Guideline

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

Year of Publication

2025

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

16 included recommendations

Use of darunavir/ritonavir and other protease inhibitors in HIV treatment. Darunavir/ritonavir (DRV/r) is the preferred boosted protease inhibitor option for antiretroviral treatment.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Use of darunavir/ritonavir and other protease inhibitors in HIV treatment. Atazanavir/ritonavir (ATV/r) or lopinavir/ritonavir (LPV/r) can be used as an alternative boosted protease inhibitor for antiretroviral treatment

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Moderate

Use of tenofovir and abacavir for initial and subsequent regimens in HIV treatment. Tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) + lamivudine (3TC) or emtricitabine (FTC) is the preferred nucleoside reverse transcriptase inhibitor (NRTI) backbone for initial and subsequent ART in adults, adolescents and children > 30 kg. This includes individuals previously treated with or exposed to tenofovir or zidovudine (AZT).

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Use of tenofovir and abacavir for initial and subsequent regimens in HIV treatment. Abacavir (ABC) or tenofovir alafenamide (TAF) + lamivudine (3TC) or emtricitabine (FTC) is the suggested nucleoside reverse transcriptase inhibitor (NRTI) backbone for subsequent ART in children < 30 kg. This includes children previously treated with ABC or zidovudine (AZT)

Status

Updated

Recommended in favor

Conditional

Use of oral two-drug antiretroviral regimens in HIV treatment. Dolutegravir + lamivudine (DTG+3TC) can be used for treatment simplification in adults and adolescents, with undetectable HIV viral load on 3-drug ARV regimens and without active hepatitis B infection.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Moderate

Use of long-acting injectable antiretroviral regimens in HIV treatment. Long-acting injectable cabotegravir + rilpivirine (CAB+RPV) can be used as an alternative switching option in adults and adolescents who have an undetectable HIV viral load on oral ART and no active hepatitis B infection.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Moderate

Infant postnatal prophylaxis. Infants who are not at high risk of acquiring HIV should receive six weeks of infant prophylaxis with a single drug, with nevirapine (NVP) as the preferred option.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Infant postnatal prophylaxis. Infants who are not at high risk of acquiring HIV should receive six weeks of infant prophylaxis with a single drug. DTG or 3TC are alternative options.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Very low

Infant postnatal prophylaxis. Infants who are at high risk of acquiring HIV should receive a three-drug regimen, with ABC/3TC-DTG as the preferred option.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

Infant postnatal prophylaxis.Breastfeeding infants who complete six weeks of a three-drug regimen should follow with single-drug prophylaxis until maternal viral suppression is achieved or for the remainder of breastfeeding. NVP is the preferred option

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

Infant postnatal prophylaxis.Breastfeeding infants who complete six weeks of a three-drug regimen should follow with single-drug prophylaxis until maternal viral suppression is achieved or for the remainder of breastfeeding. DTG is an alternative option

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Very low

Infant postnatal prophylaxis.Breastfeeding infants who complete six weeks of a three-drug regimen should follow with single-drug prophylaxis until maternal viral suppression is achieved or for the remainder of breastfeeding. 3TC is an alternative option

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Moderate

HIV and infant feeding. Duration of breastfeeding by mothers living with HIV: mothers living with HIV should breastfeed for at least 12 months and may continue breastfeeding for up to 24 months or longer (as for the general population) while being fully supported for ART adherence.

Status

Maintained

Recommended in favor

Strong

HIV and infant feeding. In settings where the national programme recommends replacement feeding: mothers living with HIV who are receiving ART and virally suppressed should be offered the choice of breastfeeding and supported in their infant feeding choice.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Low

HIV and infant feeding. Offer enhanced community- and facility-based interventions to support mothers living with HIV who are breastfeeding in order to optimize ART adherence, improve retention of mother-and-infant pairs in care and optimize breastfeeding

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Very low

In adults and adolescents with HIV eligible for tuberculosis preventive treatment (TPT), three months of weekly isoniazid + rifapentine (3HP) is the suggested preferred regimen; six or nine months of daily isoniazid (6H or 9H) are alternative regimens.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low