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EACS updates HIV guidelines for adults
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At this year’s European AIDS Conference, the European AIDS Clinical Society presented its updated guidelines, which include detailed recommendations on ART, as well as diagnosis, monitoring and treatment of comorbidities, coinfections and opportunistic diseases in adults with HIV in Europe.
“The diagnosis and management of HIV infection and related coinfections, opportunistic diseases and comorbidities require a multidisciplinary effort, for which the 2017 version of the EACS Guidelines will provide an excellent basis,” Manuel Battegay, MD, chief of the division of infectious diseases and hospital epidemiology at the University Hospital of Basel, Switzerland, chair and coordinator of the EACS guidelines and immediate past president of the EACS, said in a press release.
According to the EACS, the incidence of HIV in Europe has remained relatively unchanged. In 2015, there were 29,747 new cases of HIV in the European Union and the European Economic Area — with about 6.3 cases per 100,000 people vs. 6.6 cases per 100,000 people in 2006. Data monitored by the European Center for Disease Prevention and Control suggest 1.2 million people live with HIV in Europe and Central Asia, and among those, 25% are undiagnosed and 40% have not achieved viral suppression. In addition, current estimates show that 2.3 million patients are coinfected with HIV and hepatitis C globally.
In January, EACS released version 8.2 of its guidelines, but the most recent installment — version 9.0 — has removed, updated and introduced sections to reflect the most currently available data.
ART
EACS has removed older ART drugs and changed the order of the listed regimens to reflect preference of use based on available clinical data.
“Our recommended initial treatments have more details regarding the issue of backbone drugs,” Anton Pozniak, MD, FRCP, consultant physician, honorary senior lecturer and director of HIV services at the Chelsea and Westminster Hospital in London, said in the release. “Important issues, highly relevant to women, were also revised, especially in regard to which drugs we recommended during pregnancy and to which special monitoring is needed.”
The guidelines also include information on switch strategies and post-exposure prophylaxis.
Comorbidities
EACS introduced four new sections to include recommendations on nonalcoholic fatty liver disease, chronic lung disease, prescribing in the elderly and solid organ transplantation to address the increased risk for these comorbidities related to HIV.
“As antiretroviral therapies improve and people with HIV get older, accompanying health conditions and diseases become increasingly more important,” Georg Behrens, MD, PhD, professor in the department of clinical immunology and rheumatology at Hannover Medical School in Germany, said in the release.
Coinfections
EACS also updated its recommendations regarding HCV testing and treatment. In the release, Massimo Puoti, MD, a specialist in gastroenterology and infectious disease from the Niguarda Hospital in Milan, said that two approved pan-genotypic HCV combination regimens, with simple treatment indication and a shortened treatment duration, have been added to the guidelines. In addition, according to Puoti, tenofovir alafenamide may be a “feasible” treatment option for patients because of its dual activity against hepatitis B virus and HIV and improved safety profile.
Opportunistic infections
Highlights in the opportunistic infections section of the guidelines include treatment of cryptococcal meningitis when flucytosine is unavailable. They also include approaches to treating tuberculosis in patients with HIV. EACS added the preliminary results of the Nix-TB trial, which involves a regimen that shows promise in simplifying and shortening treatment for multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB). The guidelines now emphasize using a 9-month treatment duration for latent TB, particularly in countries with high TB prevalence, and the need for more preventive regimens to treat latent infection with MDR-TB or XDR-TB in countries with high rates of resistant TB. – by Savannah Demko
Reference:
EACS. Guideline Version 9.0. October 2017. http://www.eacsociety.org/files/guidelines_9.0-english.pdf. Accessed on October 27, 2017.
Disclosures: Infectious Disease News was unable to confirm relevant financial disclosures at the time of publication.
Perspective
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Jens Lundgren, MD, DMSC
The guidelines are used widespread within Europe and outside (of note, they are translated into seven languages). They are user-friendly, easy to navigate and instructive. These guidelines need to be up to date — and the 9.0 version is providing this. The guidelines will impact many clinicians to ensure that care for HIV-positive persons is provided using state-of-the-art methodology. A section of the guidelines outlined the specific sections where updates have been made, so “old users” can be aware.
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