EACS Guidelines: 11th edition (October 2021)

Simon Collins, HIV i-Base

The 11th update of the EACS guidelines were launched in a special session on the last day of the conference, to discuss the major updates. [1]

These guidelines are primarily as an easy reference guide for doctors that covers the minimum standards of care for the management of HIV. They are designed as a handbook based on look-up tables and algorithms for all aspect of care, and are available in two electronic formats. [2]

  • An 150-page PDF file.
  • A free App for IOS and Android devices.

The printed booklet version was not produced this year.


The guidelines are organised into seven main sections.

  1. Assessment of and monitoring from first diagnosis
  2. ART (including first and subsequent treatment, pregnancy, PEP and PrEP)
  3. Drug interactions and prescribing issues, including for different demographic groups
  4. Prevention and management of comorbidities. This cover 50 different complications of care including a wide range of side effects and lifestyle, quality of life and age-related issues.
  5. Management of coinfection with viral hepatitis
  6. Opportunistic infections, including COVID-19
  7. Paediatric HIV care

Each section has a separate writing group, and an overall editorial group means that more than 100 leading experts from across Europe are involved in each edition.

Main changes to this edition

The guidelines have been updated throughout, with two new sections added on COVID-19 and paediatric care. Key updates are highlighted below but please refer to the comprehensive summary of all changes on page 4 of the PDF file.

ART section

  • Recommended drugs have been updated to add doravirine and long-acting cabotegravir plus rilpivirine. Dropped drugs include elvitegravir, atazanavir/b, darunavir/b plus raltagravir, and abacavir combinations with efavirenz, darunavir/b and raltegravir. The dual ART of atazanaivr/b plus 3TC is also dropped.
  • In pregnancy, criteria for using dolutegravir and TAF are updated and atazanavir/b, AZT and lopinavir/r have been removed.
  • Timing for ART in TB coinfection.
  • A fully updated section on all aspects of PrEP.

Drug interactions

  • Interactions for latest drugs: cabotegravir oral, CAB/RPV LA and fostemsavir.
  • New interaction tables for TB drugs, anxiolytics, COVID-19 treatments and hormone replacement therapy.
  • All recent updates to Liverpool Drug Interaction website are added. This include new drugs added to antidepressants, hypertensives, analgesics, anticoagulants, bronchodilators and malarial drugs.


  • This section has the most updates including side effects with latest ARVs and new management guidelines for cancer screening, cardiovascular disease, hypertension, diabetes, renal and hepatic toxicity (including NAFLD) and organ transplant.
  • Major revisions on weight gain and obesity.
  • A new section on anxiety and major update on frailty.
  • Significant updates to the section on sexual health, including new sections on managing the menopause, transgender sexual health and improving sexual health for women.
  • U=U and PrEP are now prioritised for HIV prevention.


  • Minor changes overall, mainly on ART timing.
  • New section added on management of COVID-19

Paediatric care

  • This is a new section adding the PENTA-ID guidelines for the first time, including coordinating with some recommendations for adult care.


The current edition is in English but translations are planned shortly.

The previous edition is still online in Chinese, French, German, Dutch, Japanese, Portuguese, Russian, Spanish and Turkish.


Comments and feedback is welcomed by emailing:


  1. EACS guidelines special session. EACS 2021. Saturday 30 October, 11.30 – 12.45. (webcast for delegates only).
  2. EACS. EACS Guidelines, 11th edition (October 2021). (PDF)

Links to other websites are current at date of posting but not maintained.