WHO Updates HIV Clinical Guidelines, Unlocking More Scalable Treatment Models

New recommendations embrace long-acting therapies, optimized drug regimens and streamlined TB prevention to accelerate progress toward ending AIDS.

The World Health Organization (WHO) has issued updated HIV clinical management recommendations, reflecting major advances in treatment science and service delivery since its last consolidated guidelines in 2021.

The new guidance introduces optimized antiretroviral regimens, long-acting injectable options, simplified tuberculosis (TB) prevention, and strengthened strategies to prevent vertical HIV transmission — all designed to improve outcomes, reduce mortality and make HIV care more cost-effective, resilient and scalable.

For digital health innovators, biotech developers and health systems, the update signals a clear shift toward simplification, adherence-friendly therapies and integrated service delivery.

Optimized Antiretroviral Therapy: Fewer Pills, Better Outcomes

WHO reaffirms dolutegravir-based regimens as the preferred choice for both initial and subsequent HIV treatment, reflecting their superior efficacy, resistance profile and tolerability.

For patients requiring a protease inhibitor, darunavir/ritonavir is now the preferred option, replacing older regimens. The guideline also endorses the reuse of tenofovir and abacavir in later treatment lines — a move expected to deliver both clinical and cost advantages for national programmes.

Notably, WHO now recommends:

• Long-acting injectable antiretroviral therapy for adults and adolescents who struggle with daily pill adherence

• Oral two-drug regimens as treatment-simplification options for clinically stable individuals

These updates align with growing interest in long-acting medicines, digital adherence tools and decentralized care models.

Preventing Vertical Transmission with a Person-Centred Approach

While global progress has reduced mother-to-child transmission, WHO notes that new infant infections continue to occur, particularly during breastfeeding.

The updated guidance reinforces:

• Exclusive breastfeeding for six months, with continued breastfeeding up to 12 months or longer

• Effective maternal antiretroviral therapy throughout breastfeeding

• Six weeks of infant prophylaxis, preferably with nevirapine

• Enhanced triple-drug prophylaxis for infants at higher risk

Extended infant prophylaxis may be used until maternal viral suppression is achieved, supporting safer outcomes without undermining maternal choice.

TB Prevention: A Shorter, Smarter Regimen

Tuberculosis remains the leading cause of death among people living with HIV. To improve uptake and completion of preventive therapy, WHO now recommends three months of weekly isoniazid plus rifapentine (3HP) as the preferred TB preventive regimen for adults and adolescents with HIV.

This shorter regimen supports:

• Better adherence

• Easier service integration

• Reduced TB-related mortality

Other WHO-recommended TB preventive options remain available based on clinical and programmatic needs.

A Platform for Health-Tech and Program Innovation

“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 of WHO’s Department of HIV, TB, Viral Hepatitis and STIs.

For health-tech startups, pharmaceutical developers, AI-driven care platforms and national HIV programmes, the guidance opens clear opportunities to:

• Scale long-acting and simplified treatment models

• Integrate TB and HIV services digitally

• Deploy adherence-support technologies

• Reduce costs while improving outcomes

Call to Action: Early Adoption for Faster Impact

WHO is urging countries, clinicians, partners and innovators to rapidly integrate the updated recommendations into national guidelines, digital care platforms and service delivery models.

Early adopters — particularly in low- and middle-income settings — can leverage these evidence-based updates to save lives, simplify care pathways and accelerate progress toward ending AIDS as a public health threat.

The recommendations will be incorporated into the upcoming edition of the WHO consolidated HIV guidelines and are intended to guide global action across clinical, policy and technology ecosystems.