French Pharmacies To Sell AIDS Therapies

In France, a report on reimbursement for AIDS patients is to become a model for reimbursement for serious viral diseases. Health Secretary Herve Gaymard has said that antiviral drugs will be "henceforth available in pharmacies in such a way as to enable general practitioners to follow their patients' treatment and progress." AIDS will now be regarded as a chronic disease in the same category as diabetes and high blood pressure.

Prof Jean Dormont's report outlines the state of knowledge of major viral diseases and the positions for GPs to adopt in various medical situations. Prescribing criteria for antiretroviral treatment have evolved in recent years, he notes. While the existence of a permanent and significant viral replication, even in asymptomatic patients, argues in favor of prompt treatment, the uncertainty of maintaining effective treatment over several years has led to a more qualified attitude. It is now considered advisable to treat patients with less than 300-350 CD4 lymphocytes. Abstention is justified when both the risk of progression and plasma-viral levels are low, but treatment is recommended if there is a high risk of progression.

Prof Dormont says antiretroviral drugs should be available to GPs, but the initial prescription should be made in hospital, and attention must be paid to pharmacist training. The immediate effect is that AIDS drugs issued outside the hospital sector will be reimbursed, though it is doubtful if more than a small percentage of GPs will take advantage of this.