Australia risks being 'stuck in the past' on HIV treatment

Australia's reputation as a world leader in HIV/AIDS treatment is at risk due to the failure of the Australian government to fund a key diagnostic test, the National Association of People Living with HIV/AIDS (NAPWA) has warned.

Resistance testing, which enables doctors to identify which anti-HIV drugs will work best and which will not work, is now a standard part of HIV care in most developed countries. But the Medicare Benefits Advisory Committee has refused to give Australian doctors access to it, despite receiving several submissions from NAPWA and the Australasian Society for HIV Medicine (ASHM [1]Australasian Society for HIV Medicine. The peak Australasian organisation representing the medical and health sector in HIV/AIDS and related areas. ).

"Being chosen as the host country for the 2007 International AIDS Society Conference is a great honour to Australia and a reflection of our country's standing in the global medical community," said NAPWA Treatments Convenor Bill Whittaker. "But unless we get access to resistance testing to enable us to maximise the benefit from HIV drugs we risk being stuck in the past."

For people living with HIV/AIDS, avoiding the development of drug-resistant [2]HIV which has mutated and is less susceptible to the effects of one or more anti-HIV drugs is said to be resistant. viral strains is vitally important. HIV mutates quickly and if resistance develops the consequences for the individual can be catastrophic. Resistance testing can identify drugs to which the individual is unlikely to respond, and those which are likely to be responsive. This saves time, money and – for the patient – the heartache of failing treatments. Since their development in the late 1990s, these tests have become part of the standard of care for people with HIV in almost all developed countries, including the US, UK and Europe – but not Australia.

"At present, doctors who need access to resistance testing have to apply to their state hospitals to fund the test," explained Whittaker. "This situation means that the availability of the test depends on what state you live in and the willingness of state health departments to foot the bill. Fortunately many states have been doing so on a limited basis, but it's time for the cost-shifting to end and for HIV resistance testing – like thousands of other diagnostic tests – to be funded by Medicare."

Whittaker stressed the fact that the cost to the public purse would not be great. "The tests cost only a few hundred dollars and typically need to be performed only once every few years at most per patient. On the contrary, we believe these tests actually save money by identifying drugs which are unlikely to work for an individual patient."

"Without resistance testing, Australian doctors will have to rely on educated guesswork to determine which drugs they prescribe, as they did before these tests were developed. Until these tests are given Medicare funding, Australia is stuck with an out-of-date approach to treatment – and one which will cost both money and lives in the long run."