Special report
SHORT STATEMENT OF THE FIRST EUROPEAN CONSENSUS CONFERENCE ON THE TREATMENT OF CHRONIC HEPATITIS B AND C IN HIV CO-INFECTED PATIENTS,

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Introduction

Despite recent advances in the management of hepatitis and HIV co-infection, there is no clear consensus among hepatology, infectious diseases and virology experts on treatment of co-infections and patient management. This encouraged the organisation of a European Consensus Conference to review current knowledge on the treatment of chronic hepatitis B and C in HIV co-infected patients, with the view to developing this consensus statement.

An organising committee drafted questions to be addressed at the conference, and following 2-days of presentations and discussions, an independent Jury Panel assessed the evidence and prepared this statement with the aim of addressing eight questions:

  • What are the reasons to treat viral hepatitis in HIV co-infected patients in the HAART era?

  • How should viral hepatitis be diagnosed and how should disease severity be assessed in HIV-infected patients?

  • What are the current treatment options?

  • Which patients should be treated and when?

  • How should co-infected patients be treated (treatment algorithms)?

  • How should anti-hepatitis treatment be monitored?

  • How should end-stage liver disease be managed?

  • What are the most important areas for future research?

This process essentially follows the consensus process used for preparing NIH Consensus Statements. This short version of the consensus summarises the main conclusions and recommendations from the conference. We will subsequently publish a more detailed version of these recommendations with additional information on the background and supporting data. And in a supplement to Journal of Hepatology, articles prepared by individual presenters will be published to elaborate on the recommendations made here. Statements and recommendations were graded for their strength and quality using a grading system based on the Infectious Diseases Society of America (IDSA) system (Table 1).

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Background

Globally, an estimated 370–400 million people are chronic carriers of hepatitis B virus (HBV) and over 180 million people are chronic carriers of hepatitis C virus (HCV). Overlapping routes of transmission of these hepatitis viruses and HIV, result in a high frequency of co-infection. Worldwide, several million people are co-infected with HBV and HIV or HCV and HIV. Prevalence of HBV and HCV in HIV-infected patients in Europe is high and estimated to be 40% for HCV and 8% for HBsAg-positivity.

Alcohol consumption

Continued alcohol consumption increases HCV replication, accelerates fibrogenesis and liver disease progression in hepatitis B and in hepatitis C, and also diminishes the response and adherence to anti-hepatitis treatment (especially if consumption is >50 g/day). Therefore, psychological, social and medical support should be made available to encourage patients with a high alcohol intake to limit alcohol consumption and preferably to stop drinking (AII).

Active drug users

Active drug use should not be an absolute

Screening for HCV

All HIV-infected patients should be screened for HCV. Screening for HCV in HIV-infected patients should be done using a third generation anti-HCV antibody test (AII). A positive result should be followed by evaluation for the presence of HCV-RNA (AII). Detection of HCV-RNA indicates active disease. A negative anti-HCV antibody test excludes HCV infection—except if the patient has acute HCV (diagnostic window) or has a blunted immune response, in which case HCV-RNA should be measured to document

Screening for HBV

All HIV-positive patients should be tested for HBsAg and anti-HBc antibodies, and questioned about their HBV vaccination history (AII).

If patients are negative for HBsAg and positive for anti-HBc, they should be tested for anti-HBs (AII). In patients with isolated anti-HBc positivity, a test for serum HBV-DNA might be considered to assess occult HBV infection (see below) (CIII).

All patients who are HBsAg-positive should be tested for anti-HDV (AII). However, none of the currently available

Future studies and recommendations

A wide variety of unresolved issues exist in the management of patients co-infected with hepatitis B or C and HIV. During the conference, a number of potential areas for future research were identified (Table 2).

Consensus Development Conference Committees

Presidents: Y. Benhamou (France), D. Salmon-Ceron (France).

International Organising Committe: J.M. Pawlotsky (France), J. Rockstroh (Germany), V. Soriano (Spain).

Local Organising Committe: Patrice Cacoub (France), Gilles Pialoux (France).

Scientific Committe: M. Battegay (Switzerland), M. Carneiro de Moura (Portugal), M. Colombo (Italy), M. Dupon (France), G. Dusheiko (UK), R. Esteban (Sapin), B. Gazzard (UK), A. Hatzakis (Greece), A. Horban (Poland), C. Katlama (France), J. Lange (Netherlands),

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In our strive to keep our readership aware of the developments on the management of liver disease in patients co-infected with HIV, the Journal of Hepatology endeavoured to publish a concise statement generated by members of the Jury of the First European Consensus Conference on treatment of HBV and HCV in HIV co-infected patients. This document was distributed as a loose leaflet insert in the abstract book of the EASL Annual Meeting and is published bound in the current issue of the Journal of Hepatology for reference—Mario U. Mondelli, Co-Editor.

Endorsed by the European Association for the Study of the Liver (EASL), the European AIDS Clinical Society (EACS), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the European Federation of Internal Medicine (EFIM), the International AIDS Society (IAS), the French Society of Infectious Diseases (SPILF) and the European AIDS Treatment Group (EATG). Hosting societies include the French Association for the Study of Liver Disease (AFEF) and the French Society of Internal Medicine (SNFMI). Supported by the French Agency for Research on AIDS (ANRS) and the French Ministry of Health.

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