WHO Updates HIV clinical Management Recommendations
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The world Health Organization (WHO) has recently released updated recommendations for HIV clinical management, encompassing advancements in antiretroviral therapy (ART), prevention of vertical HIV transmission, and tuberculosis (TB) prevention for individuals living with HIV. thes updated guidelines aim to improve treatment outcomes, reduce HIV-related mortality, and accelerate progress toward ending AIDS as a public health threat [[1]].
The updated recommendations continue to prioritize dolutegravir-based regimens as the preferred frist-line and subsequent treatment option for HIV. significant changes are introduced for individuals experiencing treatment failure.When a protease inhibitor (PI) is required,darunavir/ritonavir is now the recommended choice,superseding previous preferences for atazanavir/ritonavir or lopinavir/ritonavir. The guidelines also support the reuse of tenofovir and abacavir in subsequent regimens, citing improved outcomes, programmatic benefits, and potential cost savings.
Moreover, the WHO now recommends long-acting injectable ART in specific cases, notably for adults and adolescents who struggle with adherence to daily oral medications. Oral two-drug regimens are also suggested as simplification options for clinically stable individuals.
strengthening Prevention of Vertical HIV Transmission
Despite significant progress in eliminating mother-to-child transmission of HIV, new infections continue to occur, especially during breastfeeding. The updated guidelines emphasize a person-centered public health approach that supports maternal choice and infant well-being.
The WHO maintains its recommendation for mothers with HIV to exclusively breastfeed for the first six months, continuing up to 12 months, and possibly up to 24 months or longer, alongside effective maternal ART 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 used until maternal viral suppression is achieved or breastfeeding ceases.
Prioritizing Tuberculosis Prevention
Tuberculosis remains a leading cause of death among people living with HIV. To enhance the uptake and completion of TB preventive therapy, the WHO now recommends three months of weekly isoniazid plus rifapentine (3HP) as the preferred regimen for adults and adolescents living with HIV.Alternative WHO-recommended regimens remain available based on clinical and programmatic considerations. These changes aim to integrate services more effectively and reduce TB-related mortality in people living with HIV while streamlining service delivery.
Impact and Implementation
“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, Department of HIV, TB, viral Hepatitis and STIs of WHO Headquarters in Geneva. “By simplifying treatment, improving adherence and addressing persistent gaps in prevention, they will help countries strengthen HIV programmes and save lives.”
These recommendations will be incorporated into the forthcoming revision of the consolidated guidelines on HIV prevention, testing, treatment, service delivery, and monitoring [[1]] and are intended to inform national HIV programs, clinicians, partners, and communities globally. The 2016 WHO consolidated guidelines provided a foundational framework for delivering HIV services across the care cascade [[2]], and this update builds upon that work, incorporating new evidence as 2016 [[3]].
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