Major revision version 12.0 of the European AIDS Clinical Society guidelines 2023

Abstract

BackgroundThe European AIDS Clinical Society (EACS) guidelines were revised in 2023 for the 19th time, and all aspects of HIV care were updated.Key Points of the Guidelines UpdateVersion 12.0 of the guidelines recommend the same six first‐line treatment options for antiretroviral treatment (ART)‐naïve adults as versions 11.0 and 11.1: tenofovir‐based backbone plus an unboosted integrase inhibitor or doravirine; abacavir/lamivudine plus dolutegravir; or dual therapy with lamivudine or emtricitabine plus dolutegravir. The long‐acting section has been expanded in the ART and drug–drug interaction (DDI) panels. Tables for preferred and alternative ART in children and adolescents have been updated, as has the section on prevention of vertical transmission, particularly with new guidance for breastfeeding. A new DDI table has been included for the ART and anti‐infective drugs used for opportunistic infections, sexually transmitted infections, and other infectious conditions; lenacapavir has been included in all DDI tables. New sections on alcohol use and patient‐reported outcome measures (PROMs) have been included in the comorbidity panel, in addition to updates on many relevant topics, such as new resource guidance for deprescribing in people with HIV. Other sections, including travel, cognitive impairment, cancer screening, sexual health, and diabetes have also been revised extensively. The algorithm for the management of acute hepatitis C virus infection has been removed, as current guidelines recommend immediate treatment of all people with recently acquired hepatitis C virus. Updates on vaccination for hepatitis B virus and recommendations for simplification to tenofovir‐free two‐drug regimens in people with isolated anti‐hepatitis B core antibodies are provided. In the opportunistic infections and COVID‐19 panel, guidance on the management of COVID‐19 in people with HIV has been updated according to the most up‐to‐date evidence, and a new section on monkeypox has been added.ConclusionsIn 2023, the EACS guidelines were updated extensively and now include several new sections. The recommendations are available as a free app, in interactive web format, and as a pdf online.

Outcomes of Drug Interactions Between Antiretrovirals and Co-Medications, Including Over-the-Counter Drugs: A Real-World Study

“…Documenting real-world cases helps bridge knowledge gaps, ultimately enhancing the quality of care for PWH. Notably, the integration of real-world cases for clinical decisions on DDIs has been recently incorporated into the EACS HIV treatment guidelines [20].…”

Pathophysiology and Clinical Management of Dyslipidemia in People Living with HIV: Sailing through Rough Seas

“…The introduction of HAART as a combination of three antiretroviral agents, typically including two NRTIs and one PI, NNRTI or integrase strand transfer inhibitor (INSTI), has revolutionized the treatment of HIV infection. However, nowadays, the long-term metabolic side effects of those regimens, such as dyslipidemia, have become a concern [63]. The impact of HAART on the lipid profile is often challenging to determine, considering the significant variability between different classes of ART drugs and drugs within the same class, as well as the multidrug nature of HIV treatment itself.…”

Lamivudine, Doravirine, and Cabotegravir Downregulate the Expression of Human Endogenous Retroviruses (HERVs), Inhibit Cell Growth, and Reduce Invasive Capability in Melanoma Cell Lines

“…Given the similarities between human immunodeficiency virus (HIV) and HERVs, antiretroviral drugs are intriguing; millions of people living with HIV/AIDS, generally experiencing negligible side effects, take these drugs daily. In order to be virologically and clinically effective, an antiretroviral therapy against HIV consists of a variable combination of 2-4 drugs belonging to at least two of the before-mentioned classes (for instance, a combination of tenofovir plus emtricitabine-both NRTIs-plus bictegravir, an INSTI) [36]. Despite their efficacy, protease inhibitors (PIs) have recently been discontinued as first-line antiretroviral therapy due to 'poor practicality', stemming from frequent interactions with concurrent medications and other issues.…”