Highlights of the 2017 European AIDS Clinical Society (EACS) Guidelines for the treatment of adult HIV‐positive persons version 9.0

Abstract

BackgroundThe European AIDS Clinical Society (EACS) Guidelines have since 2005 provided multidisciplinary recommendations for the care of HIV‐positive persons in geographically diverse areas.Guideline highlightsMajor revisions have been made in all sections of the 2017 Guidelines: antiretroviral treatment (ART), comorbidities, coinfections and opportunistic diseases. Newly added are also a summary of the main changes made, and direct video links to the EACS online course on HIV Management. Recommendations on the clinical situations in which tenofovir alafenamide may be considered over tenofovir disoproxil fumarate are provided, and recommendations on which antiretrovirals can be used safely during pregnancy have been revised. Renal and bone toxicity and hepatitis C virus (HCV) treatment have been added as potential reasons for ART switches in fully virologically suppressed individuals, and dolutegravir/rilpivirine has been included as a treatment option. In contrast, dolutegravir monotherapy is not recommended. New recommendations on non‐alcoholic fatty liver disease, chronic lung disease, solid organ transplantation, and prescribing in elderly are included, and human papilloma virus (HPV) vaccination recommendations have been expanded. All drug–drug interaction tables have been updated and new tables are included. Treatment options for direct‐acting antivirals (DAAs) have been updated and include the latest combinations of sofosbuvir/velpatasvir/voxilaprevir and glecaprevir/pibrentasvir. Recommendations on management of DAA failure and acute HCV infection have been expanded. For treatment of tuberculosis (TB), it is underlined that intermittent treatment is contraindicated, and for resistant TB new data suggest that using a three‐drug combination may be as effective as a five‐drug regimen, and may reduce treatment duration from 18‐24 to 6‐10 months.ConclusionsVersion 9.0 of the EACS Guidelines provides a holistic approach to HIV care and is translated into the six most commonly spoken languages.

Prevalence of impaired renal function in virologically suppressed people living with HIV compared with controls: the Copenhagen Comorbidity in HIV Infection (COCOMO) study*

“…According to the Kidney Disease: Improving Global Outcomes (KDIGO) eGFR classification of renal impairment, an eGFR > 90 mL/min/1.73 m 2 is considered to represent normal to high renal function, whereas eGFR 69–89 mL/min/1.73 m 2 represents mild impairment, eGFR ≤ 60 mL/min/1.73 m 2 moderate impairment, eGFR ≤ 30 mL/min/1.73 m 2 severe impairment and eGFR ≤ 15 mL/min/1.73 m 2 renal failure . We calculated eGFR based on creatinine levels using the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) . Serum creatinine was collected and measured uniformly in all participants of both cohorts using an isotope dilution mass spectrometry (IDMS) calibrated ‘Jaffe method’.…”

Rapid initiation of antiretroviral therapy at HIV diagnosis: definition, process, knowledge gaps

“…The question now focuses on how soon to initiate ART. Although no guidance recommends a specific starting day , several publications call for more investigation of same‐day ART : guidelines from the International Antiviral Society‐USA now explicitly state that ART should commence immediately after diagnosis .…”

Antiviral activity of HIV‐1 integrase strand‐transfer inhibitors against mutants with integrase resistance‐associated mutations and their frequency in treatment‐naïve individuals

“…Integrase strand‐transfer inhibitors (INSTIs) are key components of human immunodeficiency virus 1 (HIV‐1) antiretroviral therapy (ART). US and European treatment guidelines for initial regimens to treat most people with HIV all include one INSTI and two nucleotide reverse transcriptase inhibitors . Recent clinical trials of such triple combination regimens in ART‐naïve patients have resulted in greater than 90% treatment success (HIV‐1 RNA <50 copies/mL after 48 weeks) with little or no resistance emergence, underlining the potency of these regimens .…”