The World Health Organization (WHO) has released updated HIV clinical management guidelines, reaffirming dolutegravir-based regimens as the preferred treatment, supporting the use of long-acting injectable antiretrovirals, and recommending darunavir/ritonavir when protease inhibitors are required, as part of a broader push to improve outcomes and accelerate progress toward ending AIDS as a public health threat.
The updated recommendations, which replace parts of WHO’s last consolidated HIV guidelines published in 2021, reflect major advances in HIV treatment and new evidence on optimized antiretroviral regimens and simplified tuberculosis (TB) preventive therapy.
WHO said the guidance is designed to support “an evidence-based, cost-effective approach to improving treatment outcomes, reducing HIV-related mortality and accelerating progress towards ending AIDS.”
On antiretroviral therapy, WHO confirmed that dolutegravir-based regimens remain the preferred option for both initial and subsequent HIV treatment.
For people whose current regimens are no longer effective and who require a protease inhibitor, the guideline now recommends darunavir/ritonavir as the preferred option, replacing earlier preferences for atazanavir/ritonavir or lopinavir/ritonavir.
The guidance also supports the reuse of tenofovir and abacavir in later regimens, citing improved outcomes, programmatic advantages and potential cost savings.
The guideline further endorses long-acting injectable antiretroviral therapy in specific circumstances, particularly for adults and adolescents who struggle with adherence to daily oral treatment.
In addition, oral two-drug regimens are recommended as treatment-simplification options for selected individuals who are clinically stable.
WHO also strengthened guidance on the prevention of vertical, or mother-to-child, HIV transmission, noting that new infant infections continue to occur, especially during breastfeeding. The updated guideline emphasizes a person-centred public health approach that supports maternal choice and infant well-being.
WHO continues to recommend exclusive breastfeeding for the first six months, with continued breastfeeding up to 12 months—and possibly up to 24 months or 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 those at higher risk should receive enhanced triple-drug prophylaxis.
Addressing TB, a leading cause of death among people living with HIV, WHO now recommends three months of weekly isoniazid plus rifapentine (3HP) as the preferred TB preventive treatment regimen for adults and adolescents with HIV, while retaining other options based on clinical and programmatic needs.
“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 of WHO’s Department of HIV, TB, Viral Hepatitis and STIs. “By simplifying treatment, improving adherence and addressing persistent gaps in prevention, they will help countries strengthen HIV programmes and save lives.”
WHO said the recommendations will be integrated into the next edition of its consolidated HIV guidelines and are intended to guide national programmes, clinicians, partners and communities worldwide.
