Drug Treatment Program Update
As of January 2011 Drug Treatment Program Update
A key component of the Centre’s mandate is to monitor the impact of HIV/AIDS on British Columbia. The Centre provides essential information to local health authorities, treating physicians and the community-at-large on an ongoing basis.
The Drug Treatment Program Update is one example of the Centre’s commitment.
In B.C., all anti-HIV medications are distributed at no cost to eligible HIV-infected individuals through the Centre’s Drug Treatment Program (DTP). The DTP Update provides an important overview of available anti-HIV drugs, common drug combinations and distribution of active DTP participants throughout the province.
DTP participants are typically followed at three-monthly intervals at which time routine blood sampling is performed. Information from all recipients is entered into a database, providing data for clinical and virological outcome studies of patients receiving antiretroviral therapy. These studies form the basis of ongoing revisions to the Centre’s treatment guidelines.
HIV/AIDS continues to be a pressing concern in B.C. As of January 2011, 5,584 persons were receiving anti-retrovirals or other anti-HIV medications from the DTP.
Table of Contents
HIV/AIDS drugs available through the Centre...... 2 Active HIV/AIDS drug treatment program participants within select cities Distribution of active DTP participants • Vancouver...... 10 by health authority...... 3
• Victoria...... 11 Distribution of active DTP participants by health services delivery areas...... 4 • Surrey...... 12
DTP participants within health authorities • Kelowna...... 13 • Vancouver Coastal Health...... 5 • Prince George...... 14 • Fraser Health Authority...... 6 Number of drugs • Vancouver Island Health Authority...... 7 percent distribution of DTP participants on ARV therapies...... 15
• Interior Health Authority...... 8 Drug combination distribution of DTP participants...... 16 • Northern Health Authority...... 9 Definitions...... 16
1 HIV/AIDS Drugs available through the Centre (January 2011)
The following HIV/AIDS Treatment Program and Special Access Program (SAP) drugs can be Drugs available through Health Canada's requested through the Centre using a drug request prescription form. All requests received Special Access Program will be assessed in terms of how they meet the established HIV/AIDS drug treatment ° Albendazole – Microsporidium ® guidelines. Eligible individuals will obtain, at no cost, HIV/AIDS therapies offered by the ° Amphotericin, suspension (Fungilin ) — Azole-resistant Centre’s Drug Treatment Program. oral candidiasis ® ° Didanosine powder for oral solution (Videx ) — for children Antiretroviral Drugs for HIV infection ® ® Efavirenz liquid (DMP, Sustiva ) — for children ° Abacavir (Ziagen ) ° Atazanavir (Reyataz®) ° Foscarnet infusion (Foscavir) — Cytomegalovirus (CMV) affecting ° sight or organ systems Atripla® (Efavirenz, Emtricitabine and Tenofovir in one tablet) ° Nevirapine liquid (Viramune®) — for children Combivir® (Zidovudine and Lamivudine in one tablet) ° ° Stavudine liquid (D4T, Zerit®) — for children § Darunavir (Prezista®) — for extended therapy only ° ® ° Delavirdine (Rescriptor ) ® ° Didanosine (Videx-EC ) ® ° Efavirenz (Sustiva ) Program Statistics (as of January 2011) ® § Enfuvirtide (Fuzeon ) — for extended therapy only Number of participants ® § Etravirine (Intelence ) — for extended therapy only Ever enrolled 9,955 ® § Maraviroc (Celsentri ) — for extended therapy only Currently on antiretrovirals 5,584 ® ° Fosamprenavir (Telzir ) Newly enrolled in January 2011 81 ® ° Indinavir (Crixivan ) ® Gender ° Kaletra (Lopinavir/ritonavir – tablets and liquid) ® Men 84% ° Kivexa (Abacavir and Lamivudine in one tablet) ® Women 16% ° Lamivudine (3TC – tablets and liquid) ® ° Nelfinavir (Viracept ) Health Authorities ® ° Nevirapine (Viramune ) Vancouver Coastal 58% § Raltegravir (Isentress®) — for extended therapy only Fraser 22% ® ° Ritonavir (Norvir – tablets, capsules and liquid) Vancouver Island 11% ® Interior 6% ° Saquinavir-HG (Saquinavir hard gelcaps and tablets, Invirase ) ® Northern 3% ° Stavudine (Zerit ) ® ° Tenofovir (Viread ) § Tipranavir (Aptivus®) — for extended therapy only ® ° Truvada (Emtricitabine and Tenofovir in one tablet) ® ° Trizivir (Zidovudine, Lamivudine and Abacavir in one tablet) ® ° Zidovudine (Retrovir – capsules and liquid) § Certain restrictions apply to these drugs – please contact St. Paul’s Ambulatory Pharmacy for further information. Drugs for the Indicator Diseases of AIDS covered by the program ® ° Aerosol Pentamidine (Pneumopent ) – Prophylaxis for PCP ® ° Atovaquone (Mepron ) — One-time treatment for PCP, treatment for unresponsive toxoplasmosis, fourth-line PCP prophylaxis ® ° Azithromycin (Zithromax ) — Prophylaxis for MAC, treatment for unresponsive toxoplasmosis ° Ciprofloxacin — For clarithromycin-resistant Mycobacterium avium infections (MAC) ® ° Clarithromycin (Biaxin ) — Mycobacterium avium infections (MAC) ® ° Ethambutol (Myambutol ) — Mycobacterium avium infections (MAC) ® ° G-CSF (Filgrastim, Neupogen ) — Neutropenia ° Ganciclovir, infusion & intravitreal — Cytomegalovirus (CMV ) affecting sight or organ systems ® ° Octreotide (Sandostatin ) — HIV-related diarrhea ® ° Paromomycin (Humatin ) — Cryptosporidium ® ° Rifabutin (Mycobutin ) — Mycobacterium avium infections (MAC) ® ° Valganciclovir (Valcyte ) – Cytomegalovirus (CMV ) affecting sight or organ systems
2 Distribution of active DTP participants by health authority (January 2011)
Total = 5,584
0
1 – 99 Northern 100 – 499
500 – 999
1000+
Vancouver Coastal
Interior
Vancouver Island Vancouver Coastal
Fraser
3 Distribution of active DTP participants by health services delivery areas (January 2011)
Total = 5,584 Northwest Northeast 0
1 – 9
10 – 99
100 – 499
500 – 999
1000+
Northern Interior
North Shore/ Coast Garibaldi
Thompson Cariboo Shuswap
North Vancouver Island North Shore/ Okanagan Coast Garibaldi East Kootenay Kootenay Fraser Fraser Boundary North Central Vancouver Island East
Vancouver South Vancouver Island
Richmond Fraser Fraser South East
4 Active DTP participants within health authorities: Vancouver Coastal Health (January 2011)
Total = 3,239
0
1 – 9
10 – 49 North Shore/ Coast Garibaldi 50 – 99
100 – 999
1000+
North Shore/ Coast Garibaldi
Vancouver Richmond
5 Active DTP participants within health authorities: Fraser Health (January 2011)
Total = 1,226
0
1 – 9
10 – 49
50 – 99
100 – 999
1000+
Fraser East
Fraser North
Fraser South
6 Active DTP participants within health authorities: Vancouver Island Health (January 2011)
Total = 628
0
1 – 9
10 – 49 North Vancouver 50 – 99 Island 100 – 999
1000+
Central Vancouver Island
South Vancouver Island
7 Active DTP participants within health authorities: Interior Health (January 2011)
Total = 333
0
1 – 9
10 – 49
50 – 99
100 – 999
1000+
Thompson Cariboo Shuswap
East Kootenay
Kootenay Boundary
Okanagan
8 Active DTP participants within health authorities: Northern Health (January 2011)
Northwest Total = 147
0
1 – 9 Northeast 10 – 49
50 – 99
100 – 999
1000+
Northern Interior
9 Active DTP participants within select cities: Vancouver (January 2011)
Total = 2,660
0
1 – 9
10 – 19 City Centre 20 – 49 161 V6C V7X 50 – 99 V6G V7Y 100+ V6E Downtown Eastside V5K V6B 162 V5L V6A
V6T V6R V6K V5T V5M North East 163 V5V V5N V6S V6L V6J V6H V6Z Midtown 165 V5Y V5R Westside 164 V6M V5W V6N V5P South 166 V5S V6P V5X
10 Active DTP participants within select cities: Victoria (January 2011)
Total = 265
0
1 – 9
10 – 19
20 – 49 V8Y 50 – 99
V9E 100+
V8X V8N V9B V8Z
V8P
V9A V8T V8R
V8S V8V
V8W
V9C
11 Active DTP participants within select cities: Surrey (January 2011)
Total = 310
0 V3V V3T V3R 1 – 9
V4N 10 – 19
20 – 49
50 – 99 V3W 100+ V3S Surrey V3X
V4A V4P
V4B South Surrey/ White Rock
12 Active DTP participants within select cities: Kelowna (January 2011)
Total = 81
0
1 – 9
10 – 19
20 – 49
50 – 99
100+
V1V
V1X V1Y V1P V1Z
V1W V4T
13 Active DTP participants within select cities: Prince George (January 2011)
Total = 67
0
1 – 9
10 – 19
20 – 49
50 – 99
100+ V2K
V2M
V2L
V2N
14 Percent Distribution of Participants on ARV Therapies by Number of Drugs (January 1996 – January 2011)
15 Drug Combination: Distribution of DTP Participants (January 1999 – January 2011)
Definitions:
NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor): an Boosted PI: a combination therapy regimen of four or fewer antiretroviral antiretroviral drug that binds to and disables reverse transcriptase, an drugs, including one PI and a small (less than 800mg daily) additional dose enzyme that HIV needs to make copies of itself. of ritonavir. The addition of ritonavir inhibits metabolism of other PIs and improves their exposure. This may allow for decreased dosing frequency or PI (Protease Inhibitor): an antiretroviral drug that binds to and blocks HIV pill burden and may improve adherence and antiretroviral activity. protease from working, thus preventing the production of new functional viral particles. NNRTI/no PI: a combination therapy regimen of four or fewer antiretroviral drugs, including an NNRTI, but no PIs. MDRT (Multiple Drug Rescue Therapy, Mega-HAART): the use of five or more antiretroviral drugs to treat HIV, typically some or all of which have Other: a combination therapy regimen of four or fewer antiretroviral drugs, been used previously by the individual. other than MDRT, 1 or more PI, Boosted PI, NNRTI/no PI (e.g. Triple NRTI regimen). 1 or more PI: a combination therapy regimen of four or fewer antiretroviral drugs, including one unboosted PI or two or more PIs with or without a small (less than 800mg daily) additional dose of ritonavir.
16 BC Centre for Excellence in HIV/AIDS > Improve the health of British Columbians with HIV through comprehensive research and treatment programs;
> Develop cost-effective research and therapeutic protocols;
> Provide educational support programs to health-care professionals;
> Monitor the impact of HIV/AIDS on B.C. and conduct analyses of the effectiveness of HIV-related programs.
Contact information 608 – 1081 Burrard St. Vancouver, B.C. V6Z 1Y6
Tel: 604.806.8477 Fax: 604.806.9044
Physician Drug Hotline: 1.800.665.7677 St. Paul’s Hospital Pharmacy Hotline: 1.888.511.6222 website: www.cfenet.ubc.ca e-mail: [email protected]
Funding for the BC Centre for Excellence in HIV/AIDS is provided by the B.C. Ministry of Health through Pharmacare and the Provincial Health Services Authority.