Eligibility of non-residents for NHS treatment
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《英国医生杂志》
EDITOR—We agree with Pollard and Savulescu that the new guidelines directed towards recovering costs for HIV from overseas visitors are not only unethical but also could lead to an escalation of new cases in the United Kingdom by failing to treat highly infectious cases with advanced immunosuppression.1
In this hospital most new HIV cases present with low CD4 cell counts and medical complications that usually require urgent treatment. These patients invariably have minimal financial resources. Pre-test HIV discussion with these people at high risk includes treatment issues and the likelihood that highly active antiretroviral treatment (HAART) will be recommended, if not immediately then in the near future. If the guidelines are to be implemented this discussion will have to include the information that the government will seek to recover medical costs from patients who may be extremely ill with conditions causing respiratory distress, such as Pneumocystis carinii pneumonia and tuberculosis, or Cytomegalovirus retinitis, which may result in irreversible blindness. We believe that the psychological distress that this will cause both patients and those involved in pre-test discussion will be considerable.
In the mid-1980s, before antiretroviral drugs were available, many people were counselled that there was little point in getting tested if bad news was the most likely outcome. Surely we cannot go back to this era? People with advanced immunosuppression are more likely to have high viral loads, rendering them highly infectious compared with others diagnosed early on or taking HAART. By not offering free treatment to this group who cannot afford HAART, the risk of new infections is likely to be increased considerably. In addition to the human rights issues, the public health aspects of the new guidelines seem to have been glossed over and require urgent attention by HIV commissioning groups.
Nigel O'Farrell, consultant physician
Nigel.O'Farrell@eht.nhs.uk
Stephen Ash, consultant physician, Paul Fox, consultant physician, William Lynn, consultant physician
Pasteur Suite, Ealing Hospital, London UB1 3HW
Competing interests: None declared.
References
Pollard AJ, Savulescu J. Eligibility of overseas visitors and people of uncertain residential status for NHS treatment. BMJ 2004;329: 346-9. (7 August.)
In this hospital most new HIV cases present with low CD4 cell counts and medical complications that usually require urgent treatment. These patients invariably have minimal financial resources. Pre-test HIV discussion with these people at high risk includes treatment issues and the likelihood that highly active antiretroviral treatment (HAART) will be recommended, if not immediately then in the near future. If the guidelines are to be implemented this discussion will have to include the information that the government will seek to recover medical costs from patients who may be extremely ill with conditions causing respiratory distress, such as Pneumocystis carinii pneumonia and tuberculosis, or Cytomegalovirus retinitis, which may result in irreversible blindness. We believe that the psychological distress that this will cause both patients and those involved in pre-test discussion will be considerable.
In the mid-1980s, before antiretroviral drugs were available, many people were counselled that there was little point in getting tested if bad news was the most likely outcome. Surely we cannot go back to this era? People with advanced immunosuppression are more likely to have high viral loads, rendering them highly infectious compared with others diagnosed early on or taking HAART. By not offering free treatment to this group who cannot afford HAART, the risk of new infections is likely to be increased considerably. In addition to the human rights issues, the public health aspects of the new guidelines seem to have been glossed over and require urgent attention by HIV commissioning groups.
Nigel O'Farrell, consultant physician
Nigel.O'Farrell@eht.nhs.uk
Stephen Ash, consultant physician, Paul Fox, consultant physician, William Lynn, consultant physician
Pasteur Suite, Ealing Hospital, London UB1 3HW
Competing interests: None declared.
References
Pollard AJ, Savulescu J. Eligibility of overseas visitors and people of uncertain residential status for NHS treatment. BMJ 2004;329: 346-9. (7 August.)