British HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals

Abstract

The British HIV Association (BHIVA) Guidelines Co-ordinating Committee (April 12, p 1086)1BHIVA Guidelines Co-ordinating CommitteeBritish HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals.Lancet. 1997; 349: 1086-1092Summary Full Text Full Text PDF PubMed Scopus (209) Google Scholar provide, as intended, a statement of broadly agreed principles on current therapeutic choices in HIV health care and is, indeed, useful for those engaged in purchasing and planning HIV services. Accordingly, most of the guidelines justified the recommendations made on the basis of published evidence. However, one glaring omission should raise concern among purchasers and providers of HIV care.The committee rightly identifies that cost is a major stumbling block to the use of combination therapies in the UK National Health Service and other health-care funding bodies, and then states that “preliminary analyses demonstrate that, per year of life saved, these [treatment] combinations compare favourably with a range of other medical interventions”. This statement is not backed up by appropriate references. Whether or not it is true, the next sentence is even more misleading: “Increased drug costs are likely to be more than offset by savings in health-care resources elsewhere”. Again, this claim is not justified nor are references supplied. The first of these two sentences is contradicted by the second, since most medical interventions are not offset by savings in health resources elsewhere.2Department of Health, Economics and Operational Research DivisionRegister of cost-effectiveness studies. Department of Health, London1994Google Scholar Worse is the implication that for health-care providers or purchasers no extra net funds are likely to be required. This has not been the case in the move from monotherapy to dual combination therapy and, indeed, for Sheffield Health Authority only about a third of the extra resources required for dual combination therapy have been provided by additional funds made available centrally.Purchasers do find consensus statements such as the BHIVA guidelines useful, but only when they are based on evidence and not conjecture. Although the best affordable treatment should be made available, the same rules about supporting evidence must apply to statements about health economics as they do to virology and therapeutics. The British HIV Association (BHIVA) Guidelines Co-ordinating Committee (April 12, p 1086)1BHIVA Guidelines Co-ordinating CommitteeBritish HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals.Lancet. 1997; 349: 1086-1092Summary Full Text Full Text PDF PubMed Scopus (209) Google Scholar provide, as intended, a statement of broadly agreed principles on current therapeutic choices in HIV health care and is, indeed, useful for those engaged in purchasing and planning HIV services. Accordingly, most of the guidelines justified the recommendations made on the basis of published evidence. However, one glaring omission should raise concern among purchasers and providers of HIV care. The committee rightly identifies that cost is a major stumbling block to the use of combination therapies in the UK National Health Service and other health-care funding bodies, and then states that “preliminary analyses demonstrate that, per year of life saved, these [treatment] combinations compare favourably with a range of other medical interventions”. This statement is not backed up by appropriate references. Whether or not it is true, the next sentence is even more misleading: “Increased drug costs are likely to be more than offset by savings in health-care resources elsewhere”. Again, this claim is not justified nor are references supplied. The first of these two sentences is contradicted by the second, since most medical interventions are not offset by savings in health resources elsewhere.2Department of Health, Economics and Operational Research DivisionRegister of cost-effectiveness studies. Department of Health, London1994Google Scholar Worse is the implication that for health-care providers or purchasers no extra net funds are likely to be required. This has not been the case in the move from monotherapy to dual combination therapy and, indeed, for Sheffield Health Authority only about a third of the extra resources required for dual combination therapy have been provided by additional funds made available centrally. Purchasers do find consensus statements such as the BHIVA guidelines useful, but only when they are based on evidence and not conjecture. Although the best affordable treatment should be made available, the same rules about supporting evidence must apply to statements about health economics as they do to virology and therapeutics. DEPARTMENT OF ERRORBritish HIV Association guidelines for antiretroviral treatment of HIV seropositive individuals– In this letter by P B Carey and colleagues (June 21, p 1837), the “standard initial therapy” referred to in the last paragraph should have been”…zidovudine and didanosine (or lamivudine) and saquinavir…”. Full-Text PDF British HIV Association guidelines for antiretroviral treatment of HIV seropositive individualsAuthors' reply Full-Text PDF