EACS Guidelines Shift Focus to Aging HIV Population and Comorbidities
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new recommendations prioritize holistic health management, with only incremental changes to core antiretroviral therapy.
The European AIDS Clinical society (EACS) has significantly broadened its guidance to address the evolving healthcare needs of an aging population living with HIV, placing increased emphasis on managing comorbidities and preventative care. Version 13.0 of the EACS guidelines,unveiled at the 20th European AIDS Conference and published in HIV Medicine,represents a strategic shift toward holistic health management,while maintaining stability in first-line antiretroviral therapy (ART) regimens.
Aging with HIV: A new Era of Care
“They don’t only cover HIV treatment and management of co-infections, but also deal with comorbidities, which are becoming more and more important in an aging population living with HIV,” explained Jürgen Rockstroh, MD, head of infectious diseases at University Hospital Bonn, Germany, and chair of the EACS Guidelines. The updated guidelines provide practical targets and tools for HIV physicians, recognizing that they often manage these complex health issues without dedicated specialist support. This comprehensive approach reflects a growing understanding of the long-term health challenges faced by individuals living with HIV.
ART: Stability with Strategic Adjustments
First-line therapy remains largely consistent, continuing to prioritize second-generation integrase inhibitors. Doravirine is retained as a viable option despite the absence of direct comparative trials against newer integrase-based regimens. For individuals who acquire HIV while already on long-acting cabotegravir PrEP, the guidelines recommend initiating a triple regimen including boosted darunavir, discouraging the use of dual therapy.
Addressing Emerging Challenges: HIV-2 and Prevention
A new section dedicated to HIV-2 has been added, acknowledging its increasing prevalence in Europe due to migration patterns, notably among individuals with ties to West Africa. the guidelines detail best practices for suspecting, diagnosing, treating, and monitoring this less common strain of the virus.
Prevention strategies have also been updated to incorporate long-acting injectable PrEP options, including cabotegravir and lenacapavir. The EACS now recommends HIV RNA testing prior to initiating PrEP, especially for those with recent high-risk exposure or when utilizing long-acting agents. For post-exposure prophylaxis in individuals already on oral PrEP, the guidance advises a two-tablet dose promptly following exposure, followed by one tablet daily until a full medical evaluation can be completed.
Vaccination and Hepatitis B: Critical Updates
The guidelines now recommend the RSV vaccine for individuals aged 75 years and older. A considerable revision has been made to the hepatitis B vaccination section, with new CpG-adjuvanted vaccines demonstrating near-100% response rates, even in those who previously did not respond to v
A central theme of the updated guidelines. Following the REPRIEVE study, there is growing support for initiating statins earlier – particularly in individuals over 40 – and intensifying lipid control. The benefits of statins may extend beyond LDL lowering, perhaps offering anti-inflammatory effects. The hypertension intervention threshold has been lowered to 129 mm Hg, aligning with the 2024 European Society of Cardiology guidelines.
Obesity guidance has been extensively rewritten to address weight trends linked to ART regimens and lifestyle factors,encompassing lifestyle interventions,pharmacotherapy,and bariatric options.GLP-1 agonists are discussed, although evidence specific to people with HIV remains limited.
New screening tools and practical guidance have been incorporated for mental health, including suicide-risk screening with the Ask Suicide-Screening Questions and addressing alcohol and chemsex-related harms. A new drug-drug interaction table links antiretrovirals with recreational substances, and a unified substance-use framework has been introduced.
“These guidelines help clinicians manage people who are getting older and developing comorbidities,” Rockstroh concluded, emphasizing that they provide clear targets for blood pressure and LDL, identify appropriate candidates for statins and cancer screening, and integrate simple mental-health tools alongside treatment guidance.
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