If your doctor decides that Stribild is the best option, then there is flexibility for it to be prescribed. But this drug, like other combinations, is not necessarily better medically because there is much less information about it.

If your doctor decides that this would be the best option for you and that cost is the only block, then please contact i-Base again in case we can help with access.

Your question about cost and access are also complicated when research doesn’t show one drug to have advantages over another, but a company prices it much more highly. In this case it is reasonable – in fact it is really important – that the NHS choses the most cost effective option.

Please see this article on London prescribing and get back in touch if it raises new questions.
https://i-base.info/new-arv-prescribing-guidelines-for-london-2014.