New HIV medication’s PBS listing welcomed

THE HIV Foundation Queensland has welcomed moves made by the Australian Government to subsidise a new HIV medication along with the decision to reduce restrictions on accessing HIV treatment by patients.

Dolutegravir, known as ‘Tivicay’, is one of the latest once-a-day HIV medications that was released late last year in the US and recently granted Australian approval in February.

The decision to list Tivicay on the Pharmaceutical Benefits Scheme (PBS) is an important development in the treatment of the disease according to the foundation’s chair, Dr Darren Russell.

“Treatment has come a long way over the years, meaning with an early diagnosis and appropriate treatment, people living with HIV can expect to live a near normal lifespan,” he said.

Studies in Europe found that Tivicay was statistically superior to other recent HIV medications such as Isentress, and Dr Russell said the benefits of the drug were the convenience of the dosage for patients and studies showing reduced side effects.

“It doesn’t appear to have gastrointestinal side effects and given that it’s a once-daily medication, the convenience for patients is a step forward for treatment of HIV.”

Other benefits of Tivicay appear to be a reduced viral load count and the fewer long-term side effects such as organ damage that can result in heart attacks and disease.

Meanwhile, ACON’s HIV Health Promotion Officer Neil McKellar-Stewart said another advantage of Tivicay was that it did not require any additional “boosting” drugs that could add to potential side-effects.

“Tivicay additionally does not require any ‘boosting’ drug to ensure that its levels in circulating blood plasma are sufficient to fully suppress HIV replication,” he said,

“This provides an advantage over the protease inhibitors and over elvitegravir (one of the three drugs in the ‘Quad’ pill, Stribild to be released on PBS listing in May).”

McKellar-Stewart also noted that the possibility of the HIV virus becoming resistant to this new medication was low due to a high genetic barrier to resistance.

“In fact, dolutegravir is licensed for use in people who have developed resistance to other drugs in the integrase inhibitors class,” he told the Star Observer.

Prior to listing on the PBS, Tivicay cost users up to $800 a month according to the head of the HIV, Immunology and Infectious Diseases Unit at St Vincent’s Hospital, Professor Andrew Carr, who also highlighted the reduced side-effects of the drug.

“It doesn’t appear to have… side effects like nausea and diarrhoea that some other pills have. And you might imagine that chronic nausea is a big impediment to people taking a daily medication for the rest of their lives,” Professor Carr told the ABC.

“It doesn’t have some of the neuro-psychiatric side effects that some of the other medications can cause, such as sleep disturbance.

Dr Russell highlighted recent reports indicating early treatment as an effective means of preventing the spread of HIV along with the improved health outcomes for people living with the disease.

“Every clinician in the country is working towards the common goal of reducing HIV transmission and we hold a common understanding that early treatment initiation is very important in achieving this,” he said.

“As clinicians we are always trying to gain a thorough understanding of the barriers preventing early treatment uptake so we can overcome those to encourage people living with HIV to seek treatment early.

“Studies continue to find that treatment can greatly reduce a person’s chance of transmitting the virus to a partner.”

Tivicay was listed on the PBS on April 1 and is available for around $20 a month.

Restrictions placed on early access to Tivicay and other HIV medications was lifted recently following more changes made to the PBS.

The changes saw the removal of specific conditions placed on people living with HIV in order to access medication, such as a CD4 count about 500 and displaying clinical symptoms.