The World Health Organization (WHO) has released updated recommendations on HIV clinical management providing new and revised guidance on antiretroviral therapy, management of vertical HIV transmission, and tuberculosis (TB) prevention for people living with HIV. These recommendations support an evidence-based, cost-effective approach to improving treatment outcomes, reducing HIV-related mortality and accelerating progress towards ending AIDS as a public health threat.

The guideline reflects significant advances in HIV treatment since the last consolidated WHO guidelines published in 2021 and responds to emerging evidence on optimized antiretroviral regimens and simplified options to TB preventive treatment for people living with HIV.

Optimizing antiretroviral therapy

The updated recommendations confirm dolutegravir-based regimens as the preferred option for initial and subsequent HIV treatment and introduce important changes for people whose treatment regimen is no longer effective. When a protease inhibitor (PI) is needed, darunavir/ritonavir is now recommended as the preferred option, replacing earlier preferences for atazanavir/ritonavir or lopinavir/ritonavir. The guideline also supports the reuse of tenofovir and abacavir in subsequent regimens based on improved outcomes, programmatic advantages and potential cost savings. The guideline also recommends the use of long-acting injectable antiretroviral therapy in specific circumstances, such as for adults and adolescents who face challenges adhering to daily oral regimens; oral two-drug regimens are also recommended as treatment-simplification options for selected individuals who are clinically stable.

Strengthening the prevention of vertical HIV transmission

Despite major progress in eliminating vertical transmission, new infant HIV infections continue to occur, particularly during breastfeeding. The updated guideline emphasizes a person-centred, public health approach that supports maternal choice and infant well-being.