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; JR Arribas; C Marzolini; PGM Mallon; A Rauch; O Kirk; JM Molina; G Guaraldi; A Winston; S Bhagani; P Cinque; JD Kowalska; S Collins; M Battegay


HIV Medicine. 2020;21(10):617-624. 

In This Article

Viral Hepatitis Coinfection Section

This section was renamed Clinical management and treatment of viral hepatitis co-infections in PLWH. The overall structure of the section was also revised to improve readability.

The first subsection contains general recommendations on viral hepatitis coinfections in PLWH and focuses on screening recommendations, measures of prevention and complications related to viral hepatitis. A new table on noninvasive liver fibrosis markers was introduced.

Another subsection focuses on treatment and monitoring of PLWH coinfected with HBV and includes a part on HBV reactivation related to immunosuppressive treatment with monitoring and treatment recommendations stratified by type of immunosuppressive drugs. Awareness of the risk for HBV reactivation is particularly important in the era of ART simplification with regimens not containing NRTIs active against HBV.

There were no new direct-acting antivirals (DAAs) licensed for the treatment of HCV since the last Guideline revision. The HCV treatment recommendations table was split into two parts, with one table listing the preferred treatment options, and a second table listing the alternative options (Table 2 and Table 3). The recommendations for the management of DAA treatment failures were updated.

Acute HCV infection was renamed "recently acquired HCV infection" in accordance with the recent European AIDS Treatment Network consensus conference (NEAT) statement.[6] Lack of spontaneous clearance and progression to chronic infection can be predicted reliably by four weeks after diagnosis in those with less than a 2 × log10 reduction in HCV RNA.[7] Accordingly, this situation is considered as early chronic HCV infection and immediate DAA therapy is recommended. DAA treatment is recommended as in treatment-naïve noncirrhotic individuals (except for those with pre-existing liver cirrhosis), as several trials failed to demonstrate noninferiority of shortened treatment courses.[6]

Finally, the recommendations on the management of viral hepatitis D and E in PLWH were expanded.