Editorial – Difficult choices

On first sight, it is alarming to read that a new study found that some HIV clinics are making treatment decisions on the basis of cost. It implies that HIV-positive people aren’t getting the best possible care.

But HIV clinics are having to face some difficult choices. They have received real increases in their funding, but there are more people living with HIV in the UK. What’s more, there are more anti-HIV drugs to choose from than ever before. Often there is little to choose between these drugs in terms of their potency or side-effects but big differences in price.

So clinics have to decide if they allow doctors to prescribe any drug regardless of its cost, therefore reducing the amount of money available for other services offered by the clinic, or to guide doctors to prescribing the cheaper of equally effective drugs and using the money saved to pay for things like longer opening hours, more staff, and additional services.

There needs to be flexibility. Not everybody with HIV has the same treatment needs and doctors should have the freedom to decide which drug is best for a particular patient. And at the moment clinics have this flexibility, meaning that every treatment-experienced patient who needs the newly licensed darunavir (Prezista) will receive it.

Anti-HIV therapy

Side-effects

Treatment for infections

Next week

There will be a daily bulletin next week from Tuesday onwards summarising the key news from the annual Conference on Retroviruses and Opportunistic Infections (CROI) one of the most important HIV conferences of the year, which takes place in Los Angeles.