WHO updated recommendations on HIV clinical management: recommendations for a public health approach

This guideline provides updated WHO recommendations on HIV clinical management within a public health approach, focusing on optimization of antiretroviral therapy (ART), prevention of vertical HIV transmission and tuberculosis (TB) prevention among people living with HIV. It reflects new evidence and programmatic experience since the publication of the 2021 consolidated HIV guidelines and aims to support progress towards ending AIDS as a public health threat by 2030. The document addresses the use of preferred and alternative antiretroviral regimens across different populations, including adults, adolescents, pregnant women and children, with emphasis on treatment efficacy, safety, adherence and feasibility in low- and middle-income countries.

The guideline introduces updated recommendations on the use of darunavir/ritonavir as the preferred boosted protease inhibitor, recycling of tenofovir- and abacavir-containing regimens, oral two-drug regimens and long-acting injectable antiretroviral formulations. It also provides revised guidance on infant postnatal prophylaxis, breastfeeding among mothers living with HIV, and management of infants at high risk of HIV acquisition. In addition, the guideline recommends preferred shorter TB preventive treatment regimens for people living with HIV to improve treatment completion and reduce TB-related mortality. The recommendations are intended to guide national HIV programmes, clinicians and policy-makers in strengthening integrated, person-centred HIV services.