European Guidelines for the HIV Treatment Esteban Martínez Infectious Diseases Unit Hospital Clínic University of Barcelona Barcelona SPAIN

“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”

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.