[Recommendations of Gesida/PNS/AEEH for the management and treatment of the adult patient co-infected with HIV and hepatitis A, B and C virus].

OBJECTIVE: This review updates clinical guidelines on HIV+ and hepatitis A, B and C in coinfected adult patients.
METHODS: This consensus has been adopted by an expert panel from several scientific societies (GESIDA/SPNS/AEEH). Published data on epidemiology, natural history, prevention and treatment of viral hepatitis in HIV+ patients have been reviewed. These statements are classified according to the rating scheme of the DHHS for the strength and quality of evidence of the data. The evidence has been sub-typed as "a" and "b", depending on whether the available data were from coinfected or non-coinfected patients.
RESULTS: These guidelines focus on conditions associated with the care of the hepatic diseases, such as prevention of these hepatitis, alcohol intake, drug use, antiretroviral therapy with or without treatment of chronic hepatitis. Follow-up is individualised, based on virological data and non-invasive assessment of liver fibrosis. Several nucleoside/nucleotide analogues have activity against HBV and HIV, so the majority of the patients will receive combined therapy. A significant proportion of patients can resolve HCV infection. It is important to select the patient appropriately and a good knowledge of these therapies is required. With advanced liver disease, it may be necessary to adapt HAART and consider liver transplantation.
CONCLUSIONS: We have effective drugs and diagnostic procedures in order to evaluate all coinfected patients and consider a high proportion suitable for therapy against hepatitis viruses. These patients should have the same therapeutic options as the general population. Copyright 2009 Elsevier España, S.L. All rights reserved.