WHO Updates HIV Treatment Guidelines, Prioritizes Simpler Regimens & Prevention
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New recommendations from the World Health Organization aim to accelerate progress towards ending AIDS as a public health threat through evidence-based, cost-effective strategies.
The World Health Organization (WHO) released updated recommendations on Thursday regarding the clinical management of HIV, offering revised guidance on antiretroviral therapy, preventing vertical HIV transmission, and addressing tuberculosis (TB) prevention for individuals living wiht HIV. These updates, reflecting advancements in treatment sence the last consolidated guidelines in 2021, are designed to improve treatment outcomes, reduce HIV-related mortality, and ultimately contribute to ending AIDS as a global health crisis.
The updated guidelines reaffirm dolutegravir-based regimens as the preferred choice for both initiating and continuing HIV treatment. Critically important changes are also outlined for patients experiencing treatment failure. When a protease inhibitor (PI) is necessary, darunavir/ritonavir is now the recommended option, superseding previous preferences for atazanavir/ritonavir or lopinavir/ritonavir.
Furthermore, the guidelines support the reuse of tenofovir and abacavir in subsequent treatment regimens, citing improved outcomes, programmatic benefits, and potential cost savings. Recognizing challenges with daily medication adherence,the WHO also recommends long-acting injectable antiretroviral therapy for suitable adults and adolescents. For clinically stable individuals, oral two-drug regimens are now recommended as a simplification option.
Strengthening Prevention of Mother-to-Child HIV Transmission
Despite significant progress in eliminating vertical HIV transmission – the passage of the virus from mother to child – new infections continue to occur, particularly during breastfeeding. The updated guidance emphasizes a person-centered, public health approach that prioritizes both maternal choice and infant well-being.
The WHO continues to recommend exclusive breastfeeding for the first six months, with continuation up to 12 months, and possibly up to 24 months or longer, alongside effective maternal antiretroviral therapy and appropriate complementary feeding. All infants exposed to HIV should receive six weeks of postnatal prophylaxis, ideally with nevirapine, while those at higher risk should receive enhanced triple-drug prophylaxis. Extended infant prophylaxis can be utilized until maternal viral suppression is achieved or breastfeeding ceases.
Prioritizing Tuberculosis Prevention in People Living with HIV
Tuberculosis remains a leading cause of death among people living with HIV. To enhance uptake and completion of TB preventive therapy, the WHO now recommends a three-month regimen of weekly isoniazid plus rifapentine (3HP) as the preferred option for adults and adolescents living with HIV. Alternative WHO-recommended regimens remain available based on clinical and programmatic considerations. These changes aim to streamline service delivery and reduce TB-related mortality within the HIV-positive population.
Global Impact and implementation
“These updated recommendations reflect WHOS commitment to ensuring that people living with HIV benefit from the most effective, safe and practical treatment options available,” stated a senior official from the 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.”
The recommendations will be incorporated into the next edition of the WHO consolidated HIV guidelines and are intended to inform national HIV programs, clinicians, partners, and communities worldwide.
