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 Sirolimus ic50 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 the following: increased discussion on hepatitis screening and prevention The Writing Group used an evidence-based medicine approach to produce these guidelines. Many important aspects of clinical practice remain to be formally evaluated and many trials have been
performed in order to obtain licensing approval for a drug. However, the design of such trials is not ideally suited
to addressing questions concerning clinical use. In most cases, the only available data on long-term outcomes are from routine clinical cohorts. While such cohorts are representative of routine clinical populations, the lack of randomization to different regimens means that comparisons between the outcomes of different treatments are susceptible to bias. Expert opinion forms an important part of all consensus guidelines; however, this is the least valuable and robust form of evidence. There are many prevention and management principles that are common to both hepatitis B and C. We will therefore discuss these before concentrating find more on issues specific to each type of hepatitis. In the disease-specific section of these guidelines click here we have demonstrated that there is an ongoing epidemic of acute HCV infection amongst HIV-infected men who have sex with men (MSM) in the UK and Western Europe [1,2] linked with mucosal traumatic sexual practices and co-transmitted with other sexually transmitted infections [3]. Early recognition of acute HCV infection is therefore important, as early treatment offers the best chance of viral clearance [4]. Acute HBV infection continues to be a problem for HIV-positive patients. We also
know that 5–10% of new HIV-positive patients have chronic hepatitis B or C. There is therefore a need to screen newly diagnosed HIV-positive patients on an ongoing basis. 3.1.1.1 Screening for hepatitis in new HIV-positive patients • All newly diagnosed HIV-positive patients should be screened for coinfection with HBV and HCV as part of their initial work-up (III). This screening would normally be with the HBsAg, anti-HBV core antigen (anti-HBc) and anti-HCV antibody tests with appropriate further tests if positive. See also sections 4.2 and 5.2. 3.1.1.2 Ongoing hepatitis testing in known HIV-positive patients • All HCV-negative patients should have an annual anti-HCV antibody screen, and more frequent tests if at higher risk [e.g. if injecting drug user (IDU) or MSM at sexual risk] (III).