2019 update of the European AIDS Clinical Society Guidelines for treatment of people living with HIV version 10.0
L Ryom, A Cotter, R De Miguel, C Béguelin, D Podlekareva, J R Arribas, C Marzolini, Pgm Mallon, A Rauch, O Kirk, J M Molina, G Guaraldi, A Winston, S Bhagani, P Cinque, J D Kowalska, S Collins, M Battegay, EACS Governing Board, Rosa De Miguel Buckley, Antonella d'Arminio Monforte, Margherita Bracchi, Nikos Dedes, Andrzej Horban, Christine Katlama, Inga Latysheva, Jens D Lundgren, Sheena McCormack, Cristina Mussini, Anton Pozniak, Federico Pulido, François Raffi, Peter Reiss, Hans-Jürgen Stellbrink, Marta Vasylyev, Sara Gibbons, Françoise Livio, Georg Behrens, Mark Bower, Juliet Compston, Stéphane De Wit, Leonardo M Fabbri, Christoph A Fux, Magnus Gisslen, Jens D Lundgren, Esteban Martínez, José M Miro, Eugenia Negredo, Neil Poulter, Peter Reiss, Giada Sebastiani, Juan Berenguer, Christoph Boesecke, Raffaele Bruno, Svilen Konov, Karine Lacombe, Stefan Mauss, Luís Mendão, Lars Peters, Massimo Puoti, Jürgen K Rockstroh, Juan Ambrosioni, Nathalie De Castro, Gerd Fätkenheuer, Hansjakob Furrer, José M Miro, Cristiana Oprea, Anton Pozniak, Alain Volny-Anne, Jürgen K Rockstroh, Ann Sullivan, Esteban Martínez, Fiona Mulcahy, Antonella d'Arminio Monforte, Georg Behrens, Christine Katlama, Jens D Lundgren, Cristina Mussini, Cristiana Oprea, Anton Pozniak, Peter Reiss, Annemarie Wensing, L Ryom, A Cotter, R De Miguel, C Béguelin, D Podlekareva, J R Arribas, C Marzolini, Pgm Mallon, A Rauch, O Kirk, J M Molina, G Guaraldi, A Winston, S Bhagani, P Cinque, J D Kowalska, S Collins, M Battegay, EACS Governing Board, Rosa De Miguel Buckley, Antonella d'Arminio Monforte, Margherita Bracchi, Nikos Dedes, Andrzej Horban, Christine Katlama, Inga Latysheva, Jens D Lundgren, Sheena McCormack, Cristina Mussini, Anton Pozniak, Federico Pulido, François Raffi, Peter Reiss, Hans-Jürgen Stellbrink, Marta Vasylyev, Sara Gibbons, Françoise Livio, Georg Behrens, Mark Bower, Juliet Compston, Stéphane De Wit, Leonardo M Fabbri, Christoph A Fux, Magnus Gisslen, Jens D Lundgren, Esteban Martínez, José M Miro, Eugenia Negredo, Neil Poulter, Peter Reiss, Giada Sebastiani, Juan Berenguer, Christoph Boesecke, Raffaele Bruno, Svilen Konov, Karine Lacombe, Stefan Mauss, Luís Mendão, Lars Peters, Massimo Puoti, Jürgen K Rockstroh, Juan Ambrosioni, Nathalie De Castro, Gerd Fätkenheuer, Hansjakob Furrer, José M Miro, Cristiana Oprea, Anton Pozniak, Alain Volny-Anne, Jürgen K Rockstroh, Ann Sullivan, Esteban Martínez, Fiona Mulcahy, Antonella d'Arminio Monforte, Georg Behrens, Christine Katlama, Jens D Lundgren, Cristina Mussini, Cristiana Oprea, Anton Pozniak, Peter Reiss, Annemarie Wensing
Abstract
Background: The European AIDS Clinical Society (EACS) Guidelines cover key aspects of HIV management with major updates every two years.
Guideline highlights: The 2019 Guidelines were extended with a new section focusing on drug-drug interactions and other prescribing issues in people living with HIV (PLWH). The recommendations for treatment-naïve PLWH were updated with four preferred regimens favouring unboosted integrase inhibitors. A two-drug regimen with dolutegravir and lamivudine, and a three-drug regimen including doravirine were also added to the recommended initial regimens. Lower thresholds for hypertension were expanded to all PLWH and for cardiovascular disease prevention, the 10-year predicted risk threshold for consideration of antiretroviral therapy (ART) modification was lowered from 20% to 10%. Frailty and obesity were added as new topics. It was specified to use urine albumin to creatinine ratio to screen for glomerular disease and urine protein to creatinine ratio for tubular diseases, and thresholds were streamlined with the Kidney Disease: Improving Global Outcomes (KDIGO) recommendations. Hepatitis C virus (HCV) treatment recommendations were split into preferred and alternative treatment options. The algorithm for management of recently acquired HCV infection was updated and includes recommendations for early chronic infection management. Treatment of resistant tuberculosis (TB) was streamlined with the World Health Organization (WHO) recommendations, and new tables on immune reconstitution inflammatory syndrome, on when to start ART in the presence of opportunistic infections and on TB drug dosing were included.
Conclusions: The EACS Guidelines underwent major revisions of all sections in 2019. They are available in four different formats including a new interactive web-based version and are translated into Chinese, French, German, Japanese, Portuguese, Russian and Spanish.
Keywords: European AIDS Clinical Society (EACS) Guidelines; HIV; antiretroviral treatment; comorbidities; drug-drug interactions; hepatitis B virus; hepatitis C virus; opportunistic infections; prescribing in elderly patients.
© 2020 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
References
- European AIDS Clinical Society Guidelines v10.0. November 2019.
- Ryom L, Boesecke C, Gisler V et al Essentials from the 2015 European AIDS Clinical Society (EACS) guidelines for the treatment of adult HIV‐positive persons. HIV Med 2016; 17: 83–88.
- Zash R, Holmes L, Diseko M et al Neural tube defects and antiretro‐viral treatment regimens in Botswana. N Engl J Med 2019; 381: 827–840.
- Wandeler G, Mauron E, Atkinson A et al Incidence of hepatocellular carcinoma in HIV/HBV‐coinfected patients on tenofovir therapy: relevance for screening strategies. J Hepatol 2019; 71: 274–280.
- Swanepoel CR, Atta MG, D'Agati VD et al Kidney disease in the setting of HIV infection: conclusions from a kidney disease: improving global outcomes (KDIGO) controversies conference. Kidney Int 2018; 93: 545–559.
- European AIDS Treatment Network (NEAT) consensus conference statement. June 2019. Available at (accessed 12 December 2019).
- Boesecke C, Martinez EM, Nelson M et al Fueling the epidemic: low rates of spontaneous clearance of acute HCV coinfection CROI. Boston, MA, March 2018 [Abstract 129].
- WHO consolidated guidelines on drug‐resistant tuberculosis treatment. Geneva: World Health Organization; 2019. Available at (accessed 12 December 2019).
Source: PubMed