European Guidelines

for the

HIV Treatment

Esteban MartínezInfectious Diseases Unit

Hospital ClínicUniversity of Barcelona

BarcelonaSPAIN

“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”

http://www.europeanaidsclinicalsociety.org

Guidelines focused in 3 areas

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

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

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

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

Summary/brief document

Guide HIV doctors in individual

decisions on patients’ care

Guide HIV clinics and hospitals in

the organization of HIV care

Justify and rationalize allocation of

economic resources

Influence national guidelines and

armonize HIV care in Europe

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.