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

Disclosures

HIV Medicine. 2020;21(10):617-624. 

In This Article

Opportunistic Infection (OI) Section

A new table is included at the start of the revised OI section, providing guidance on when to start ART in the presence of OIs and in particular TB, cryptococcal meningitis and cytomegalovirus (CMV) end-organ disease.

Also added is a new table on immune reconstitution inflammatory syndrome (IRIS), including definitions of paradoxical and unmasking IRIS, along with recommendations on prevention and management.

For the 2019 update, extensive revisions on how to manage drug-resistant TB in PLWH were made. The recommendations are in line with the most recent World Health Organization (WHO) recommendations to use four, preferably oral and presumed effective TB drugs for the first six months of intensive treatment, followed by treatment with three active drugs for 12–14 months depending on response.[8] In addition, a new table on recommended TB drug doses and key adverse effects has been added.

Also new is the addition of talaromycosis, which is relevant in PLWH who have lived in Asia. The table contains recommendations on diagnosis, treatment and secondary prophylaxis.

Minor edits have been made to the other individual OIs, most importantly for Pneumocystis jiroveci pneumonia (PCP) and Toxoplasma gondii infection, where primary prophylaxis can now be stopped already at CD4 counts > 100 cells/μL and if viral load has been undetectable for > 3 months. For nontuberculous mycobacteria, primary prophylaxis in the case of a CD4 count < 50 cells/μL is no longer recommended if ART is started.

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