5.6 Viral infection

5.6.1 Hepatitis

Hepatitis B, Chronic

Interferons

Interferon alfa (Roferon-A^®) (parenteral) (TLS Red)

Peginterferon alfa (parenteral) (TLS Red)

• NICE TA96 Adefovir dipivoxil and peginterferon alfa-2a for treatment of chronic hepatitis B (partially updated by CG165 Chronic hepatitis B)
• NICE TA200 peginterferon (2a or 2b) and ribavirin for treatment of hepatitis C 
• NICE TA300 Peginterferon alfa and ribavirin for the treatment of chronic Hepatitis C in children and young people

Nucleoside Analogues

Entecavir (oral) (TLS Red)

• NICE TA153 Entecavir for the treatment of chronic hepatitis B
• NICE CG165 for prophylaxis of hepatitis B during immunosuppressive therapy

Telbivudine (oral) (TLS Red)

• NICE TA154 Hepatitis B - Telbivudine

Tenofovir disoproxil (oral) (TLS Red)

• NICE TA173 Tenofovir disoproxil for the treatment of chronic hepatitis B
• NICE CG165 for prophylaxis of hepatitis B during immunosuppressive therapy

Lamivudine (oral) (TLS Red)

• NICE CG165 for prophylaxis of hepatitis B during immunosuppressive therapy

Nucleotide Analogues

Adefovir dipivoxil (oral) (TLS Red)

• NICE TA96 Adefovir dipivoxil & pegylated interferon alpha-2a

Hepatitis C, Chronic

For patients with cirrhosis in accordance with NHS England Policy B07/P/a Treatment of Chronic Hepatitis C in patients with cirrhosis 

Hepatitis C: Direct acting antiviral drugs and combinations; NHS England funded via Prior Approval Scheme on Blueteq

Nucleoside Analogues

Ribavirin (oral) (TLS Red)

• Secondary care restricted, see local guidelines
• NICE TA200 Peginterferon alfa and ribavirin for the treatment of chronic hepatitis C
• NICE TA300 Peginterferon alfa and ribavirin for the treatment of chronic Hepatitis C in children and young people
• For chronic hepatitis E in post-renal transplant patients

Nucleotide Analogues

Sofosbuvir (oral) (TLS Red)

• NICE TA330 Sofosbuvir for treating chronic hepatitis C
• For patients with cirrhosis in accordance with NHS England Policy B07/P/a Treatment of Chronic Hepatitis C in patients with cirrhosis

Sofosbuvir / Velpatasvir (TLS Red)

• NICE TA430 for treating chronic hepatitis

Sofosbuvir / Velpatasvir / Voxilaprevir (TLS Red)

• NICE TA507 for treating chronic hepatitis C

 Ledipasvir / Sofosbuvir (TLS Red)

• NICE TA363 for treating chronic hepatitis C

Protease Inhibitors (Hepatitis)

Glecaprevir / Pibrentasvir (oral) (TLS Red)

• NICE TA499 for treating chronic hepatitis C

NS5A Inhibitor

Ombitasvir / Paritaprevir / Ritonavir (oral) (Viekirax^®) (TLS Red)

Ombitasvir / Paritaprevir / Ritonavir with Dasabuvir (oral) (Exviera^®) (TLS Red)

• NICE TA365 Ombitasvir / paritaprevir / ritonavir with or without dasabuvir for treating chronic hepatitis C

Elbasvir / Grazoprevir (oral) (Zepatier^®) (TLS Red)

• NICE TA413 Elbasvir–grazoprevir for treating chronic hepatitis C

Hepatitis D, Chronic

NTCP Receptor Inhibitor

Bulevirtide (TLS Red)

• NICE TA896 Bulevirtide for treating chronic hepatitis D

5.6.2 Herpesvirus infections

Nucleoside Analogues

Recommended:

Aciclovir (oral) (TLS Green)

Alternatives:

Aciclovir (parenteral) (TLS Red)

• Secondary care restricted, see local guidelines

Famciclovir (oral) (TLS Blue)

Valaciclovir (oral) (TLS Blue)

Cytomegalovirus

Non-nucleoside Pyrophosphate Analogues

Foscarnet sodium (parenteral) (TLS Red)

• Secondary care restricted, see local guidelines

Letermovir (oral) (TLS Red)

• NICE TA591 - for preventing cytomegalovirus disease after a stem cell transplant

Nucleoside Analogues

All TLS Red

Cidofovir (parenteral)

• Secondary care restricted, see local guidelines

Ganciclovir (parenteral)

• Secondary care restricted, see local guidelines

Valganciclovir (oral)

• Secondary care restricted, see local guidelines

Valganciclovir solution (oral)

• Secondary care restricted, see local guidelines

Protein Kinase Inhibitors

Maribavir (TLS Red)

• NICE TA860 Maribavir for treating refractory cytomegalovirus infection after transplant

5.6.3 HIV infection

Please see NHS England Circular SSC1460. HIV CRG guidance on non-antiretroviral prescribing. Appendix 1

And NHS England Circular SSC1614. HIV Treatments update February 2016

For Treatment as Prevention see NHS England Commissioning Policy F03/P/c

NHSE SSC 2355 National procurement for antiretrovirals for HIV treatment and prevention (pre-exposure prevention (PrEP) and post-exposure prevention (PEP))

NHSE SSC 2725 NHS England update on HIV pre-exposure prophylaxis (PrEP) and reimbursement process

Antiretroviral Therapy (ART) Prescribing Implementation Toolkit

Antiretroviral Therapy (ART) Prescribing Implementation Toolkit Generics

National procurement for antiretrovirals for HIV treatment and prevention (PrEP) FAQ

National procurement for antiretrovirals for HIV treatment and prevention (PrEP & PEP)

HIV-Fusion Inhibitors

Enfuvirtide (parenteral) (TLS Red)

HIV-Integrase Inhibitors

All TLS Red

Abacavir / Dolutegravir / Lamivudine (oral) (Triumeq^®)

• As per NHS England Clinical Commissioning Policy: Dolutegravir for treatment of HIV-1 in adults and adolescents. B06/P/a
• NHS England Circular SSC1511 dolutegravir

Bictegravir / Emtricitabine / Tenofovir Alafenamide (oral) (Biktarvy^®)

• As per NHS England Clinical Commissioning Policy: Bictegravir-emtricitabine-tenofovir alafenamide for the treatment of HIV-1 in adults

Cabotegravir with Rilpivirine

• NICE TA757 Cabotegravir with Rilpivirine for treating HIV-1

Dolutegravir (oral)

Dolutegravir / Lamivudine (oral) (Dovato^®)

• As per NHS England Clinical Commissioning Policy: Dolutegravir for treatment of HIV-1 in adults and adolescents. B06/P/a

Dolutegravir / Rilpivirine (oral) (Juluca^®)

• As per NHS England Clinical Commissioning Policy: Dolutegravir-rilpivirine for treating HIV-1 in adults

Elvitegravir / Cobicistat / Emtricitabine / Tenofovir Alafenamide (oral) (Genvoya^®)

• As per NHS England Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents

Raltegravir (oral)

Non-Nucleoside Reverse Transcriptase Inhibitors

All TLS Red

Doravirine (oral)

• As per NHS England Clinical Commissioning Policy: Doravirine for the treatment of HIV-1 in adults

Doravirine / Lamivudine / Tenofovir disoproxil fumarate (oral) (Delstrigo^®)

• As per NHS England Clinical Commissioning Policy: Doravirine for the treatment of HIV-1 in adults

Efavirenz (oral)

Etravirine (oral)

Nevirapine (oral)

Rilpivirine (oral)

Rilpivirine / Emtricitabine / Tenofovir Alafenamide (oral) (Odefsey^®)

• As per NHS England Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescent

Nucleoside Reverse Transcriptase Inhibitors

All TLS Red

Abacavir (oral)

Cobicistat / Darunavir / Emtricitabine / Tenofovir (oral) (Symtuza^®)

• Please refer to NHS England Policy 16043/P
• And NHS England Policy F03/P/b Use of cobicistat as a booster in treatment of HIV positive adults and adolescents

Didanosine (oral)

Emtricitabine (oral)

Emtricitabine / Tenofovir Alafenamide (oral) (Descovy^®)

• As per NHS England Clinical Commissioning Policy: Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents

Emtricitabine / Tenofovir disoproxil

• For Pre-Exposure Prophylaxis (PrEP) as per NHSE commissioning policy statement

Lamivudine (oral)

Rilpivirine / Emtricitabine / Tenofovir (oral) (Eviplera^®)

Stavudine (oral)

Tenofovir disoproxil (oral)

• As per NHS England Clinical Commissioning Policy16043/P

Tenofovir / Efavirenz / Emtricitabine (oral) (Atripla^®)

Tenofovir / Efavirenz / Emtricitabine / Cobicistat (oral) (Stribild^®)

Zidovudine (oral & parenteral)

Protease Inhibitors (TLS Red)

All TLS Red

NHS England Circular SSC1614. HIV Treatments update February 2016

Atazanavir (oral)

Atazanavir / Cobicistat (Evotaz^®)

Darunavir (oral)

Darunavir / Cobicistat (Rezolsta^®)

Indinavir (oral)

Lopinavir / Ritonavir (oral) (Kaletra^®)

Nelfinavir (oral)

Ritonavir (oral)

Saquinavir (oral)

Tenofovir (oral)

CCR5 Inhibitors

Maraviroc (oral)

(Not routinely commissioned by NHSE for Natalizumab induced PML)

5.6.4 Influenza and Other

Neuraminidase Inhibitors

• Influenza vaccination remains the first line preventative treatment for influenza
• NICE Guidance for the use of antivirals for seasonal influenza does not apply in an influenza pandemic, other guidelines will be issued
• Prescribers in primary care may prescribe antivirals at NHS expense when surveillance data indicates an increase in influenza cases in the community. Prescribers are notified about this via the Department of Health CAS alert
• PHE guidance on use of antiviral agents for the treatment and prophylaxis of seasonal influenza Version 11, November 2021
• Guidelines for PHE Health Protection Teams on the management of outbreaks of influenza-like illness (ILI) in care homes

Oseltamivir (oral) (TLS green)

• NICE TA158 Influenza (prophylaxis)
• NICE TA168 Influenza (treatment)

Zanamivir (oral) (TLS green)

• NICE TA158 Influenza (prophylaxis)
• NICE TA168 Influenza (treatment)

Zanamivir (intravenous) (TLS Red)

• Secondary care restricted in line with Public Health England Guidance for severe/complicated influenza (treatment), see local guidelines

Palivizumab (TLS Red)

• In line with Public Health England Guidance; NHS England funded via Prior Approval Scheme on Blueteq

5.6.5 Monkeypox

Tecovirimat (TLS Red) 

In line with the national CAS alert and interim clinical commissioning policy for the treatment of patients hospitalised with Monkeypox infection.

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