The World Health Organization (WHO) has issued new guidance on HIV clinical care, offering updated advice on antiretroviral treatment, the prevention of mother-to-child HIV transmission, and tuberculosis (TB) prevention for individuals living with HIV. These updates aim to enhance treatment success, lower the number of HIV-related deaths, and further advance the goal of ending AIDS as a global health concern.

This latest guideline builds on the progress made since the last WHO comprehensive HIV guidance released in 2021. It incorporates the latest research findings on improved antiretroviral therapies and more streamlined options for TB prevention in people with HIV.

Enhancing antiretroviral treatment

The updated guidance confirms dolutegravir-based regimens as the preferred choice for both starting and continuing HIV treatment. It also includes new options for individuals whose current therapy is not effective. When a protease inhibitor is deemed necessary, the guidance now favors darunavir/ritonavir over older options like atazanavir/ritonavir or lopinavir/ritonavir. Continued use of drugs like tenofovir and abacavir in follow-up treatment plans is recommend based on better treatment outcomes, easier program implementation, and reduced costs. Additionally, injectable long-acting antiretroviral medication is advised under specific conditions, especially for those who struggle with daily pills. Two-drug oral regimens are also suggested for stable patients looking to simplify their ongoing care.

Improving prevention of mother-to-child transmission

Although there has been notable success in reducing the number of infants born with HIV, new transmissions still happen, especially during the breastfeeding period. The guidelines prioritize approaches that focus on the needs and choices of mothers and the health of their children.

WHO maintains its recommendation that mothers with HIV breastfeed exclusively for the first six months, continuing up to 12 months and potentially to 24 months or beyond, while the mother receives effective antiretroviral treatment and appropriate nutrition is introduced. All infants exposed to HIV should receive six weeks of preventive treatment after birth, ideally with nevirapine. For infants at greater risk, a stronger three-drug prevention approach is encouraged. Prophylaxis may be extended until the mother’s viral load is under control or until breastfeeding ends.

Focusing on TB prevention in people with HIV

Tuberculosis remains a major cause of death among those living with HIV. To improve access and completion of preventive TB therapy, WHO now recommends a three-month treatment of weekly isoniazid combined with rifapentine (known as 3HP) as the preferred method for adults and adolescents with HIV. Other regimens remain available based on health system capabilities and clinical needs. Making these interventions a core part of HIV care will help reduce deaths related to TB and streamline healthcare delivery.

Helping nations strengthen HIV responses

“These updated guidelines show our dedication to ensuring that people with HIV receive the safest and most effective care,” said Dr. Tereza Kasaeva, Director of WHO’s Department of HIV, TB, Viral Hepatitis and STIs. “By making treatment easier to follow, improving patient adherence, and closing gaps in prevention, these recommendations will help countries bolster their HIV programmes and protect more lives.”