WHO Unveils Fresh HIV Management Guidelines
The World Health Organization (WHO) has unveiled updated HIV clinical management recommendations, offering new and revised guidance on antiretroviral therapy, vertical HIV transmission management, and tuberculosis (TB) prevention for individuals living with HIV. These guidelines are designed to support an evidence-based, cost-effective strategy for enhancing treatment outcomes, reducing HIV-related mortality, and accelerating progress towards eradicating AIDS as a public health concern.
The revised guidelines reflect significant advancements in HIV treatment since the last WHO consolidated guidelines published in 2021, incorporating emerging evidence on optimized antiretroviral regimens and simplified TB preventive treatments for HIV-positive individuals.
Optimizing Antiretroviral Therapy
The updated recommendations affirm dolutegravir-based regimens as the preferred choice for initial and subsequent HIV treatment. They also introduce crucial changes for individuals whose treatment regimen has become ineffective. When a protease inhibitor (PI) is required, darunavir/ritonavir is now recommended as the preferred option, replacing earlier preferences for atazanavir/ritonavir or lopinavir/ritonavir. The guidelines also endorse the reuse of tenofovir and abacavir in subsequent regimens, citing improved outcomes, programmatic advantages, and potential cost savings. Additionally, the guidelines suggest the use of long-acting injectable antiretroviral therapy in specific scenarios, such as for adults and adolescents who struggle with adhering to daily oral regimens. Oral two-drug regimens are also recommended as treatment-simplification options for selected individuals who are clinically stable.
Strengthening Vertical HIV Transmission Prevention
Despite significant progress in eliminating vertical transmission, new infant HIV infections persist, particularly during breastfeeding. The updated guidelines emphasize a person-centered, public health approach that prioritizes maternal choice and infant well-being.
WHO continues to recommend exclusive breastfeeding for the first six months for mothers with HIV, followed by continued breastfeeding up to 12 months and possibly beyond, 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 should receive enhanced triple-drug prophylaxis. Extended infant prophylaxis may be used until maternal viral suppression is achieved or breastfeeding has stopped.
Prioritizing TB Prevention in HIV-Positive Individuals
Tuberculosis remains a leading cause of death among people living with HIV. To enhance the uptake and completion of TB preventive therapy, WHO now recommends three months of weekly isoniazid plus rifapentine (3HP) as the preferred TB preventive treatment regimen for adults and adolescents living with HIV. Other WHO-recommended regimens remain options based on clinical and programmatic considerations. Mainstreamed interventions will facilitate better integration of services and aim at reducing TB-related mortality in people living with HIV while simplifying service delivery.
Assisting Countries in Accelerating Impact
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. By simplifying treatment, improving adherence, and addressing persistent gaps in prevention, they will help countries strengthen HIV programs and save lives."
The recommendations will be integrated into the next edition of the WHO consolidated HIV guidelines and are intended to inform national HIV programs, clinicians, partners, and communities worldwide.
