WHO Issues Updated HIV Clinical Management Guidelines

Advancing Global HIV Care

The World Health Organization (WHO) has released updated recommendations on HIV clinical management, introducing new guidance on antiretroviral therapy (ART), prevention of vertical HIV transmission, and tuberculosis (TB) prevention for people living with HIV. The revisions aim to improve treatment outcomes, reduce HIV‑related mortality, and accelerate progress toward ending AIDS as a public health threat.

Optimizing Antiretroviral Therapy

The guidelines confirm dolutegravir‑based regimens as the preferred option for both initial and subsequent HIV treatment. For patients requiring a protease inhibitor (PI), darunavir/ritonavir is now recommended over older options such as atazanavir/ritonavir or lopinavir/ritonavir.

Additional updates include:

• Reuse of tenofovir and abacavir in subsequent regimens, offering improved outcomes and cost savings.
• Long‑acting injectable ART for adults and adolescents struggling with adherence to daily oral medication.
• Oral two‑drug regimens as simplification strategies for clinically stable individuals.

These changes reflect emerging evidence and programmatic advantages, ensuring treatment remains effective and accessible.

Preventing Vertical Transmission

Despite progress, infant HIV infections still occur, particularly during breastfeeding. WHO emphasizes a person‑centred approach that balances maternal choice with infant well‑being.

Key recommendations include:

• Mothers with HIV should exclusively breastfeed for six months, continuing up to 12 months or longer with effective ART and complementary feeding.
• All HIV‑exposed infants should receive six weeks of postnatal prophylaxis, preferably with nevirapine.
• Infants at higher risk should receive enhanced triple‑drug prophylaxis.
• Extended prophylaxis may be used until maternal viral suppression is achieved or breastfeeding ends.

Outlook

By integrating the latest scientific evidence, WHO’s updated guidelines provide a cost‑effective, evidence‑based framework to strengthen HIV care worldwide, supporting both individual health and global public health goals.