HIV transmission elimination
NB: where more than one option listed regimens are presented in alphabetical order.
Choice of HIV regimen
The following recommendations for choice of ART have been proposed by the SHPN HIV Clinical Leads taking account of changes in cost of available ART medicines and newly licensed antiretrovirals including two-drug regimens and injectable treatment options. It is recognised that regimen prices will continue to change, but also that there are resource costs including staff/patient time associated with switching HIV treatment. It is also recognised that new drugs and combinations, will become available and more data on existing ART will become known. In the context of pregnancy or planning to conceive, the BHIVA pregnancy guidelines should be followed2. The aim is to provide guidance rather than comprehensive instruction. This will continue to be reviewed at the discretion of the SHPN HIV Clinical Leads.
As highlighted in the BHIVA treatment guidelines and BHIVA Standards of Care for people living with HIV3, it is expected that decisions on choice of HIV regimen will include discussion and consideration of the circumstances and wishes of the person living with HIV. A discussion should take place with individuals initiating therapy that they may be asked in the future to consider a change to their medicines to allow a lower cost regimen to be prescribed, which may increase tablet burden.
There are significant cost differences between options listed and recommendations are based on secondary care dispensing. Where disaggregated regimens with generic components are more cost effective this is recommended instead of single tablet regimens (STR), however drug costs can vary between secondary care, home delivery and community pharmacy dispensing. Services may also decide to opt for alternative rather than first line regimens where there are significant cost differences with agreement from MDT. It is recommended that prescribers consult with local/regional pharmacy team for up to date costs. The remainder of this guidance highlights other cost containment interventions that have been successfully used in NHS Scotland to minimise the budget impact of HIV treatment.