European AIDS Clinical Society (EACS) guidelines for the clinical management and treatment of HIV‐infected adults

Abstract

A working group of the European AIDS Clinical Society (EACS) have developed these guidelines for European clinicians to help them in the treatment of adults with HIV infection. This third version of the guidelines includes, as new topics, the assessment of patients at initial and subsequent clinic visits as well as post-exposure prophylaxis. A revision of the 2005 guidelines based on current data includes changes in the sections on primary HIV infection, when to initiate therapy, which drug combinations are preferred as initial combination regimens for antiretroviral-naïve patients, how to manage virological failure and the treatment of HIV during pregnancy.In Europe, there is a wide range of clinical practices in antiretroviral therapy depending on various factors such as drug registration, national policies, local availability, reimbursement and access to treatment. These can vary greatly from one country to another, especially in Central and Eastern parts of Europe.These guidelines are intended to help clinicians achieve the best care for their patients. In some countries, particularly where the quality of and access to care are not optimal, these guidelines should help AIDS societies and physicians or patient group organizations to negotiate with their national health authorities with a view to implementing what should be the standard of care for HIV-infected patients all over Europe.

A comparison of the long-term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study

“…Such long-term adverse events can influence the durability of a regimen. Combination antiretroviral therapy (cART) regimens most often include a nonnucleoside reverse transcriptase inhibitor, such as efavirenz or nevirapine, or a ritonavirboosted protease inhibitor, such as lopinavir [8,9]. cART regimens with durability as well as virological efficacy are required in order to achieve long-term virological suppression and to maintain CD4 cell counts at a level that significantly reduces the risk of morbidity and mortality.…”

HIV as a chronic disease

“…The BHIVA, European AIDS Clinical Society (EACS) and the American Department of Health and Human Services (DHHS) guidelines recommend that treatment is initiated before the CD4 count drops below 350 cells/mm 3 . 20,26,27 If patients with a CD4 count of greater than 350 cells/mm 3 have an AIDS diagnosis, hepatitis B or C co-infection, a low CD4 percentage (<14%), or a high risk of cardiovascular disease, BHIVA advises consideration of antiretroviral therapy. 20 An effective repertoire of antiretroviral agents exists.…”

Hiv, amming og antiretrovirale medisiner

“…Dette dilemmaet er ikke til stede på samme måte i høyinntektsland. Retningslinjene i disse landene, forenklet gjengitt, er basert på optimal viral suppresjon under svangerskap og forløsning samt keisersnitt fremfor vaginal forløsning ved hiv-1-RNA på mer enn 50 kopier/ml ved uke 34-36 og morsmelkerstatning fremfor amming (2).…”