Question
Will London guidelines mean I have to change treatment?
30 March 2011. Related: Access to treatment, Changing treatment.
I’ve just read on your website the ‘Guidelines for London prescribing of antiretroviral drugs in 2011’ have changed:
http://i-base.info/home/changes-to-hiv-drug-prescribing-in-london/
Does this mean that someone in one part of london eg Hackney may not be able to have access to the same drugs as someone eg in Chelsea, if ultimately it is down to the resources or funding of your hospital or NHS trust whether to fund or prescribe a particular drug?
Does it also mean that not all hospitals in London (where I am based) will have access to the same drugs?
Also, if someone is settled on one regime will that have to be changed now?
I am really freaked out about this news and it seems that as if dealing with HIV isn’t bad enough itself patients now have this additional headache and uncertainty and whether I should consider changing my care for a hospital which i know will be able to give me the best treatment options.
thanx for your help & reassurance.
Answer
Thanks for your important questions.
The London guidelines should help make sure that everyone in London has the same access to the same drugs. So whether you go to a large hospital or a small clinic it doesn’t depend on the budget for that hospital or trust. This has been in practice for many years now. The same process means that anyone treated in London can also access treatments like New-Fill on the NHS (the treatment for facial fat loss).
Most people who are currently on stable NNRTI-based treatment do not have to make any changes. For example, if you are currently taking Atripla (which is likely to be used less often for new patients) you will not have to change. Or if you are using Truvada (tenofovir/FTC) you do not need to change to Kivexa (abacavir/3TC).
Circumstances when you may be asked to change include:
i) if you using a protease inhibitor other than atazanavir/ritonavir. Even then, you would not be asked to change if there are good clinical reasons to stay on your current treatment. There is a lot of flexibility over PI switching and not everyone will have to change.
ii) if you use raltegravir and could use similar alternatives. Again, this is only is situation where it is appropriate based on your treatment history. People using raltegravir because they have resistance to other drugs are not being asked to change. There is flexibility here too, including the option for your hospital to pay for this.
These guidelines have been produced to reduce the need to change treatment for people currently on treatment. They have been produced with the input for doctors at every London HIV hospital and to make sure that all patients have constant access to high quality effective and individualised treatment.
If you are worried, please talk to your doctor or other health advisors, or the patient forum at your hospital, or call the i-Base phoneline where we can talk to you about whether this affect your care.
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