Select Committee on Health Written Evidence


Memorandum by Mr Nigel O'Farrell, Consultant Physician (HA 36)


  We agree with Pollard and Savulescu[45] that not only are the new guidelines directed towards recovering costs for HIV from overseas visitors unethical, but they could also lead to an escalation of new cases in the UK by failing to treat highly infectious cases with advanced immunosuppression. In our West London hospital, the majority of new HIV cases present with low CD4 counts and medical complications that usually require urgent treatment. These individuals invariably have minimal financial resources. Pre-test HIV discussion with these high-risk individuals includes treatment issues and the likelihood that highly active antiretroviral treatment (HAART) will be recommended, if not immediately, then in the near future. If the guidelines are to be implemented, this discussion will have to include the information that the government will seek to recover medical costs from patients who may be extremely ill with conditions causing respiratory distress such as Pneumocystis carinii pneumonia and tuberculosis or cytomegalovirus retinitis that may result in irreversible blindness. Our estimation is that the psychological distress that this will cause both patients and those. involved in pre test discussion alike will be considerable.

  Back in the mid eighties before antitretovirals were available, many individuals were counselled that there was little point in getting tested if bad news was the most likely outcome. Surely we cannot go back to this era. Individuals with advanced immunosuppression are more likely to have high viral loads rendering them highly infectious when compared to others diagnosed early on or those on HAART. By not offering free treatment to this group who cannot afford HAART, the risk of new infections is likely to be increased considerably. In addition to the human rights issues, the public heath aspects of the new guidelines appear to have been glossed over and require urgent attention by HIV commissioning groups.

45   Pollard AJ, Savulescu J. Eligibility of overseas visitors and people of uncertain residential status for NHS treatment. Br Med J 2004; 329: 346-349. Back

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