Drug Treatment Program Update

As of May 2011

1

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 2011, 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

• VancouverCoastalHealth ...........................................................5

• FraserHealthAuthority .................................................................6

• VancouverIslandHealthAuthority ...............................................7

• InteriorHealthAuthority .........................................................8

• NorthernHealthAuthority ............................................................9

Active HIV/AIDS drug treatment program

participants within select cities

• Vancouver ....................................................................................10

• Victoria ........................................................................................11

• Surrey...........................................................................................12

• Kelowna .......................................................................................13

• PrinceGeorge ........................................................................14

Number of drugs

percent distribution of DTP participants on ARV therapies .............15

Drug combination

distribution of DTP participants .......................................................16

Definitions ......................................................................................16

2

HIV/AIDS Drugs available through the Centre (May 2011)

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 2011)

Number of participantsEver enrolled 10,064Currently on antiretrovirals 5,693NewlyenrolledinMay2011 13

GenderMen 84%Women 16%

Health AuthoritiesVancouverCoastal 59%Fraser 22%VancouverIsland 11%Interior 6%Northern 3%

3

Distribution of active DTP participants by health authority (May 2011)

0

1 – 99

100 – 499

500 – 999

1000+

Total = 5,693

Northern

Interior

VancouverCoastal

VancouverCoastal

Fraser

VancouverIsland

4

Distribution of active DTP participants by health services delivery areas (May 2011)

Fraser East

Fraser South

Fraser North

NorthwestNortheast

Thompson Cariboo Shuswap

Okanagan

Kootenay Boundary

EastKootenay

NorthernInterior

North Vancouver Island

Central Vancouver Island

South Vancouver IslandVancouver

Richmond

0

1 – 9

10 – 99

100 – 499

500 – 999

1000+

Total = 5,693

North Shore/Coast Garibaldi

FraserEast

North Shore/Coast Garibaldi

5

Active DTP participants within health authorities: Vancouver Coastal Health (May 2011)

0

1 – 9

10 – 49

50 – 99

100 – 999

1000+

Total = 3,338

North Shore/ Coast Garibaldi

Vancouver

Richmond

North Shore/ Coast Garibaldi

6

Active DTP participants within health authorities: Fraser Health (May 2011)

0

1 – 9

10 – 49

50 – 99

100 – 999

1000+

Total = 1,226

Fraser East

Fraser North

Fraser South

7

Active DTP participants within health authorities: Vancouver Island Health (May 2011)

North Vancouver Island

CentralVancouver Island

SouthVancouver Island

0

1 – 9

10 – 49

50 – 99

100 – 999

1000+

Total = 619

8

Active DTP participants within health authorities: Interior Health (May 2011)

Thompson Cariboo Shuswap

Okanagan

Kootenay Boundary

East Kootenay

0

1 – 9

10 – 49

50 – 99

100 – 999

1000+

Total = 338

9

Active DTP participants within health authorities: Northern Health (May 2011)

Northern Interior

Northeast

Northwest

0

1 – 9

10 – 49

50 – 99

100 – 999

1000+

Total = 150

10

Active DTP participants within select cities: Vancouver (May 2011)

0

1 – 9

10 – 19

20 – 49

50 – 99

100+

Total = 2,731

City Centre161

Downtown162

Eastside

North East163

Midtown165

South166

Westside164

V6T V6R V6K

V6L V6J V6H V6Z

V5Y

V6P V5X

V5W

V5V

V5T

V6A

V6B

V6E

V7Y

V6C

V7XV6G

V5LV5K

V5M

V5N

V5R

V5S

V5P

V6S

V6N

V6M

11

Active DTP participants within select cities: Victoria (May 2011)

0

1 – 9

10 – 19

20 – 49

50 – 99

100+

Total = 243

V9E

V8Y

V8X V8N

V8P

V8RV8TV9A

V8W

V8VV8S

V8ZV9B

V9C

12

Active DTP participants within select cities: Surrey (May 2011)

South Surrey/White Rock

Surrey

0

1 – 9

10 – 19

20 – 49

50 – 99

100+

Total = 335

V3W

V3X

V3V V3T V3R

V4N

V4A

V4B

V4P

V3S

13

Active DTP participants within select cities: Kelowna (May 2011)

0

1 – 9

10 – 19

20 – 49

50 – 99

100+

Total = 78

V4T

V1Z

V1Y

V1W

V1V

V1X

V1P

14

0

1 – 9

10 – 19

20 – 49

50 – 99

100+

Total = 61

Active DTP participants within select cities: Prince George (May 2011)

V2K

V2M

V2L

V2N

15

Percent Distribution of Participants on ARV Therapies by Number of Drugs (January 1996 – May 2011) British ColumbiaCentre for Excellence in HIV/AIDS

Percent Distribution of Participants on ARV Therapiesby Number of Drugs

Jan-1996M

ar-1996M

ay-1996Jul-1996Sep-1996N

ov-1996Jan-1997M

ar-1997M

ay-1997Jul-1997Sep-1997N

ov-1997Jan-1998M

ar-1998M

ay-1998Jul-1998Sep-1998N

ov-1998Jan-1999M

ar-1999M

ay-1999Jul-1999Sep-1999N

ov-1999Jan-2000M

ar-2000M

ay-2000Jul-2000Sep-2000N

ov-2000Jan-2001M

ar-2001M

ay-2001Jul-2001Sep-2001N

ov-2001Jan-2002M

ar-2002M

ay-2002Jul-2002Sep-2002N

ov-2002Jan-2003M

ar-2003M

ay-2003Jul-2003Sep-2003N

ov-2003Jan-2004M

ar-2004M

ay-2004Jul-2004Sep-2004N

ov-2004Jan-2005M

ar-2005M

ay-2005Jul-2005Sep-2005N

ov-2005Jan-2006M

ar-2006M

ay-2006Jul-2006Sep-2006N

ov-2006Jan-2007M

ar-2007M

ay-2007Jul-2007Sep-2007N

ov-2007Jan-2008M

ar-2008M

ay-2008Jul-2008Sep-2008N

ov-2008Jan-2009M

ar-2009M

ay-2009Jul-2009Sep-2009N

ov-2009Jan-2010M

ar-2010M

ay-2010Jul-2010Sep-2010N

ov-2010Jan-2011M

ar-2011M

ay-2011

Date

0

20

40

60

80

100

% o

f Par

ticip

ants

(January 1996 - May 2011)

1 drug

2 drugs3 drugs

4 drugs

5 drugs6 or more drugs

Please refer to Disclaimer Report Date: 29-JUN-2011

16

Drug Combination: Distribution of DTP Participants (January 1999 – May 2011)

Definitions:

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 800mg daily) additional dose of ritonavir.

Boosted PI: a combination therapy regimen of four or fewer antiretroviral drugs, including one PI and a small (less than 800mg 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,includinganNNRTI,butnoPIs.

Other: a combination therapy regimen of four or fewer antiretroviral drugs, otherthanMDRT,1ormorePI,BoostedPI,NNRTI/noPI(e.g.TripleNRTIregimen).

British ColumbiaCentre for Excellence in HIV/AIDS

Distribution of Participants in HIV/AIDS Drug Treatment Program byDrug Combination

Jan-1999M

ar-1999M

ay-1999Jul-1999Sep-1999N

ov-1999Jan-2000M

ar-2000M

ay-2000Jul-2000Sep-2000N

ov-2000Jan-2001M

ar-2001M

ay-2001Jul-2001Sep-2001N

ov-2001Jan-2002M

ar-2002M

ay-2002Jul-2002Sep-2002N

ov-2002Jan-2003M

ar-2003M

ay-2003Jul-2003Sep-2003N

ov-2003Jan-2004M

ar-2004M

ay-2004Jul-2004Sep-2004N

ov-2004Jan-2005M

ar-2005M

ay-2005Jul-2005Sep-2005N

ov-2005Jan-2006M

ar-2006M

ay-2006Jul-2006Sep-2006N

ov-2006Jan-2007M

ar-2007M

ay-2007Jul-2007Sep-2007N

ov-2007Jan-2008M

ar-2008M

ay-2008Jul-2008Sep-2008N

ov-2008Jan-2009M

ar-2009M

ay-2009Jul-2009Sep-2009N

ov-2009Jan-2010M

ay-2010Jul-2010Sep-2010N

ov-2010Jan-2011M

ar-2011M

ay-2011

Date

0

10

20

30

40

50

60

70

80

90

100

Perc

enta

ge (%

)

(January 1999 - May 2011)

NNRTI/no PI

OTHER

1 OR MORE PIs

MDRT

BOOSTED PI

Please refer to DisclaimerSee Definitions at the end of report Report Date: 29-JUN-2011

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;

>MonitortheimpactofHIV/AIDSonB.C.andconductanalysesofthe

effectiveness of HIV-related programs.

Contact information608 – 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: info@cfenet.ubc.ca

FundingfortheBCCentreforExcellenceinHIV/AIDS

isprovidedbytheB.C.MinistryofHealththrough

Pharmacare and the Provincial Health Services Authority.