The World Health Organization (WHO) has released updated recommendations on HIV clinical management, introducing new and revised guidance on AntiRetroviral Therapy (ART), prevention of vertical HIV transmission, and tuberculosis (TB) prevention for people living with HIV.

The updated guidance reflects major advances in HIV treatment since the last consolidated WHO HIV guidelines were published in 2021. It incorporates emerging evidence on optimised antiretroviral regimens and simplified, more effective TB preventive treatment options, with the aim of improving treatment outcomes, reducing HIV-related mortality and accelerating global efforts to end AIDS as a public health threat.

Dr. Tereza Kasaeva, Director of the Department of HIV, TB, Viral Hepatitis and STIs at WHO said, “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. By simplifying treatment, improving adherence and addressing persistent gaps in prevention, they will help countries strengthen HIV programmes and save lives.”

The revised recommendations reaffirm dolutegravir-based regimens as the preferred choice for both initial and subsequent HIV treatment. For individuals requiring protease inhibitor–based therapy, darunavir/ritonavir is now recommended as the preferred option, replacing earlier regimens that favored atazanavir/ritonavir or lopinavir/ritonavir. The guidelines also support the reuse of tenofovir and abacavir in subsequent treatment regimens, citing improved clinical outcomes, programmatic benefits and potential cost savings.

In addition, WHO has expanded guidance on treatment simplification, recommending long-acting injectable antiretroviral therapy in specific situations, particularly for adults and adolescents who struggle with adherence to daily oral medications. Oral two-drug regimens are also endorsed as simplification options for selected, clinically stable individuals.

Despite significant progress in eliminating vertical HIV transmission, new infant infections continue to occur, especially during breastfeeding. The updated guidelines emphasize a person-centered, public health approach that prioritises maternal choice while safeguarding infant health.

WHO continues to recommend exclusive breastfeeding for the first six months for mothers living with HIV, followed by continued breastfeeding up to 12 months and potentially 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 infants at higher risk are advised to receive enhanced triple-drug prophylaxis. Extended infant prophylaxis may be considered until maternal viral suppression is achieved or breastfeeding has ceased.

Tuberculosis remains a leading cause of death among people living with HIV. To improve uptake and completion of TB preventive therapy, WHO now recommends a three-month regimen of weekly isoniazid plus rifapentine (3HP) as the preferred TB preventive treatment for adults and adolescents with HIV. Other WHO-recommended regimens remain available based on clinical and programmatic needs. The updated guidance also promotes better integration of HIV and TB services to reduce TB-related mortality and simplify care delivery.

The recommendations will be incorporated into the next edition of the WHO consolidated HIV guidelines and are intended to guide national HIV programmes, clinicians, policymakers, partners and communities worldwide.