The World Health Organization (WHO) has released updated HIV clinical guidelines, offering new and revised recommendations on antiretroviral therapy, prevention of mother-to-child transmission, and tuberculosis (TB) care for people living with HIV. 

 

The guidance aims to improve treatment outcomes, reduce HIV-related deaths, and accelerate progress toward ending AIDS as a public health threat.

 

The updated guidelines reflect major advances in HIV treatment since WHO’s last consolidated guidance in 2021, incorporating emerging evidence on optimized antiretroviral regimens and simplified TB prevention strategies.

 

The recommendations reaffirm dolutegravir-based regimens as the preferred option for both initial and subsequent HIV therapy. For patients needing a protease inhibitor (PI), darunavir/ritonavir is now recommended, replacing atazanavir/ritonavir and lopinavir/ritonavir. 

 

The guidelines also support reusing tenofovir and abacavir in later regimens for improved outcomes, cost savings, and programmatic efficiency.

 

Long-acting injectable antiretroviral therapy is recommended in specific cases, such as for adults and adolescents who struggle with daily oral dosing. Oral two-drug regimens are also suggested as treatment-simplification options for clinically stable individuals.

 

Despite progress, new infant HIV infections still occur, particularly during breastfeeding. WHO emphasizes a person-centred, public health approach that “supports maternal choice and infant well-being.”

 

The organization continues to recommend exclusive breastfeeding for the first six months, with continued breastfeeding up to 12 months—and potentially longer—alongside effective maternal antiretroviral therapy and appropriate complementary feeding.

 

All HIV-exposed infants should receive six weeks of postnatal prophylaxis, preferably with nevirapine, while higher-risk infants may receive enhanced triple-drug prophylaxis. Extended prophylaxis can continue until maternal viral suppression is achieved or breastfeeding ends.

 

Tuberculosis remains a leading cause of death among people living with HIV. WHO now recommends a three-month weekly course of isoniazid plus rifapentine (3HP) as the preferred TB preventive therapy for adults and adolescents living with HIV. 

 

Other regimens remain available depending on clinical and programmatic needs. Mainstreamed interventions are designed to simplify service delivery while reducing TB-related mortality.

 

“These updated recommendations reflect WHO’s commitment to ensuring that people living with HIV benefit from the most effective, safe and practical treatment options available,” said Dr. Tereza Kasaeva, Director, Department of HIV, TB, Viral Hepatitis and STIs at WHO Headquarters in Geneva. 

 

“By simplifying treatment, improving adherence and addressing persistent gaps in prevention, they will help countries strengthen HIV programmes and save lives.”