European guidelines on HIV care were significantly updated, including a structural re-organization into two parts: prevention and management of HIV and related infections, and also prevention and management of co-morbidities and other relevant topics.  For treatment naïve adults, preferred options remain: tenofovir (TXF) plus XTC with either dolutegravir or bictegravir or doravirine* (*review of baseline genotype is advised prior to using doravirine-based therapy to ensure no transmitted drug resistance); or XTC plus dolutegravir for people who are HBsAg-negative and have baseline viral load less than 500,000 copies/mL (this two-drug regimen is not recommended in cases of suspected oral PrEP failure).  Boosted darunavir-based three-drug combinations are still recommended for people who acquire HIV while on long-acting cabotegravir as pre-exposure prophylaxis (PrEP).  For pregnant people with HIV, specifics on viral load monitoring frequency have now been added, based on pre-pregnancy viral load.  Of note, dolutegravir is now included as a preferred first-line option in term newborns, based on results of the PETITE-DTG study.  For people using oral PrEP who have an exposure where post-exposure prophylaxis (PEP) is indicated, the European panel advises taking two tablets of oral PrEP as soon as possible after the exposure, followed by one tablet daily until the initial medical evaluation occurs, to avoid delays in PEP initiation.

These guidelines, recently released at the 20^th European AIDS Conference, highlight an intentional shift towards inclusion of updated evidence and recommendations for the prevention and management of important comorbidities and coinfections affecting people with HIV.  Similar to HHS guidelines, cardiovascular and metabolic health concerns are now increasingly emphasized, with new content on cardiovascular risk management and the importance of lifestyle and behavioral modifications.