A meeting of European and North American hepatitis and HIV specialists held last week in Paris has announced pan-European guidelines for the management of HIV and hepatitis.
A panel of ten specialists from eight European countries, led by Professor Alfredo Alberti (Italy) and Professor Nathan Clumeck (Belgium), drew up the recommendations. "Our goal is to ensure that a consistent therapeutic approach is adopted at the European level, and to increase the number of patients who are diagnosed and treated," said Professor Clumeck. "Today there is too much variation from one country to another. Our recommendations are adapted to the European context, both in terms of the patients and the health care systems."
The First European Consensus Conference on the Treatment of Chronic Hepatitis B and C in HIV Co-infected Patients made the following key recommendations:
- HIV/HCV: Treatment should consist of a combination of pegylated interferon and ribavirin. The consensus meeting recommended increasing the dose of ribavirin among patients infected with genotype 1 HCV, which is more resistant to treatment than the other genotypes. After the first three months of treatment, efficacy can be assessed to determine whether or not to continue to the end of the treatment period (48 weeks).
- HIV/HBV: Antiviral compounds are effective against both HIV and HBV, but they are complex to administer because both viruses may develop resistance to the drugs. The choice of which combinations to use must be made according to identifiable resistance and the specific biological parameters of each patient.
- For patients whose immune system has been significantly depressed (low CD4 counts), antiretroviral treatment for HIV must first enable the CD4 count to rise, before treatment for HCV and HBV can begin.
- There is a need for further studies to better understand the natural progression of co-infections and to determine exact treatment dosages and durations. Data about infection with HBV and HIV/HBV co-infection is especially lacking. One of the pressing questions that must be addressed is whether or not to continue HBV treatment, perhaps with reduced doses, when the viral response is not very satisfactory, in order to slow progression toward liver disease or the worsening of hepatitis B disease.
- Studies to evaluate new drugs currently under development be conducted at an earlier stage among patients co-infected with HIV and hepatitis B and C viruses.
These recommendations are due to be published in full in the Journal of Hepatology in May 2005.