Thanks to advancements in highly effective antiretroviral therapy (ART), the lifespan of the population living with HIV has significantly increased. However, with advancing age, the risk of developing comorbidities also rises.
In response to this clinical challenge, the European AIDS Clinical Society (EACS) has published the latest guidelines, which focus not only on viral control but also on the integrated management of these concurrent conditions. This update represents a strategic direction towards comprehensive, patient-centered care.
The updated EACS guidelines offer clinicians and patients evidence-based recommendations for the prevention and management of conditions such as cardiovascular and oncological diseases, mental health disorders, obesity, and bone and kidney pathologies.
What Is New in HIV Treatment?
The fundamental principles of Antiretroviral Therapy (ART) remain essentially unchanged. Second-generation integrase inhibitors are still preferred as first-line therapy due to their high efficacy and safety profile. However, the guidelines include important new clinical recommendations:
For those who developed HIV infection despite using long-acting injectable Pre-Exposure Prophylaxis (PrEP), an intensive three-component therapy is recommended.
A new section on HIV-2 infection has been added to the guidelines, providing instructions for improving its diagnosis and treatment. This is particularly important due to increased migratory flows in Europe.
New forms of long-acting injectable PrEP (drugs such as cabotegravir and lenacapavir) are now fully integrated into HIV infection prevention strategies.
New drug regimens and precise viral load monitoring for pregnant women help doctors optimally manage both the mother’s and the infant’s health.
Comorbidity Management Is a Priority
One of the most substantial changes concerns the management of comorbidities. The recommendations offer tools tailored to specific therapeutic goals for these conditions:
Cardiovascular and Metabolic Health
Initiating statins is recommended at an earlier stage, including in patients with moderate cardiovascular risk (based on data from the REPRIEVE study).
Blood pressure target values have been tightened: the new threshold is .
The definition of obesity now includes the assessment of excess adipose mass and is not limited solely to Body Mass Index (BMI). Weight gain of 5% or more is considered clinically relevant.
Updated recommendations include lifestyle modification, pharmacological therapy, and bariatric intervention for effective obesity management.
Musculoskeletal System and Renal Function Management
Updated osteoporosis screening criteria pay more attention to low BMI and family or personal history of fractures.
New medicinal agents have been added to the guidelines, such as the drug denosumab.
Kidney pathology management guidelines confirm that certain ART regimens can be used safely even in cases of significant renal function impairment.
Liver and Pulmonary Pathologies
The old term has been replaced by Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD).
The goal of screening is the timely identification of liver fibrosis.
Chronic Obstructive Pulmonary Disease (COPD) is the main chronic pulmonary pathology considered according to the latest GOLD guidelines.
Mental Health and Psychoactive Substance Use
To reflect a multidisciplinary approach, the term “psychotherapy” has been replaced by psychological intervention (or treatment).
Screening is recommended to detect the risk of suicide, sleep disorders, and harm associated with excessive alcohol consumption.
Management of Older Patients
Routine screening for Frailty starts from the age of 50.
Vitamin D supplements are recommended only in cases of laboratory-confirmed deficiency.
The guidelines include cognitive, nutritional, hearing, visual, and psychosocial assessments for older patients with HIV.
Other Key Aspects
Vaccination Recommendations: The Respiratory Syncytial Virus (RSV) vaccine is recommended for individuals aged 75 and older. New Hepatitis B vaccines significantly increase the rate of seroconversion(production of protective antibodies) in HIV-infected patients.
Oncology Screening: Updated recommendations for anal, breast, prostate, liver, cervical, and lung cancer screening emphasize the assessment of risk factors and the development of a personalized strategy based on available resources.
The guidelines include new recommendations on the use of lubricants, hormone replacement therapy, and drug interactions between ART and medications for sexual dysfunction.
Pediatrics: New recommendations include the use of dolutegravir in newborn treatment regimens and instructions on how to ensure a seamless transition of patients from pediatric to adult care systems.
Digital Guidelines: The EACS guidelines are now a Living Document online. This means they are updated quickly as soon as new scientific data emerges.
This comprehensive update turns HIV care into a new model of patient-centered care. Clinicians have clear, evidence-based guidance for optimizing long-term outcomes. Patients receive integrated care that extends beyond virological control and allows them to be actively involved in the therapeutic process. The main challenge remains ensuring that these advancements are accessible to everyone.
Source: HIV Medicine
