Drug Treatment Program Update

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1 Drug Treatment Program Update As of May 211

2 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 May 211, 5,693 persons were receiving anti-retrovirals or other anti-hiv medications from the DTP. Table of Contents HIV/AIDS drugs available through the Centre...2 Distribution of active DTP participants by health authority...3 Distribution of active DTP participants by health services delivery areas...4 DTP participants within health authorities Vancouver Coastal Health...5 Fraser Health Authority...6 Vancouver Island Health Authority...7 Active HIV/AIDS drug treatment program participants within select cities Vancouver...1 Victoria...11 Surrey...12 Kelowna...13 Prince George...14 Number of drugs percent distribution of DTP participants on ARV therapies...15 Interior Health Authority...8 Northern Health Authority...9 Drug combination distribution of DTP participants...16 Definitions

3 HIV/AIDS Drugs available through the Centre (May 211) The following HIV/AIDS Treatment Program and Special Access Program (SAP) drugs can be requested through the Centre using a drug request prescription form. All requests received will be assessed in terms of how they meet the established HIV/AIDS drug treatment guidelines. Eligible individuals will obtain, at no cost, HIV/AIDS therapies offered by the Centre s Drug Treatment Program. Antiretroviral Drugs for HIV infection Abacavir (Ziagen ) Atazanavir (Reyataz ) Atripla (Efavirenz, Emtricitabine and Tenofovir in one tablet) Combivir (Zidovudine and Lamivudine in one tablet) Darunavir (Prezista ) for extended therapy only Delavirdine (Rescriptor ) Didanosine (Videx-EC ) Efavirenz (Sustiva ) Enfuvirtide (Fuzeon ) for extended therapy only Etravirine (Intelence ) for extended therapy only Maraviroc (Celsentri ) for extended therapy only Fosamprenavir (Telzir ) Indinavir (Crixivan ) Kaletra (Lopinavir/ritonavir tablets and liquid) Kivexa (Abacavir and Lamivudine in one tablet) Lamivudine (3TC tablets and liquid) Nelfinavir (Viracept ) Nevirapine (Viramune ) Raltegravir (Isentress ) for extended therapy only Ritonavir (Norvir tablets, capsules and liquid) Saquinavir-HG (Saquinavir hard gelcaps and tablets, Invirase ) 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 Drugs available through Health Canada's Special Access Program Albendazole Microsporidium Amphotericin, suspension (Fungilin ) Azole-resistant oral candidiasis Didanosine powder for oral solution (Videx ) for children Efavirenz liquid (DMP, Sustiva ) for children Foscarnet infusion (Foscavir) Cytomegalovirus (CMV) affecting sight or organ systems Nevirapine liquid (Viramune ) for children Stavudine liquid (D4T, Zerit ) for children Program Statistics (as of May 211) Number of participants Ever enrolled 1,64 Currently on antiretrovirals 5,693 Newly enrolled in May Gender Men 84% Women 16% Health Authorities Vancouver Coastal 59% Fraser 22% Vancouver Island 11% Interior 6% Northern 3% 2

4 Distribution of active DTP participants by health authority (May 211) Total = 5,693 Northern Vancouver Coastal Interior Vancouver Island Vancouver Coastal Fraser 3

5 Distribution of active DTP participants by health services delivery areas (May 211) Northwest Northeast Total = 5, Northern Interior North Shore/ Coast Garibaldi Thompson Cariboo Shuswap North Vancouver Island Fraser North Central Vancouver Island North Shore/ Coast Garibaldi Fraser East Okanagan Kootenay Boundary East Kootenay Vancouver South Vancouver Island Richmond Fraser South Fraser East 4

6 Active DTP participants within health authorities: Vancouver Coastal Health (May 211) Total = 3,338 North Shore/ Coast Garibaldi North Shore/ Coast Garibaldi Vancouver Richmond 5

7 Active DTP participants within health authorities: Fraser Health (May 211) Total = 1, Fraser East Fraser North Fraser South 6

8 Active DTP participants within health authorities: Vancouver Island Health (May 211) Total = 619 North Vancouver Island Central Vancouver Island South Vancouver Island 7

9 Active DTP participants within health authorities: Interior Health (May 211) Total = Thompson Cariboo Shuswap East Kootenay Kootenay Boundary Okanagan 8

10 Active DTP participants within health authorities: Northern Health (May 211) Total = 15 Northwest 1 49 Northeast Northern Interior 9

11 Active DTP participants within select cities: Vancouver (May 211) Total = 2, City Centre 161 V6G V6E V7X V6B V6C V7Y Downtown 162 V6A Eastside V5L V5K V6T V6R V6K V6S Westside 164 V6N V6L V6J V6H V6Z V6M V5Y V5T V5V Midtown 165 V5W V5N V5M North East 163 V5R V6P South 166 V5X V5P V5S 1

12 Active DTP participants within select cities: Victoria (May 211) Total = V8Y V9E 1+ V9B V8Z V8X V8N V8P V9A V8T V8R V8V V8S V8W V9C 11

13 Active DTP participants within select cities: Surrey (May 211) Total = 335 V3V V3T V3R V4N 1 19 V3W V3X V3S Surrey V4A V4P V4B South Surrey/ White Rock 12

14 Active DTP participants within select cities: Kelowna (May 211) Total = V1V V1Z V1Y V1X V1P V4T V1W 13

15 Active DTP participants within select cities: Prince George (May 211) Total = V2K 1+ V2M V2L V2N 14

16 1 Percent British Distribution Columbia of Participants on ARV Therapies by Number of Drugs (January 1996 May 211) Centre for Excellence in HIV/AIDS Percent Distribution of Participants on ARV Therapies by Number of Drugs (January May 211) 6 or more drugs 5 drugs 8 4 drugs 6 % of Participants 4 2 drugs 3 drugs 2 1 drug May-211 Mar-211 Jan-211 Nov-21 Sep-21 Jul-21 May-21 Mar-21 Jan-21 Nov-29 Sep-29 Jul-29 May-29 Mar-29 Jan-29 Nov-28 Sep-28 Jul-28 May-28 Mar-28 Jan-28 Nov-27 Sep-27 Jul-27 May-27 Mar-27 Jan-27 Nov-26 Sep-26 Jul-26 May-26 Mar-26 Jan-26 Nov-25 Sep-25 Jul-25 May-25 Mar-25 Jan-25 Nov-24 Sep-24 Jul-24 May-24 Mar-24 Jan-24 Nov-23 Sep-23 Jul-23 May-23 Mar-23 Jan-23 Nov-22 Sep-22 Jul-22 May-22 Mar-22 Jan-22 Nov-21 Sep-21 Jul-21 May-21 Mar-21 Jan-21 Nov-2 Sep-2 Jul-2 May-2 Mar-2 Jan-2 Nov-1999 Sep-1999 Jul-1999 May-1999 Mar-1999 Jan-1999 Nov-1998 Sep-1998 Jul-1998 May-1998 Mar-1998 Jan-1998 Nov-1997 Sep-1997 Jul-1997 May-1997 Mar-1997 Jan-1997 Nov-1996 Sep-1996 Jul-1996 May-1996 Mar-1996 Jan-1996 Date Please refer to Disclaimer Report Date: 29-JUN

17 Drug Combination: British Columbia Distribution of DTP Participants (January 1999 May 211) Centre for Excellence in HIV/AIDS Distribution of Participants in HIV/AIDS Drug Treatment Program by Drug Combination (January May 211) 1 OTHER 9 8 NNRTI/no PI 7 Percentage (%) BOOSTED PI OR MORE PIs MDRT May-211 Mar-211 Jan-211 Nov-21 Sep-21 Jul-21 May-21 Jan-21 Nov-29 Sep-29 Jul-29 May-29 Mar-29 Jan-29 Nov-28 Sep-28 Jul-28 May-28 Mar-28 Jan-28 Nov-27 Sep-27 Jul-27 May-27 Mar-27 Jan-27 Nov-26 Sep-26 Jul-26 May-26 Mar-26 Jan-26 Nov-25 Sep-25 Jul-25 May-25 Mar-25 Jan-25 Nov-24 Sep-24 Jul-24 May-24 Mar-24 Jan-24 Nov-23 Sep-23 Jul-23 May-23 Mar-23 Jan-23 Nov-22 Sep-22 Jul-22 May-22 Mar-22 Jan-22 Nov-21 Sep-21 Jul-21 May-21 Mar-21 Jan-21 Nov-2 Sep-2 Jul-2 May-2 Mar-2 Jan-2 Nov-1999 Sep-1999 Jul-1999 May-1999 Mar-1999 Jan-1999 Please refer to Disclaimer See Definitions: at the end of report NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor): an antiretroviral drug that binds to and disables reverse transcriptase, an enzyme that HIV needs to make copies of itself. PI (Protease Inhibitor): an antiretroviral drug that binds to and blocks HIV protease from working, thus preventing the production of new functional viral particles. 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 been used previously by the individual. 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 8mg daily) additional dose of ritonavir. Date Report Date: 29-JUN-211 Boosted PI: a combination therapy regimen of four or fewer antiretroviral drugs, including one PI and a small (less than 8mg daily) additional dose of ritonavir. The addition of ritonavir inhibits metabolism of other PIs and improves their exposure. This may allow for decreased dosing frequency or pill burden and may improve adherence and antiretroviral activity. NNRTI/no PI: a combination therapy regimen of four or fewer antiretroviral drugs, including an NNRTI, but no PIs. Other: a combination therapy regimen of four or fewer antiretroviral drugs, other than MDRT, 1 or more PI, Boosted PI, NNRTI/no PI (e.g. Triple NRTI regimen). 16

18 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 Burrard St. Vancouver, B.C. V6Z 1Y6 Tel: Fax: Physician Drug Hotline: St. Paul s Hospital Pharmacy Hotline: website: 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.

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