APPENDIX 28
Memorandum by Mr Nigel O'Farrell, Consultant
Physician (HA 36)
ELIGIBILITY FOR
HIV TREATMENT
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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