The World Health Organization (WHO) has released updated recommendations on HIV clinical management, providing new guidance on antiretroviral therapy, prevention of vertical transmission, and tuberculosis (TB) management for people living with HIV. The revised guidelines aim to support evidence-based, cost-effective strategies to improve treatment outcomes, reduce HIV-related mortality, and accelerate progress towards ending AIDS as a public health threat.
Reflecting advances in HIV treatment since the last consolidated WHO guidelines in 2021, the updates respond to emerging evidence on optimized antiretroviral regimens and simplified TB preventive treatment options.
The updated recommendations confirm dolutegravir-based regimens as the preferred option for initial and subsequent HIV treatment. For cases where a protease inhibitor (PI) is required, darunavir/ritonavir is now recommended, replacing earlier preferences for atazanavir/ritonavir or lopinavir/ritonavir. The guideline also supports the reuse of tenofovir and abacavir in subsequent regimens, citing improved outcomes, programmatic advantages, and potential cost savings.
New treatment-simplification options are included, such as long-acting injectable antiretroviral therapy for adults and adolescents with adherence challenges, and oral two-drug regimens for selected clinically stable individuals. These updates aim to simplify therapy while maintaining efficacy and safety.
Despite progress in eliminating mother-to-child HIV transmission, new infant infections continue, particularly during breastfeeding. The updated guidance emphasizes a person-centred approach prioritizing maternal choice and infant well-being.
Mothers with HIV are recommended to exclusively breastfeed for the first six months, with continued breastfeeding up to 12 months and potentially up to 24 months, alongside effective maternal antiretroviral therapy and appropriate complementary feeding. HIV-exposed infants should receive six weeks of postnatal prophylaxis, preferably with nevirapine, while those at higher risk should receive enhanced triple-drug prophylaxis. Extended prophylaxis may continue until maternal viral suppression is achieved or breastfeeding ends.
Tuberculosis remains a leading cause of death among people living with HIV. The updated WHO recommendations identify a three-month weekly regimen of isoniazid plus rifapentine (3HP) as the preferred TB preventive therapy for adults and adolescents with HIV. Alternative WHO-approved regimens remain options depending on clinical and programmatic needs. These measures are designed to improve uptake, completion, and integration of TB preventive therapy within HIV care services, ultimately reducing TB-related mortality.
The updated recommendations will be integrated into the next edition of WHO’s consolidated HIV guidelines and are intended to guide national HIV programmes, clinicians, partners, and communities worldwide. By simplifying treatment, improving adherence, and addressing gaps in prevention, the guidelines aim to strengthen HIV programmes and improve outcomes for people living with HIV globally.
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