european guidelines for the hiv treatment esteban martínez infectious diseases unit hospital...
TRANSCRIPT
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European Guidelines
for the
HIV Treatment
Esteban MartínezInfectious Diseases Unit
Hospital ClínicUniversity of Barcelona
BarcelonaSPAIN
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“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 Conference
every two years in a different European city.– Issuing Treatment Guidelines
regularly updated. – Education and Training of HIV Physicians
through 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”
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http://www.europeanaidsclinicalsociety.org
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Guidelines focused in 3 areas
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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
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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
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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
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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
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Summary/brief document
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Guide HIV doctors in individual
decisions on patients’ care
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Guide HIV clinics and hospitals in
the organization of HIV care
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Justify and rationalize allocation of
economic resources
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Influence national guidelines and
armonize HIV care in Europe
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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.