Global access to HIV treatment improving, but still not good enough

At least two million people worldwide started antiretroviral treatment in the year 2015, the United Nations body UNAIDS has reported. The number of people receiving treatment has increased significantly in the last few years – rising from 7.5 million people in 2010 to 17 million people in 2015.

But still only 46% of people living with HIV have the treatment that they need.

Since 2010, the number of people receiving treatment has more than doubled in every region of the world apart from western Europe and north America (where access to treatment was already good). Progress has been particularly impressive in eastern and southern Africa.

As a result, there has been a big decline in deaths due to AIDS.

However access to treatment remains poor in eastern Europe and central Asia – only one in five people living with HIV receive treatment.

Legal challenge to the NHS on hepatitis C treatment

The Hepatitis C Trust has announced it is considering seeking judicial review of NHS England's decision to impose a cap on the number of people treated for hepatitis C in England. There are around 160,000 people living with hepatitis C, but treatment will be rationed to just 20,000 individuals over the next two years. Only people with the most advanced liver disease will get the drugs.

Legally, the NHS should provide treatments that NICE (the National Institute for Health and Care Excellence) has decided are cost-effective. NICE has made a series of recommendations on hepatitis C treatments which NHS England has refused to implement in full. Far fewer people will receive treatment under NHS England’s plans. The Hepatitis C Trust therefore wants to ask the High Court to rule on whether NHS England has acted lawfully.

“People have been waiting years for these drugs because they felt what was on offer before was too toxic,” said Samantha May of the Hepatitis C Trust. “Now suddenly to be told they may have to wait months, even years more is really distressing. Our helpline is overwhelmed with people who cannot understand why NICE says they can be treated now but their hospitals are sending them away and telling them they’ll get a letter at some point in the future.” 

Meanwhile, both Australia and France have recently announced that they will provide treatment to every person living with hepatitis C in their countries. The Australian government negotiated a good deal with pharmaceutical companies in which the price of treatment comes down as long as a large number of people are treated. France will need to negotiate a similar deal.

In contrast, the NHS is showing a lack of ambition. Their programme will limit cases of serious illness and hospital treatment over the next few years, but it won’t do anything to reduce new infections.

The Hepatitis C Trust is appealing for financial support for their legal challenge in a crowdfunding campaign.

Legal challenge to the NHS on PrEP

Meanwhile, in a similar move, the National AIDS Trust (NAT) has said that it plans to seek a judicial review of NHS England’s decision on pre-exposure prophylaxis (PrEP). This is also being supported by a crowdfunding campaign.

On May 31, NHS England confirmed that it would not commission PrEP. NHS England said it does not have the legal power to commission PrEP as local authorities are the responsible commissioner for HIV prevention services.

Deborah Gold of NAT commented: “NHS England is sitting on something that could be the beginning of the end for the HIV epidemic – if only it were made available.  The refusal to commission it for all those at significant risk is astonishing.”

“There is an easy answer,” commented Simon Collins of HIV i-Base. “The Secretary of State can authorise access to PrEP – which has already passed public consultation and review – and fund it out of the numerous contingency budgets available for crisis situations.”

In the House of Commons yesterday, public health minister Jane Ellison faced a hostile and protracted grilling by MPs on the issue. Fifteen MPs rounded on the minister variously accusing her, the government and NHS England of “having their head in the sand”, of “passing the buck”, and of being “incompetent”.

Andrew Gwynne MP said: "Seventeen people are diagnosed with HIV every day. Each year, there are thousands of new infections. We know that PrEP has the potential to be a game-changer ­– yet as a result of this latest decision, this life-changing drug will remain inaccessible to people at risk of HIV."

Jane Ellison announced that NICE (the National Institute for Health and Care Excellence) would be asked to review the scientific evidence on PrEP over the next few months. NICE will provide a critical review of the strengths and weaknesses of the existing scientific evidence, especially of cost-effectiveness. The review is designed to help decision makers but will not be formal NICE guidance.

But campaigners are concerned this could be a delaying tactic. Ian Green of Terrence Higgins Trust said: “Enough time has already been wasted. The NICE review into PrEP is yet another unnecessary layer of bureaucracy standing between those at high risk of HIV and the drug that could stop them from getting the virus.”

The National AIDS Trust (NAT) have decided to take a judicial review to the High Court to challenge the legal arguments behind NHS England’s decision. But NAT say that as a small charity they won’t be able to cover the costs of their campaign and legal costs alone.

They need the financial support of other people who are concerned about the NHS’ policy on PrEP. You can contribute to their crowdfunding campaign here.

Tenofovir works well for people with sub-type C

People with HIV sub-type C – which is most commonly found in people with links to African countries – have good results with tenofovir-based HIV treatment, UK researchers have shown. There had been some concern that the drug was less effective with sub-type C than sub-type B, but this large study has reassuring results.

Different strains or sub-types of HIV are found in different parts of the world. Sub-type B is dominant in Europe and north America. Sub-type C is common in eastern Africa, southern Africa and India. Due to travel and migration, there is increasing mixing of sub-types. Many HIV-positive people of African ethnicity living in the UK have sub-type C.

Scientists were concerned that people with sub-type C might develop resistance to tenofovir more easily, making the drug ineffective. Tenofovir is a very widely-used medication, included in the tablets Viread, Truvada, Descovy, Atripla, Eviplera, Stribild and Genvoya.

But the study of over 8000 patients beginning HIV treatment found that people with sub-type C were no more likely to experience virologic failure (a detectable viral load) than people with sub-type B.