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UK: National AIDS Trust calls for the NHS to provide earlier HIV treatment

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  1. How does this differ from the established 2008 guidelines setting the CD level at 350 “However, it’s currently recommended in UK HIV treatment guidelines that you start taking HIV treatment immediately if you are ill because of HIV, or have an AIDS-defining illness. If you do not have any symptoms, then UK treatment guidelines (published in 2008) recommend that you start treatment when your CD4 cell count is around 350. Your doctor should start discussing HIV treatment with you when your CD4 cell count is around this figure and you are advised to start treatment as soon as you are ready.

    UK treatment guidelines also make other recommendations about whether you should take HIV treatments, depending on the length of time you have been infected with HIV, the level of your CD4 cell count and the amount of HIV in your blood – your viral load.”

    I refer or

    1. “However, it’s currently recommended in UK HIV treatment guidelines that you start taking HIV treatment immediately if you are ill because of HIV” – this specifically relates to opportunistic infections (pneumonia, PCP, Kaposi’s sarcoma) which can occur at CD4 cell counts higher than 350 (rarely) but more frequently applies to co-infection with Hep C / B, tuberculosis , or certain cancers & pregnancy.

      The 2008 guidelines were updated in 2012, and now include a section specifically about treatment as a form of prevention in sero-discordant relationships. HIV Clinicians are encouraged to have discussions about starting treatment earlier, regardless of CD4 cell count because it has been recognised that achieving an undetectable viral load significantly reduces the potential for HIV to be passed on to a negative partner.

      There have been concerns that in the new NHS arrangements no funding would be available to this sort of intervention, hopefully HIV commissioners will now take note!

    1. PN could we also widen the field as items and reports in context relating to new items are informative and not just selective.

      Items of interest, further read:

  2. whatevernext 23 Jan 2013, 5:26pm

    What about “In another case study cited, a family used false identities to claim for HIV drugs worth £2.2m, which were then sold on for profit.”

  3. Haven’t the careerists at NAT been telling us these last few years how wonderful and effective HIV treatments now are and how they can provide a normal lifespan – itself a clear enticement for some to then go out and get infected – without having to stoop this low?

    NAT is merely stepping into line with all other paid for pharma shills who are manically pushing all manner of toxic drugs at HEALTHY people under the guise of pre-emptive treatment:- all of which have their own added side effects and addictive qualities.

    Indeed, pharma drugs are the leading cause of death in the US today – fact!

    To stay in optimum health with or without HIV, simply take good care of yourselves, eat the right nutritious foods and supplements to feed your body, get plenty of exercise and DON’T fall for the latest wheeze being perpetuated by the most discredited and heavily fined industry on earth.

    Cue W6:-

    1. Are you suggesting that people living with HIV should not take treatment when it is indicated Samuel? Think carefully about that one!

      If you were a +ve gay man would you not want to take all available precautions to ensure the risk of HIV transmission was as low as possible?

      1. W6, just a week ago we were told of the spectre of cheaper generic drugs being prescribed to HIV positive men:- now the all ut redundant NAT is joining the “drug-up-for-the-sake-of-it-at-the-taxpayers’-expense” bandwagon by encouraging earlier prescription of treatments when they have been telling us all these years that existing drug protocols already provide “long and happy lifespans”.

        They can’t have it both ways, surely?

        But then, it isn’t their own money NAT is suggesting frittering away, is it?

        Oh, and W6, please don’t dangle the “take-all-available-precautions-to- ensure-the-risk-of-HIV-transmission-was-as-low-as-possible” carrot as the emotive stick with which to bang the drums of mass medication for all.

        In an age where mass medication, inoculation and vaccination are being pushed at us at an increasing and alarming rate, the only people who seem not to have noticed that the rest of the world has woken up to this global scam are the pharma foot soldiers peddling this tosh.

        1. It might help if you read the article correctly Samuel as it sees you have not grasped what is being suggested here. This is about the positive partner in a sero-discordant couple having the opportunity to start treatment in order to reduce the risk of transmission to an absolute minimum………….it is about individual choice, it really isn’t about you & your crusade against Pharma Co’s

          Once again you are showing your complete lack of the appreciation of the concepts involved here.

          I note you swerved the question I posed relating to your suggestion that +ve people should not take meds when indicated. Perhaps you could clarify your position in this!

          1. If the sero-discordant couple are practising safe sex in the first place then they darned well needn’t incur an additional burden to the tax payer by participating in yet another hare-brained scheme that blatantly incentivises unsafe sex in that the positive partner’s viral load becomes undetectable thereby providing a green light for the couple to have sex in the raw.

            THAT seems to be the REAL pretext behind this wheeze:- and of course the attractive proposition it presents will in turn boost big pharma’s coffers as sero discordant couples take up this initiative in droves since it is of course at the tax payers’ expense.

            And all disguised as HIV prevention in this upside down, back to front, inside out PC world of ours where truth left the equation long, long ago.

          2. As you seem to be unable to provide clarity on your position in relation to HIV treatment when indicated, are we to assume that you believe that HIV can be successfully managed by a good diet, exercise & natural remedies without using ARV’s when clinically indicated? I think this is an important point on which to press you on!

            The correct term is “safer sex” not “safe sex” as you have suggested. Condoms are not 100% effective 100% of the time, the higher the viral load the greater the risk of HIV transmission should a condom fail. I think many +ve people would take the view that they would do as much as it takes to protect their partner – sometimes the emotional stress of knowing they are infectious to their partner is hard to cope with. We should be treating the whole person not just the virus!

            I know you like the narrow confines of HIV amongst MSM, but some don’t have the choice to use condoms, some couples want to conceive naturally, some want natural sex- it’s called choice!

          3. factsandfigures 24 Jan 2013, 2:58pm

            Problems with sex among gay and bisexual men with HIV

            We have just published a new article in BMC Public Health that shows that more than two thirds (70.5%) of gay men with diagnosed HIV report problems with sex in the last year. It describes the problems and examines how they vary by age, time since HIV diagnosis, and current use of ARVs. The findings show we need to expand services to meet the needs of people with HIV, especially their ability to negotiate sex that is safe and satisfying.

  4. I take my HIV drugs, because I have to. They stop me getting ill.

    I lead what is a relatively healthy lifestyle, eat well and exercise regularly. The idea I could give up taking the drugs is fanciful.

    Toxic or not, they are life savers. The only other medication I take is the very occasional paracetamol for a headache.

    Shame Samuel’s argument skirted way too close to the denialist crap to be taken serious. I agree that people take too many drugs, but the idea that HIV people are being controlled by some Big Pharma conspiracy in taking drugs they don’t need is foolish.

    I do worry a bit that NAT are officially saying that people should start treatment early to protect their partners. Particularly, as the legal framework is not in place to protect them from possible criminal proceedings.

    1. NAT have timed this to co-inside with the separation of the HIV prevention role (going to local authorities) from that of a care & treatment provided by the NHS. The treatment as Prevention (TaP) concept sits in the middle of these two functions & it is unclear who would pay for the period of early treatment, prior to clinical need.

      NAT are quite rightly concerned that TaP would become somewhat of a “clinic” lottery, (which it already is to some degree) & depending on the individual clinic finances & rigour of prescribing the changes may not provide equity for this intervention as it should do. HIV clinics will in the future only be able to prescribe & refer for very specific HIV related treatment & interventions & it is this sort of thing that will get lost through the cracks from April this year

      We will not notice much of all this upheaval this year, as the Gov have pumped in a load of extra cash to ensure the changes appear to be for the better, 2014 will be v different!

    2. Where did I ever suggest giving up the drugs, Charles?

      Read what I actually wrote why don’t you!

      I trust you’d agree that looking after oneself – whether HIV+ or – – maintains one’s body in optimum health?

      Nowhere have I advocated a healthy lifestyle as an alternative to HIV drugs regimens, but certainly as a way of maintaining optimum health for as long as possible until one’s t-cell count dictate treatment:- at the stage which they’ve been decreed for many years now.

      NAT is now advocating their prescription for zero discordant partners considering premeditated risky sex, which isn’t just extremely reckless but an unnecessary and unwanted additional burden on the taxpayer.

      If sero discordant partners can’t accept that they have to play by safer sex rules to avoid HIV transmission just like the rest of us, then they should jolly well pay for these superfluous “preventive” treatments themselves – and for any HIV drugs to treat the likelihood of infection come to that!

      1. “NAT is now advocating their prescription for zero discordant partners considering premeditated risky sex”

        This is your perception of the NAT announcement & a perception that is way off the mark; where is there any suggestion that +ve people with an undetectable VL should not use condoms? It is very wrong of you to deliberately mis-interpret what NAT have stated in an effort to suit your particular ideology. Both the British HIV Association & the Expert Advisory Group on Aids have provided much needed high quality evidence to support the position NAT has taken on this issue. You really make me cross with your constant put downs relating to all things HIV. If it were cancer you would take a different line I am sure!

        Charles makes a very good point – your rhetoric is sailing close to the wind of being an HIV denialist – we have debated this several times, yet you continue to claim you are not a denialist – I think your record on these pages speaks for itself on this particular point.

  5. Jock S. Trap 24 Jan 2013, 10:57am

    I agree.

    Surely the outcome of this would cost less!

    I did think that people already could and it’s criminal if people aren’t given this choice. It protect and controls the virus. Surely that has to be better.

    Another thing I would like to see is opening up organ donation between HIV patients. It would free up the already long waiting lists of livers and kidneys etc for those HIV patients who need transplants because of the medication.

  6. factsandfigures 24 Jan 2013, 2:44pm

    Results: Overall, 70.5% of the gay and bisexual men with diagnosed HIV completing the survey reported one or
    more problems with sex within the previous 12 months. Most commonly reported problems include loss of libido
    (44.0%, n=540), poor self-image or low self confidence (43.9%, n=534), worries about passing HIV to potential sexual
    partners (37.3%, n=454), and fears of rejection from sexual partners (34.7%, n=422). Responses varied according to
    age, time since diagnosis, and whether or not the respondent was currently taking anti-retroviral therapy.
    Qualitative analysis of data relating to what support might help men overcome problems with sex indicate a need
    for therapeutic support to increase self esteem and confidence, clarity on criminalisation of HIV transmission, the
    tackling of HIV related stigma and help to achieve a higher quality (as opposed to quantity) of sex.

  7. And who do the NAT expect to fund this new treatments for prevention” scam?

    Certainly not the NHS, which is currently refusing life-saving cancer treatments to genuinely needy cancer patients.

    And the public simply would not support such a hair-brained crackpot scheme.

    So again I ask, who would fund “treatment as prevention” when the possible transmission of HIV between sero discordant partners – who invariably are intent on willfully endangering the negative partner’s long-term health and life expectancy and billing their recklessness to the NHS come what may – is not even guaranteed to be prevented by this approach?

    NAT, not fit for purpose and a drain on us all.

    I mean, can someone kindly elucidate what they actually DO?!

    1. “Certainly not the NHS, which is currently refusing life-saving cancer treatments to genuinely needy cancer patients”

      And here we have it – cancer is obviously such a more deserving condition than HIV. Cancer seems to be perhaps is a more “respectable” illness in your view. Cancer patients are “genuine”, HIV patients are not. What a divisive individual you are Samuel, but given your leanings to the Right I guess we should expect more of the same form you – put deserving cancer patients against undeserving HIV Patients. Both cancer & HIV deserve to be funded appropriately not one or the other!

      “who invariably are intent on willfully endangering the negative partner’s long-term health and life expectancy”

      how so? are you suggesting +ve individuals should only be partnered by other +ve people?

      You clearly do not understand what NAT et al are proposing; this is not the same as PrEP where the -ve partner takes drugs you fool! Learn to read & understand! God help us……………..

      1. Your propensity to twist words to run other people’s submissions down knows no ends, W6.

        There’s an acute difference between funding the provision of drugs to people who are dying from a terminal illness and funding expensive drugs for the benefit of those with HIV – many of whom were willfully reckless in the first place to have acquired the virus – simply to enable them to know how raw penetration feels like.

        And until the efficacy of these drugs is 100% proven to be safe, NAT has absolutely no right to be advocating for such a potentially costly – in terms of money and peoples’ health – scheme.

        One wonders what kick-backs NAT receive for putting such potentially disastrous notions into our community’s psyche.

        After 30+ years fighting this horrible disease, how dare Mz. Jack attempt to palm this scam off as an HIV prevention initiative when it is anything but.

        Doublespeak at its worse, and I’ve a good mind to submit a letter of complaint to The Charity Commission.

        1. Why don’t you just do that Samuel, complain to the Charity Commission, at least for once you will be doing something constructive, rather than just bleat here on PN.

          As for my interpretation of your writings I think there are many who would agree that your have a propensity to be decisive, use inflammatory words & more often than not provide a totally inaccurate assessment of the key points of any story relating to HIV – the use of rhetoric is your main stay & you seem unable to deal with any detail what so ever (the devil is always in the detail). good

          It seems your over riding purpose is to stymie debate in favour of your own prejudices relating to Pharma Co’s & your fanatical interest in HIV charities. For someone who is HIV negative you really do seem to have a fixation about all things HIV, but sadly your understanding of the topic does not match your vigour to be critical of anyone who does have a reasonable understanding of the subject area.

    2. factsandfigures 24 Jan 2013, 4:14pm

      The resources for local commissioners are comprised of three key elements:

      An allocation to CCGs to cover the local services they will commission on behalf of their populations (£63.4 billion, representing 2.3% nominal growth or 0.3% real terms growth). Current assumptions suggest that an average CCG successfully delivering its QIPP schemes should in fact require less than 1% to cover expected cost pressures;
      The running costs allocated to CCGs, as published on 8 November 2012 (£1.3 billion); and
      An allocation to local authorities to fund services that benefit both health and social care, which will increase by 38% to £0.9 billion in 2013/14, as previously announced.

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