An infectious disease expert says British Columbians with HIV have less access to injection drugs than patients in other parts of the country, who can get shots every two months instead of taking them every day. That’s what it means.
Dr. Brian Conway questioned why the BC Center for Excellence in HIV/AIDS would decide to prescribe the extended-release injectable drug called Cavenuva to eligible people, rather than health care professionals.
Center Unlike other provinces without such a centralized system, British Columbia procures, distributes, and monitors HIV drugs, as well as reviews applications from prescribers.
Conway said the center has denied Cavenuva approval for all 15 patients who have applied since the spring. He added that six of the applicants were rejected simply because they were thought to respond well to the tablet drug.
Conway said the drug had a “long application process that led to zero approvals in my case,” and that it was prescribed based on discussions between health care providers and patients, without “unnecessary” oversight. He said he thinks it should be done.
“Like all of our other HIV medications, this is not just a routine prescription, it is a 25-question questionnaire and supporting documentation.”
A spokesperson for the center said it has received 39 applications for Cabenuva since last year, of which 15 have been approved, but 11 are still pending and 13 have been withdrawn or not processed for other reasons. said.
The center said patients could be refused the shot for a variety of reasons, including intolerance to one or both of the drugs involved or side effects.
Dr. Julio Montaner, the center’s executive director, could not provide details of the decision-making process.
Conway said 10 of the approximately 500 people with HIV are taking Cavenuva because they received it in clinical trials and continue to take it. that Before Canada became the first country to approve the long-lasting therapy three years ago.
He said injectables have many advantages compared to daily pills, and patients should have the option without a third party making decisions.
“Some people don’t want to be reminded every day that they have HIV. They’re afraid people will find their medicine,” he said.
Cabenuva is a combination of cabotegravir and rilpivirine for patients 12 years of age and older. Studies have shown it to be as effective as oral therapy in treating symptoms. The virus can be transmitted through sexual contact, sharing drug injection equipment, and during pregnancy, childbirth, and breastfeeding.
This injectable HIV drug is considered a breakthrough in the evolution of medicine for patients with the virus who once had to take multiple pills a day. They often had debilitating and visible side effects such as fat and muscle loss and dark cheeks.
A spokesperson for the BC Center for Excellence in HIV/AIDS said the organization has had an administrative role in handling HIV drugs since the 1990s, based on funding province decisions.
“This is different than other jurisdictions across the country and elsewhere,” he said in an email.
Conway said the center does not have enough staff to provide shots at clinics and clinics, which also need to be equipped with refrigerators to store medications. . But he added that many offices, including his, have refrigerators, and administering the shot is no different than many other types of shots.
British Columbia’s Ministry of Health did not respond to questions about why patients cannot directly access Cavenuva with a doctor’s prescription. The center said it is establishing guidelines for health care providers to be involved in prescribing and monitoring all antiretroviral drugs.
Sarah Chown, executive director of AIDS Vancouver, said members whose Cavenuva applications were rejected don’t understand why an organization that hasn’t met the decision-makers made that decision.
She said applicants who want to get the vaccine every few months will need to submit a letter explaining why they can’t take the pill every few months.
“We do not believe that patients need to prove they are unable to continue on oral medications to enjoy the freedom, privacy and flexibility that comes with long-acting treatments,” she said.
“We are concerned and frustrated about the people who are still being rejected here in British Columbia, especially since we know that some of those people will also be approved in other provinces. is.”
The Ontario Ministry of Health said that HIV patients whose doctors have prescribed Cavenuva can obtain it at pharmacies like any other drug.
“There is no need to apply for individual approval.” “Therefore, there is no application process or rejection.”
Dr. Jonathan Angell, director of the Ottawa Hospital’s HIV clinic, said prescribing Cavenuva is a puzzlingly “complex” issue for patients in B.C.
“These are people who don’t have enough voice or power to get these drugs in B.C.,” he said.
Dr. Angell, who has prescribed Cavenuva to 127 patients since 2020, said some patients dislike injections and would rather continue taking a pill every day, but the choice should be theirs.
Cabenuva’s price is considered comparable to the most common daily HIV treatment called Biktarvy, and that would not be a factor in not approving it for patients in British Columbia, he said.
States negotiate prices for some drugs directly with drug companies, and the costs are confidential.
This report by The Canadian Press was first published Nov. 12, 2023.
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