The World Health Organization (WHO) has introduced updated recommendations aimed at improving HIV clinical management, focusing on antiretroviral therapy, the prevention of vertical HIV transmission, and tuberculosis (TB) prevention. These revisions are designed to enhance treatment outcomes and reduce HIV-related mortality, ultimately contributing to the global goal of eliminating AIDS as a public health threat.
The new guidelines reflect significant advancements in HIV treatment since the last comprehensive recommendations were published in 2021. They respond to emerging evidence and emphasize evidence-based strategies that are both cost-effective and practical for diverse healthcare settings.
Optimizing Antiretroviral Therapy
The updated recommendations endorse dolutegravir-based regimens as the preferred choice for both initial and ongoing HIV treatment. Notably, when a protease inhibitor (PI) is required, the guidelines now recommend darunavir/ritonavir as the primary option, moving away from previous preferences for atazanavir/ritonavir or lopinavir/ritonavir.
Furthermore, the guidelines advocate for the reuse of tenofovir and abacavir in subsequent treatment regimens based on improved clinical outcomes and potential cost savings. Long-acting injectable antiretroviral therapy is recommended for specific patient groups, particularly adults and adolescents who struggle with adherence to daily oral medications. Additionally, oral two-drug regimens are suggested as simplified treatment options for clinically stable individuals.
Strengthening Prevention of Vertical HIV Transmission
Despite notable progress in reducing vertical transmission of HIV, new infections among infants continue, particularly during breastfeeding. The updated guidelines emphasize a person-centered approach that prioritizes both maternal choice and infant health. WHO advises that mothers living with HIV should exclusively breastfeed for the first six months and continue breastfeeding for up to 24 months or longer, provided they are receiving effective antiretroviral therapy and appropriate complementary feeding.
All infants exposed to HIV are recommended to receive six weeks of postnatal prophylaxis, preferably with nevirapine. For higher-risk infants, enhanced triple-drug prophylaxis is advised, which may be extended until maternal viral suppression is achieved or breastfeeding is concluded.
Prioritizing TB Prevention in People Living with HIV
Tuberculosis remains a leading cause of death among individuals living with HIV. To enhance the uptake and completion of TB preventive therapy, WHO now recommends a regimen of three months of weekly isoniazid plus rifapentine (3HP) for adults and adolescents living with HIV. Other regimens continue to be available based on clinical needs and programmatic considerations.
Integrating TB prevention into HIV care is essential for reducing TB-related mortality. The new guidelines aim to streamline service delivery and improve access to preventive treatments.
Dr. Tereza Kasaeva, Director of the Department of HIV, TB, Viral Hepatitis, and STIs at WHO Headquarters in Geneva, stated, “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.” She emphasized that simplifying treatment protocols and addressing gaps in prevention will empower countries to strengthen their HIV programs and ultimately save lives.
The newly released recommendations will be incorporated into the next edition of the WHO consolidated HIV guidelines and are intended to guide national HIV programs, clinicians, and communities worldwide in their efforts to combat this persistent public health challenge.
