THE LATEST World Health Organization (WHO) HIV guidelines mark a significant update in global HIV care, reflecting advances in antiretroviral therapy, vertical transmission prevention, and tuberculosis (TB) management. With nearly 40 million people living with HIV worldwide and more than 30 million on treatment by the end of 2024, the guidance aims to accelerate progress towards ending AIDS as a public health threat by 2030.
WHO HIV Guidelines Refine First- and Second-Line ART
Central to the updated WHO HIV guidelines is the continued recommendation of dolutegravir (DTG)-containing regimens as the preferred option for first-line treatment and for individuals failing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based therapy. For patients who experience failure on DTG-containing regimens, protease inhibitors are now emphasised as anchor drugs, with darunavir/ritonavir identified as the preferred option.
Notably, the guidelines support recycling tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF) in subsequent regimens for adults and adolescents, and abacavir in children, even after previous treatment failure. This shift reflects improved outcomes, programme simplicity, and potential cost savings compared with switching to zidovudine-based regimens. The choice between TDF and TAF should be guided by clinical and programmatic considerations.
New Formulations and Long-Acting Options
The guidance highlights the growing role of simplified regimens, including oral two-drug combinations designed to reduce toxicity and improve adherence, while acknowledging ongoing concerns about drug resistance. For the first time, long-acting injectable antiretrovirals are recommended in specific circumstances, such as for adults and adolescents who struggle with adherence to daily oral three-drug regimens.
Vertical Transmission Prevention
Despite major progress in preventing mother-to-child transmission, new infant infections persist, particularly postpartum. The WHO HIV guidelines adopt a public health approach centred on both maternal and infant wellbeing. Mothers on effective ART are supported to make informed choices about breastfeeding, even where national policies favour replacement feeding. Exclusive breastfeeding for 6 months, with continuation up to 12 months or longer, remains recommended alongside appropriate prophylaxis.
All HIV-exposed infants should receive 6 weeks of single-drug prophylaxis, preferably nevirapine. Enhanced triple-drug prophylaxis is advised for infants at high risk when mothers are not on ART.
Tackling TB Alongside HIV
TB remains a leading cause of death among people living with HIV. The guidelines prioritise simplified TB preventive treatment, recommending 3 months of weekly isoniazid and rifapentine as the preferred option, with alternatives available to suit clinical and programme needs.
Together, these updates will inform programme priorities, funding, and service delivery as they are integrated into the consolidated WHO HIV guidelines in 2026.
Reference
World Health Organization (WHO). WHO updated recommendations on HIV clinical management: recommendations for a public health approach. Available at: https://www.who.int/publications/i/item/9789240119468. Last accessed: 15 January 2026.
