HIV/hepatitis coinfection in eastern Europe and new pan-European approaches to hepatitis prevention and management
HIV/hepatitis coinfection in eastern Europe and new pan-European approaches to hepatitis prevention and management
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DOI：
10.1016/j.drugpo.2007.01.011
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发表时间：
2007-10-01
影响因子：
4.4
通讯作者：
Matic, Srdan
中科院分区：
文献类型：
--
作者：
Lazarus, Jeffrey V.;Shete, Priya B.;Matic, Srdan
问题：欧洲的艾滋病毒/肝炎合并感染；世卫组织关于艾滋病毒/艾滋病和乙肝或丙型肝炎(乙肝或丙型肝炎)混合感染者管理的欧洲临床方案；利益攸关方对更好的丙型肝炎病毒服务的建议。简介：在整个欧洲和中亚，高效抗逆转录病毒治疗的可用性越来越高，改变了艾滋病毒/艾滋病感染者(PLWHA)的共病和死亡模式，因为在西欧国家，肝脏疾病越来越多地取代艾滋病，成为PLWHA的死亡原因。在PLWHA中，丙型肝炎病毒的平均流行率为40%，在通过注射吸毒导致艾滋病毒流行的国家，丙型肝炎病毒的感染率要高得多。在欧洲，由于缺乏明确的艾滋病毒/肝炎混合感染的临床管理指南，高昂的费用，以及国家未能认识到肝炎是一个关键的健康问题，因此，PLWHA和注射吸毒者获得肝炎治疗的机会仍然非常有限。描述：2006年10月，世卫组织欧洲区域办事处发布了艾滋病毒/丙型肝炎和艾滋病毒/乙肝混合感染的临床管理方案。它们包括根据资源可获得性调整的诊断算法，以及对尚不需要治疗的患者、只需要肝炎或仅需要艾滋病毒/艾滋病治疗的患者以及同时需要这两种治疗的患者的管理指南。尽管这些协议应该为医生提供实用的指南，并帮助制定国家治疗标准，但仍然需要有针对性的预防、治疗和护理干预措施。为了扩大肝炎预防和治疗的机会，需要提高公众意识，国家政治领导人需要将肝炎作为一个公共卫生问题来解决。有效的公共卫生措施包括降低抗肝炎药物的价格；有针对性的检测、咨询和预防活动；增加乙肝和丙型肝炎治疗的机会以及最危险人群接种乙肝疫苗的机会。(C)2007 Elsevier B.V.保留所有权利。
Issues: 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.Introduction: 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.Description: 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. (C) 2007 Elsevier B.V. All rights reserved.