HIV Infection Clinical Practice Guidelines (2019)

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.^[1]

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.

For more information, please go to HIV Infection and AIDS.

For more Clinical Practice Guidelines, please go to Guidelines.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: HIV Infection Clinical Practice Guidelines (2019) - Medscape - Dec 03, 2019.

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