What are the European AIDS Clinical Society guidelines on antiretroviral therapy (ART) and chronic HIV infection?

Updated: Dec 02, 2019
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

The European AIDS Clinical Society (EACS) has issued updated guidelines on the management of HIV infection. In this latest version of the guidelines (version 10), a new drug-drug interaction panel has been introduced. The guidelines have six main sections, including a general overview table of all major issues in patients living with HIV infection; recommendations on antiretroviral treatment (ART); drug-drug interactions; and diagnosis, monitoring, and treatment of comorbidities, coinfections, and opportunistic diseases. [158]

Antiretroviral therapy

A new recommendation in the updated guideline favors an unboosted integrase strand transfer inhibitor (INSTI) with high genetic barrier (bictegravir [BIC] or dolutegravir [DTG]) as a third agent for therapy initiation in treatment-naïve individuals with HIV infection.

Two nucleos(t)ide reverse transcriptase inhibitors (NRTIs) plus doravirine (DOR) has been included among the recommended regimens.

Tenofovir disoproxil fumarate (TDF)/lamivudine (3TC) has been added as a backbone, when indicated.

DTG plus 3TC dual therapy has been upgraded as a recommended regimen.

High-genetic-barrier INSTI or protease inhibitors pharmacologically boosted with cobicistat or ritonavir (PI/b) are recommended as initial therapy for primary HIV infection if resistance testing is unavailable.

Ritonavir- or cobicistat-boosted darunavir (DRV/b) plus rilpivirine (RPV) has been included as a dual-therapy option.

Monotherapy with PI/b is not recommended.

Initiation of ART in patients with tuberculosis (TB) and HIV coinfection who have a CD4 cell count of more than 50/µL may be deferred up to 8 weeks after TB treatment has been started.

Tenofovir alafenamide (TAF)/emtricitabine (FTC), raltegravir (RAL) once daily, and bictegravir (BIC) have been added as potential drugs for postexposure prophylaxis (PEP).

TAF/FTC is now included as an alternative for pre-exposure prophylaxis (PrEP) in men who have sex with men (MSM) and transgender women.

Comorbidities

Screening for kidney disease should incorporate albumin/creatinine ratio for glomerular disease and protein/creatinine ratio for screening for and diagnosing antiretroviral-related tubulopathy.

Lipid targets have been updated in terms of the threshold for ART modification, from 20% 10-year risk for cardiovascular disease (CVD) to 10% 10-year risk for CVD.

Medical management of hypertension has been updated to include amended drug-sequencing suggestions and recommended drugs.

The workup of liver disease among individuals with HIV infection should now include a fourth step to include risk stratification based on risk prediction tools and transient elastography and an updated algorithm for surveillance of varices.


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