title: HIV/hepatitis coinfection in eastern Europe and new pan-European approaches to hepatitis prevention and management.
abstract: OBJECTIVE
  HIV/hepatitis coinfection in Europe; WHO European clinical protocols on the management of people coinfected with HIV/AIDS and hepatitis B or C (HBV or HCV); stakeholder recommendations for better HCV services.
  
  
  BACKGROUND
  The increasing availability of highly active antiretroviral therapy throughout Europe and central Asia has changed comorbidity and mortality patterns among people living with HIV/AIDS (PLWHA) as liver disease has increasingly replaced AIDS as the cause of death in PLWHA in western European countries. The average prevalence of HCV among PLWHA is 40 per cent, and much higher in countries where the HIV epidemic is driven by injecting drug use. Access to hepatitis treatment for PLWHA and IDUs is still very limited in Europe due to a lack of clear clinical management guidelines for HIV/hepatitis coinfections, high costs and a national failure to recognise hepatitis as a critical health issue.
  
  
  METHODS
  In October 2006, the WHO Regional Office for Europe issued protocols for the clinical management of HIV/HCV and HIV/HBV coinfections. They include diagnostic algorithms adjusted for resource availability, and guidelines for the management of patients who do not yet need treatment, those who need only hepatitis or only HIV/AIDS treatment, and those who need both. Though the protocols should provide practical guidelines for physicians and assist in the development of national treatment standards, there is still a need for targeted prevention, treatment and care interventions. To expand access to hepatitis prevention and treatment, public awareness needs to be raised and national political leaders need to address hepatitis as a public health issue. Effective public health measures include price reductions for anti-hepatitis drugs; targeted testing, counselling and prevention activities; increased access to hepatitis B and C treatment and to HBV vaccination for the populations most at risk.
authors.affiliation: Sexually Transmitted Infections/HIV/AIDS Programme, WHO Regional Office for Europe, Copenhagen Ø, Denmark. jla@euro.who.int <jla@euro.who.int>
authors.forename: Jeffrey V
authors.initials: JV
authors.lastname: Lazarus
authors.forename: Priya B
authors.initials: PB
authors.lastname: Shete
authors.forename: Irina
authors.initials: I
authors.lastname: Eramova
authors.forename: Simona
authors.initials: S
authors.lastname: Merkinaite
authors.forename: Srdan
authors.initials: S
authors.lastname: Matic
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use; D005061:Europe, Eastern / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D040261:Harm Reduction; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility; D006509:Hepatitis B / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D018671:Needle-Exchange Programs; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D015995:Prevalence; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014761:Viral Hepatitis Vaccines; D014944:World Health Organization
chemical_list: D000998:Antiviral Agents; D014761:Viral Hepatitis Vaccines