British HIV treatment guidelines: community consultation meeting

Gus Cairns is the editor of NAM's quarterly publication HIV treatment update. He was also one of two patient representatives on the writing panel for the new edition of the HIV treatment guidelines from the British HIV Association. The following invitation is from Gus, on behalf of the panel. Please contact him (gus@nam.org.uk) to let him know if you would like to attend the consultation meeting.

Dear fellow-patients, friends and colleagues:

You are invited to a community consultation meeting to hear about, discuss and give feedback on the 2012 British HIV Association Treatment Guidelines (Guidelines for Antiretroviral Treatment of Adults with HIV Infection). The guidelines are currently up for public consultation – see www.bhiva.org/TreatmentGuidelinesConsultation.aspx.

The meeting is on Tuesday 28 February from 10.30-12.30 at Friends House, 173-177 Euston Road, London NW1 2BJ, followed by a sandwich lunch. Friends House is opposite Euston Station: see www.friendshouse.co.uk/getting-here for a map.

The new BHIVA HIV Treatment Guidelines are the first to be published since 2008 and contain a number of significant changes to recommended HIV treatment. In addition, they are the first HIV treatment guidelines to be written in accordance with the 2009 requirements for NHS evidence accreditation (see www.evidence.nhs.uk/accreditation). UK patient representatives from the UK Community Advisory Board (UK-CAB) were included in the writing group and in a final-draft consultation meeting in December.

The guidelines incorporate a number of important changes and new sections:

• They are the first HIV treatment guidelines anywhere in the world to recommend that doctors talk about the prevention benefits of treatment to all patients and that if patients wish to start treatment in order not to infect others, it should be prescribed.
• They single out tenofovir/FTC (Truvada) as the preferred NRTI component in first-line regimens but broaden recommendations for the third drug to efavirenz, raltegravir or boosted atazanavir or darunavir.
• They retain a CD4 count of 350 cells/mm³ as the threshold for starting treatment but broaden the number of situations in which starting treatment earlier is recommended, including in early infection.
• They also include important new sections on supporting patients and adherence, and an important section on resource use.

HIV, as in so many other ways, is unusual in that the UK guidelines on what constitues the best treatment are still written by the doctors and patients who actually work and live with HIV every day, rather than by an evaluation agency such as NICE. UK HIV treatment, like much else in the NHS, is likely to go through an unprecedented degree of change in the next three years as the commissioning bodies for HIV change, responsibility for sexual health services and HIV testing shifts to local authorities, and cheap generic HIV drugs start to become available. In this setting it is especially important to have best-practice guidelines based upon firm evidence to guide NHS prescribing and funding decisions. Come and hear how they were created and what the implications are for your or your service users’ treatment.