EACS guidelines major update: ART, OIs, on demand PrEP for women, weight gain, HIV-2, pregnancy, infant feeding, sleep disorders and more

21 October 2025. Related: Early access, Conference reports, EACS 20 Paris 2025.

Simon Collins, HIV i-Base

EACS 2025 included many sessions and presentations relating to HIV guidelines, especially the major update to EACS guidelines.

The main EACS guidelines session at EACS 2025, chaired by Jürgen K Rockstroh and Alexandra Calmy, provided an in-depth review of updates to HIV management protocols, published in HIV Medicine. Developed through a transparent and collaborative process, the guidelines introduced significant changes across antiretroviral treatment, paediatric care, coinfections, and comorbidities. [1]

Laura Levi presented ART updates, including simplified tables for clinical visits, restrictions on dual therapy for individuals acquiring HIV on PrEP, and findings from the CARE study on long-acting cabotegravir and rilpivirine.

HIV-2 management was addressed in a comprehensive new section, with tailored ART regimens, diagnostic protocols, and monitoring strategies. Bictegravir or dolutegravir plus tenofovir and emtricitabine are recommended as first-line regimens.

Paolo Paioni highlighted paediatric HIV updates, such as dolutegravir dosing guidance for neonates, structured transition-to-adult-care timelines, and clarified mixed feeding recommendations.

The viral load threshold at week 36 that indicates a planned C-section at week 38 has been increased from 50 to 400 copies/mL, with delivery mode requiring case-by-case discussion for viral loads between these thresholds.

Dolutegravir is now recommended as the preferred anchor drug for term newborns from age 2-4 weeks, using a multi-dose regimen of 5 mg every 48 hours in weeks 1-2, then daily in weeks 3-4.

Anal cancer screening protocols have been refined, emphasising HPV testing and high-resolution anoscopy.

Andrea Mastrangelo discussed co-infection updates, including alignment of TB treatment with WHO guidelines, mpox management strategies, and cryptococcal meningitis dosing adjustments.

Jasmini Alagaratnam and Abiu Sempere introduced new sections on sleep health and substance use, emphasising routine screening tools like the ICD-10 criteria for substance dependence.

Simple sleep screening has been integrated into routine HIV care with the recommendation to ask, ‘How is your sleep?’ at least every two years and after ART modifications, followed by validated screening tools for insomnia, excessive daytime sleepiness, and sleep apnoea when abnormal symptoms are reported.

Updates in metabolic management redefined obesity as excess adiposity and organ dysfunction rather than just by BMI. The lack of clear benefit from switching ART means that management is focused on lifestyle interventions, GLP-1 receptor agonists, and bariatric surgery when appropriate.

The session concluded with a lively Q&A, addressing topics such as weight gain, HPV vaccination strategies, and the importance of person-centred language in the guidelines. The session underscored the commitment of EACS to evidence-based, patient-centred care in HIV management.

This report is based on an EACS AI generated summary, edited by i-Base with additional comments.

comments

The annual updates to these guidelines are always welcomed. Please refer to the full guidelines for details.

Issues not detailed in the AI summary above include clarification over infant mixed feeding covers two circumstances, also covered is two additional sessions. [2, 3]

(i) Occasional mixed breast and formula feeding is allowed in certain circumstances including when establishing breastfeeding, when switching, with mastitis and with infant gastroenteritis.

(ii) Mixed breastfeeding with solids increases the risk of HIV transmission when infants are still less than six months and is still not recommended.

The Q&A discussion also clarified that women can now use on-demand 2:7 dosing for oral PrEP. This involves starting with a double dose 24-2 hours before having sex and finishing with 7 daily doses after. This important option is also included in the UK BASHH guidelines.

Other questions included the importance of considering menopause status when considering weight gain and sleep disorder.

Several other presentations looked at cardiovascular risk, including a session on impact of the REPRIEVE study and the limited uptake this has had in different countries including Italy, Germany and Australia. [4 to 9]

Another Italian study reported that statins can partially reverse smoking-related particularly those with a history of heavy smoking. [10]

References

1. EACS guidelines. Special session. Thursday 22 October 2025 (5.30 am).
   https://player.vimeo.com/video/1128297512

2. European guidelines on HIV and breastfeeding. EACS pre-conference course. Wednesday 21 October.
   https://eacs2025.abstractserver.com/program/#/details/presentations/1155

3. Review of HIV and Breastfeeding Guidelines Across Europe: Insights from the WAVE Survey ‘Same, same, but different: European Guidelines on HIV and breastfeeding’. EACS 2025, Oral abstract O2.1.
   https://eacs2025.abstractserver.com/program/#/details/presentations/735

4. Papaioannu Borjesson R et al. Impact of REPRIEVE indications on statin prescription in people with HIV in a real-life setting. EACS 2025 Meet the experts. MTE1.1.
   https://eacs2025.abstractserver.com/program/#/details/presentations/1001
5. Carrozzo G et al. LDL target achievement in people with HIV over 40: impact of updated EACS guidelines. EACS RO3.4.
   https://eacs2025.abstractserver.com/program/#/details/presentations/646
6. Platte M et al. People with HIV at high cardiovascular risk were undertreated with statins independent of gender. EACS 2025, ePoster eP283.
   https://eacs2025.abstractserver.com/program/#/details/presentations/1032

7. Burdon R et al. An audit of antiretroviral regimens in people living with HIV attending an HIV/sexual health clinic in Sydney’s Inner West in response to the REPRIEVE study. EACS 2025, ePoster eP168.
   https://eacs2025.abstractserver.com/program/#/details/presentations/334
8. Burdon R et al. Statin initiation following the REPRIEVE trial: results of a clinical audit at an urban sexual health clinic in Sydney, Australia. EACS 2025, ePoster eP297.
   https://eacs2025.abstractserver.com/program/#/details/presentations/332

9. Falasca K et al. Same patients, different risks: a head-to-head of ESC and EACS CVD guidelines in PLWH. EACS 2025, ePoster eP293.
   https://eacs2025.abstractserver.com/program/#/details/presentations/1023

10. Milic J et al. Use of statins mitigates the impact of smoking on frailty trajectories in people with HIV: a longitudinal cohort study. EACS 2025, ePoster e P301.