By Bunmi Yekini
The World Health Organization (WHO) on Thursday released updated recommendations on HIV clinical management, unveiling new guidance aimed at improving treatment outcomes, cutting HIV-related deaths and accelerating efforts to end AIDS as a public health threat.
The revised guidance reflects major advances in HIV treatment since WHO last issued consolidated guidelines in 2021, incorporating emerging evidence on optimized antiretroviral regimens, simpler tuberculosis (TB) prevention options and improved strategies to prevent mother-to-child transmission.
At the heart of the update, WHO reaffirmed dolutegravir-based combinations as the preferred option for both initial and subsequent HIV treatment, citing strong evidence of effectiveness, safety and affordability. For people whose treatment is no longer working and who require a protease inhibitor, the agency now recommends darunavir boosted with ritonavir as the preferred option, replacing earlier choices such as atazanavir/ritonavir and lopinavir/ritonavir.
WHO also endorsed the reuse of drugs such as tenofovir and abacavir in later treatment regimens, pointing to better outcomes, programmatic advantages and potential cost savings. In a shift aimed at supporting people who struggle with daily pills, the guidance expands the role of long-acting injectable antiretroviral therapy in specific circumstances, while also recommending oral two-drug combinations as simplified options for clinically stable patients.
The new recommendations place renewed emphasis on preventing vertical, or mother-to-child, transmission of HIV, which still occurs, particularly during breastfeeding. WHO continues to advise that mothers living with HIV exclusively breastfeed for the first six months and continue breastfeeding for at least 12 months, and up to 24 months or longer, while remaining on effective antiretroviral therapy.
All infants exposed to HIV should receive six weeks of postnatal prophylaxis, preferably with nevirapine, the agency said, while those at higher risk should be given enhanced triple-drug prophylaxis. Extended prophylaxis may continue until the mother achieves viral suppression or breastfeeding ends.
Tuberculosis, the leading cause of death among people living with HIV, is another focus of the update. To improve uptake and completion of preventive treatment, WHO now recommends a three-month course of weekly isoniazid plus rifapentine, known as 3HP, as the preferred TB preventive regimen for adults and adolescents with HIV. Other options remain available depending on local 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 guidance will be incorporated into the next edition of its consolidated HIV guidelines and is intended to support national HIV programmes, clinicians and community partners worldwide as they scale up evidence-based, cost-effective care.