European Guidelines for the HIV Treatment

1. European Guidelinesfor theHIV Treatment Esteban Martínez Infectious Diseases Unit Hospital Clínic University of Barcelona Barcelona SPAIN

2. “The European AIDS Clinical Society” (EACS) • Not-for-profit group of European physicians, clinicians and researchers in the field of HIV/AIDS. • Objectives: • Organisation of the European AIDS Conferenceevery two years in a different European city. • Issuing Treatment Guidelines  regularly updated. • Education and Training of HIV Physiciansthrough four educational programmes: 1) The “Medical Exchange Programme for HIV Physicians” 2) The “European Advanced HIV Course” 3) The “ECReCO” (European Clinical Research Course) 4) The “Eastern Europe Programme”

3. http://www.europeanaidsclinicalsociety.org

4. Guidelines focused in 3 areas

5. Guidelines for the Clinical Management and Treatment • Assessment of HIV-infected patients at initial and subsequent visits • Assessing and supporting patients’readiness to start ART • Primary HIV infection • Recomendations for initiation of therapy in naive HIV-infected patients • Initial combination regimes for antiretroviral naive-patients • HAART in TB/HIV coinfection • Switch strategies for virologically suppressed patients • Virological failure • Treatment of HIV pregnant women • Post-exposure prophylaxis

6. Guidelines for Non-Infectious Co-Morbidities • Screening for non-infectious co-morbidities • Antiretroviral drugs& drug classes frequent/severe side effects • Lifestyle interventions • Prevention of cardiovascular disease • Hypertension: diagnosis and management • Diabetes: diagnosis and management • Dyslipidaemia: management • Bone disease: diagnosis, prevention and management • Depression: diagnosis and management • Hyperlactatemia: diagnosis, prevention and management • Kidney disease: diagnosis, prevention and management • Lipodystrophy: prevention and management • Increased transaminases: work-up and management • Neurocognitive impairment: diagnosis and management

7. Guidelines for Chronic Hepatitis B and C Co-infection • General recommendations: screening, vaccination and other prevention measures, HAART, end-stage liver disease • Treatment indication for HBV infection • Treatment of chronic HBV infection • Treatment recommendations for hepatitis C • Diagnostic procedures for hepatitis C • Duration of HCV therapy • Interventions for non-responders/relapsers to prior interferon-based therapies

8. What do EACS Guidelines offer? • Summary/brief document of evidence-based and expert-based recommendations • Guide HIV doctors in shaping their individual decisions on patients’ care • Guide HIV clinics and hospitals in the organization of HIV care • Justify and rationalize allocation of economic resources for diagnostic, preventive or therapeutic procedures • Influence national guidelines and ultimately armonize HIV care delivery in different European countries

9. Summary/brief document

10. Guide HIV doctors in individual decisions on patients’ care

11. Guide HIV clinics and hospitals in the organization of HIV care

12. Justify and rationalize allocation of economic resources

13. Influence national guidelines and armonize HIV care in Europe

14. Conclusions • Economic crisis: Priorization of objectives according to available resources • EACS guidelines provide a frame of objectives and suggest tools to accomplish them • Objectives may differ from country to country • Available tools may also differ • Preserving HIV-infected people healthy is the ultimate goal of HIV care.