Management of coinfection with HIV-1 and hepatitis B or C virus (2010)

Management of coinfection with HIV-1 and hepatitis B or C virus (2010) Introduction

The 2009 guidelines have been updated to incorporate all new relevant information since the previous versions in 2005. The 2005 versions came as separate hepatitis B and C guidelines but for 2009 we have decided to amalgamate them into a single document. This is to avoid duplication, as the general management of chronic liver disease is similar for both infections. The guidelines follow the methodology outlined below and all the peer-reviewed publications and important, potentially treatment-changing abstracts from the last four years have been reviewed.

The translation of data into clinical practice is often difficult, even with the best possible evidence, because of differences in factors such as trial design and inclusion criteria. The recommendations based upon expert opinion have the least good evidence but provide an important reason for writing the guidelines – to produce a consensual opinion about current practice. The Writing Group seeks to provide guidelines that optimize management, but such care needs to be individualized and we have not constructed a document that we would wish to see used as a ‘standard’ for litigation. 

The major changes/amendments include:

  • Increased discussion on hepatitis screening and prevention;
  • Clarification on the role of liver biopsy and non-invasive liver fibrosis assessment;
  • More emphasis on screening for delta virus;
  • Increased discussion on end-stage liver disease management and HCC screening;
  • Molecular diagnostic tests used for the diagnosis and management of HBV and HCV;
  • Revised CD4-based guidance on the management of chronic HBV;
  • Management of acute HBV;
  • Revised guidance on the management of chronic HCV, including ART interactions;
  • Management of acute HCV;
  • Management of treatment non-responders and relapsers in both chronic HBV and HCV.

Downloads

British HIV Association guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus 2010

Writing Group

Writing group chair and hepatitis B co-lead

  • Dr Gary Brook, North West London Hospitals NHS Trust

Writing group deputy chair and hepatitis B co-lead

  • Dr Janice Main, St Mary’s Hospital, London

Hepatitis C lead

  • Dr Mark Nelson, Chelsea and Westminster NHS Foundation Trust

General section lead

  • Dr Sanjay Bhagani, Royal Free Hampstead NHS Trust, London

Members

  • Dr Kosh Agarwal, King’s College Hospital, London
  • Mr Craig Deacon-Adams (Community Representative)
  • Dr Martin Fisher, Brighton and Sussex University Hospitals NHS Trust
  • Dr Andrew Freedman, Cardiff University School of Medicine
  • Dr Yvonne Gilleece, Brighton and Sussex University Hospitals NHS Trust
  • Dr Richard Gilson, Mortimer Market Centre, London
  • Dr Ranjababu Kulasegaram, Guy’s & St Thomas’ Hospital NHS Foundation Trust, London
  • Dr Clifford Leen, Western General Infirmary, Edinburgh
  • Prof. Caroline Sabin, Royal Free and University College Medical School, London
  • Dr Ed Wilkins, North Manchester General Hospital