Global HIV Care Gets a Reset as WHO Issues New Rules on Treatment, Infants and TB

WHO’s 2025 HIV clinical guidelines simplify and strengthen care by recommending more durable, safer treatment regimens, better protection for infants, and shorter tuberculosis prevention, all designed to work at scale in real health systems. By focusing on long-term effectiveness, affordability and patient-centred choices, the guidance aims to close remaining gaps and keep the global response on track to end AIDS as a public health threat by 2030.

The World Health Organization’s Updated Recommendations on HIV Clinical Management draw on research and experience from a wide network of institutions, including ICAP at Columbia University, Geneva University Hospitals, Johns Hopkins University, the University of Cape Town, the University of Oxford, Vanderbilt University, the Oswaldo Cruz Foundation in Brazil, and the Botswana–Harvard AIDS Institute Partnership, alongside ministries of health and research centres across Africa, Asia, Europe and the Americas. Coordinated by WHO and backed by systematic reviews from universities and public health institutes worldwide, the guideline reflects both cutting-edge science and the day-to-day realities of HIV care, especially in low- and middle-income countries.

Why New HIV Guidelines Were Needed

Nearly 40 million people are living with HIV globally, and more than 30 million are on treatment. This represents huge progress, yet the goal of ending AIDS as a public health threat by 2030 is still at risk. People are living longer with HIV, meaning long-term drug safety, resistance and adherence matter more than ever. At the same time, new HIV infections among infants continue to occur, and tuberculosis remains the leading cause of death among people living with HIV. The updated WHO guideline responds to these challenges by focusing on optimisation: making treatment simpler, safer, longer-lasting and easier for health systems to deliver at scale.

Smarter Use of HIV Medicines

A major update concerns what happens when standard HIV treatment stops working. Dolutegravir-based regimens remain the preferred first-line treatment worldwide, but more people are now failing these regimens as treatment coverage expands. WHO now recommends darunavir boosted with ritonavir as the preferred protease inhibitor in these cases. Evidence shows that darunavir works at least as well as older drugs, causes fewer serious side-effects and is effective in adults, children and pregnant women. Crucially, it has also become more affordable due to the availability of generic versions, making it a realistic option for national HIV programmes.

Another important shift relates to the backbone drugs used in treatment. For years, patients whose treatment failed were routinely switched away from tenofovir to older drugs like zidovudine. New studies show this was often unnecessary and sometimes harmful. The guideline now recommends continuing tenofovir, either TDF or TAF, even after treatment failure, because it leads to better viral suppression, fewer side-effects and lower risk of drug resistance. For younger children, abacavir is similarly preferred over zidovudine. These changes simplify treatment, reduce toxicity and lower costs for health systems.

New Options for People Struggling With Daily Pills

The guideline also recognises that daily pills do not work for everyone. For adults who are stable on treatment, WHO now allows simplified two-drug oral regimens in selected cases. It also, for the first time, recommends long-acting injectable HIV treatment for certain adults and adolescents who find it hard to stick to daily tablets. These injections are not meant for everyone, but they offer an important alternative for people facing ongoing adherence challenges, as long as careful monitoring is in place.

Protecting Babies and Supporting Mothers

Despite major progress, HIV transmission from mothers to infants still happens, especially during breastfeeding. The guideline strengthens infant protection while continuing to support breastfeeding as vital for child survival. All HIV-exposed infants should receive preventive HIV medicine for the first six weeks of life. Babies at higher risk, such as those whose mothers are not on treatment or have an unsuppressed virus, should receive stronger, three-drug protection. Importantly, WHO supports informed choice: mothers on effective treatment should be allowed and supported to breastfeed, even in countries where replacement feeding has traditionally been promoted. Ongoing support for mothers, both in clinics and communities, is seen as essential.

Tackling Tuberculosis Alongside HIV

Tuberculosis remains the biggest killer of people living with HIV. To address this, WHO now recommends a shorter, three-month preventive treatment for TB as the preferred option for adults and adolescents with HIV. Shorter regimens are easier to complete and fit better into HIV care services, making them more likely to save lives. Other TB prevention options remain available where needed, but the emphasis is firmly on simplicity and scale.

Together, these updates mark a practical shift in global HIV policy. Rather than adding complexity, the guideline focuses on treatments that work well, are easier to deliver and better suited to long-term care. By aligning medical evidence with public health realities, WHO aims to protect gains already made and push the global HIV response closer to the goal of ending AIDS as a public health threat by 2030.