Guideline

WHO guidelines on the management of advanced HIV disease

Year of Publication

2025

Issuing Institution

World Health Organization

Links

WHO IRIS

Recommendations

66 included recommendations

A package of interventions including screening, treatment and/or prophylaxis for major opportunistic infections, rapid antiretroviral Therapy initiation and intensified adherence support interventions should be offered to everyone presenting with advanced HIV disease.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

CD4 testing is recommended as the preferred method to identify advanced HIV disease among people living with HIV.

Status

Updated

Recommended in favor

Strong

Certainty of evidence

Moderate

In settings in which CD4 testing is not yet available, WHO clinical staging can be used to identify advanced HIV disease.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Very low

Hospitalized people with HIV may be provided interventions to support transitions to outpatient care and reduce avoidable readmissions. Interventions may include: • pre-discharge goal setting • medication review • transitional care planning • telephone follow-up • home visits by health-care providers and/or peer supporters • individualized support.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

Screening for cryptococcal antigen followed by pre-emptive antifungal therapy among cryptococcal antigen–positive people to prevent the development of invasive cryptococcal disease is recommended before initiating or reinitiating ART for adults and adolescents living with HIV who have a CD4 cell count <100 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

When cryptococcal antigen screening is not available, fluconazole primary prophylaxis should be given to adults and adolescents living with HIV who have a CD4 cell count <100 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Screening for cryptococcal antigen followed by pre-emptive antifungal therapy (3 among cryptococcal antigen– positive people to prevent the development of invasive cryptococcal disease may be considered before initiating or reinitiating ART for adults and adolescents living with HIV at a higher CD4 cell count threshold of <200 cells/mm3

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

When cryptococcal antigen screening is not available, fluconazole primary prophylaxis may be considered at a higher CD4 cell count threshold of < 200 cells/mm3

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

For adults, adolescents and children living with HIV suspected of having a first episode of cryptococcal meningitis, prompt lumbar puncture with measurement of cerebrospinal fluid (CSF) opening pressure and rapid cryptococcal antigen assay is recommended as the preferred diagnostic approach

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

In settings with ready access to and no contraindication for lumbar puncture: i) If both access to a cryptococcal antigen assay (either lateral flow assay or latex agglutination assay) and rapid results (less than 24 hours) are available: Lumbar puncture with rapid cerebrospinal fluid cryptococcal antigen assay is the preferred diagnostic approach.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

In settings with ready access to and no contraindication for lumbar puncture: If access to a cryptococcal antigen assay is not available and/or rapid results are not available: Lumbar puncture with cerebrospinal fluid (CSF) India ink test examination is the preferred diagnostic approach.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In settings without immediate access to lumbar puncture or when lumbar puncture is clinically contraindicated: a i) If both access to a cryptococcal antigen assay and rapid results (less than 24 hours) are available: Rapid serum, plasma or whole-blood cryptococcal antigen assays are the preferred diagnostic approaches.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

In settings without immediate access to lumbar puncture or when lumbar puncture is clinically contraindicated: If a cryptococcal antigen assay is not available and/or rapid access to results is not ensured: Prompt referral for further investigation and treatment as appropriate.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

A single high dose (10 mg/kg) of liposomal amphotericin B with 14 days of flucytosine (100 mg/kg per day divided into four doses per day) and fluconazole (1200 mg/daily for adults; 12 mg/kg per day for children and adolescents up to a maximum of 800 mg daily) should be used as the preferred induction regimen for treating people with cryptococcal meningitis.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

(Treating people with cryptococcal meningitis) If liposomal amphotericin is not available: A seven-day course of amphotericin B deoxycholate (1 mg/kg per day) and flucytosine (100 mg/kg per day, divided into four doses per day) followed by seven days of fluconazole (1200 mg daily for adults and 12 mg/kg per day for children and adolescents up to a maximum of 800 mg daily).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

(Treating people with cryptococcal meningitis) If no amphotericin formulation is available: 14 days of fluconazole (1200 mg daily, 12 mg/kg per day for children and adolescents) and flucytosine (100 mg/kg per day, divided into four doses per day)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

(Treating people with cryptococcal meningitis) If flucytosine is not available: 14 days of liposomal amphotericin B (3–4 mg/kg per day) and fluconazole (1200 mg daily, 12 mg/kg per day for children and adolescents up to a maximum of 800 mg daily).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

(Treating people with cryptococcal meningitis) If liposomal amphotericin B and flucytosine are not available: 14 days of amphotericin B deoxycholate (1 mg/kg per day) and fluconazole (1200 mg daily, 12 mg/kg per day for children and adolescents up to a maximum of 800 mg daily).

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Fluconazole (800 mg daily for adults, 6–12 mg/kg/day for children and adolescents up to a maximum of 800 mg daily) is recommended for the consolidation phase (for eight weeks following the induction phase)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

Fluconazole (200 mg daily for adults, 6 mg/kg/day for adolescents and children) is recommended for the maintenance phase (or secondary prophilaxys)

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Routine use of adjunctive corticosteroid therapy during the induction phase is not recommended in treating HIV-associated cryptococcal meningitis among adults, adolescents and children

Status

Maintained

Recommended against

Strong

Certainty of evidence

High

Immediate ART initiation is not recommended for adults, adolescents and children living with HIV who have cryptococcal meningitis because of the risk of increased mortality and should be deferred by 4–6 weeks from the initiation of antifungal treatment.

Status

Maintained

Recommended against

Strong

Certainty of evidence

Low

Among people living with HIV, disseminated histoplasmosis should be diagnosed by detecting circulating Histoplasma antigens

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Treating people living with HIV for severe or moderately severe histoplasmosis: liposomal amphotericin B, 3.0 mg/kg, for two weeks is recommended. In settings in which liposomal amphotericin B is unavailable, deoxycholate amphotericin B, 0.7–1.0 mg/kg, is recommended for two weeks

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Treating severe or moderately severe histoplasmosis among people living with HIV: In settings where liposomal amphotericin B is unavailable, deoxycholate amphotericin B, 0.7–1.0 mg/kg, is recommended for two weeks

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

As a good practice for people with renal failure, or at risk of renal injury, measures to prevent or treat toxicity are recommended

Status

Maintained

Treating mild to moderate histoplasmosis among people living with HIV: itraconazole 200 mg three times daily for three days and then 200 mg twice daily is recommended

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

(Treating mild to moderate histoplasmosis among people living with HIV, itraconazole:) Maintenance therapy: itraconazole 200 mg twice daily for 12 months is recommended

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

(Treating mild to moderate histoplasmosis among people living with HIV, itraconazole:) Maintenance therapy: Less than 12 months of therapy can be considered when the person is clinically stable, receiving antiretroviral therapy, has suppressed viral load, and the immune status has improved

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Timing of antiretroviral therapy initiation: antiretroviral therapy should be initiated as soon as possible among people with disseminated histoplasmosis for whom central nervous system involvement is not suspected or proven

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

People living with HIV with TB and histoplasmosis coinfection should receive TB therapy according to WHO treatment guidelines

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

WHO suggests paclitaxel or pegylated liposomal doxorubicin for pharmacological treatment for people living with HIV with Kaposi’s sarcoma.

Status

Updated

Recommended in favor

Conditional

Certainty of evidence

Low

In HIV-infected adults, adolescents and children diagnosed with mild/moderate Kaposi sarcoma, immediate ART initiation is recommended.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

In HIV-infected adults, adolescents and children diagnosed with severe symptomatic Kaposi sarcoma, immediate ART initiation in combination with systemic chemotherapy is recommended.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

People living with HIV should be systematically screened for TB disease at each visit to a health facility

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Among adults and adolescents living with HIV, systematic screening for TB disease should be conducted using the WHO-recommended four-symptom screen, and those who report any one of the symptoms of current cough, fever, weight loss or night sweats may have TB and should be evaluated for TB and other diseases

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Among adults and adolescents living with HIV, C-reactive protein with a cut-off of > 5 mg/L may be used to screen for TB disease

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Among adults and adolescents living with HIV, molecular WHO-recommended rapid diagnostic tests may be used to screen for TB disease

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Adult and adolescent inpatients with HIV in medical wards where the TB prevalence is > 10% should be tested systematically for TB disease with a molecular WHO-recommended rapid diagnostic test

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Among individuals younger than 15 years who are close contacts of someone with TB, systematic screening for TB disease should be conducted using a symptom screen including any one of cough, fever or poor weight gain; or chest radiography; or both

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Among children younger than 10 years who are living with HIV, systematic screening for TB disease should be conducted using a symptom screen including any one of current cough, fever, poor weight gain or close contact with a TB patient

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

For adults and adolescents with HIV who have signs or symptoms of TB, screen positive for TB, are seriously ill or have advanced HIV disease, concurrent testing using low-complexity automated nucleic acid amplification tests (NAATs) on respiratory samples and LF-LAM on urine should be used as the initial diagnostic strategy for diagnosing TB, rather than low complexity automated NAATs on respiratory samples alone.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

For children with HIV who have signs or symptoms or screen positive for pulmonary TB, concurrent testing using low-complexity automated nucleic acid amplification tests (NAATs) on respiratory and stool samples and LF-LAM on urine may be used as the initial diagnostic strategy for diagnosing TB, rather than low-complexity automated NAATs on respiratory or stool samples alone

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

Adults and adolescents living with HIV who are unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines should receive TB preventive treatment as part of a comprehensive package of HIV care. Treatment should also be given to those on antiretroviral treatment, to pregnant women and to those who have previously been treated for TB, irrespective of the degree of immunosuppression and even if testing for TB infection is unavailable

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Infants aged < 12 months living with HIV who are in contact with a person with TB and who are unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines should receive TB preventive treatment.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Children aged ≥ 12 months living with HIV who are considered unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines should be offered TB preventive treatment as part of a comprehensive package of HIV prevention and care if they live in a setting with high TB transmission, regardless of contact with TB

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Low

All children living with HIV who have successfully completed treatment for TB disease may receive TB preventive treatment.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

The following TB preventive treatment options are recommended regardless of HIV status: 6 or 9 months of daily isoniazid, or a 3-month regimen of weekly rifapentine plus isoniazid, or a 3-month regimen of daily isoniazid plus rifampicin

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

The following alternative TB preventive treatment options may be used regardless of HIV status: a 1-month regimen of daily rifapentine plus isoniazid or 4 months of daily rifampicin.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

The current WHO position paper on BCG vaccination (167) states that children known to be living with HIV should not receive BCG vaccination because they are at increased risk of developing disseminated BCG disease. However, if they are receiving ART, are clinically well and immunologically stable they should be vaccinated. Immunologically stable children have a CD4% exceeding 25% (children younger than five years) or a CD4 count of 200/mm3 or higher (children older than five years). In settings without access to CD4 testing, immunological stability may be assessed clinically based on the absence of new opportunistic infections and any other symptoms

Status

Maintained

Recommended

It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

ART should be started as soon as possible within two weeks of initiating TB treatment, regardless of CD4 cell count, among people living with HIV. Adults and adolescents

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

ART should be started as soon as possible within two weeks of initiating TB treatment, regardless of CD4 cell count, among people living with HIV. Children and infants

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

Antiretroviral therapy is recommended for all patients with HIV and drug-resistant TB requiring second-line antituberculosis drugs, irrespective of CD4 cell count, as early as possible (within the first 8 weeks) following initiation of antituberculosis treatment

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

In patients with tuberculous meningitis, an initial adjuvant corticosteroid therapy with dexamethasone or prednisolone tapered over 6-8 weeks should be used

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Very low

Co-trimoxazole prophylaxis is recommended for adults (including pregnant women) with severe or advanced HIV clinical disease (WHO stage 3 or 4) and/or with CD4 cell count ≤350 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

In settings where malaria and/or severe bacterial infections are highly prevalent, cotrimoxazole prophylaxis should be initiated regardless of CD4 cell count or WHO stage

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

Co-trimoxazole prophylaxis may be discontinued in adults (including pregnant women) with HIV infection who are clinically stable on antiretroviral therapy, with evidence of immune recovery and viral suppression.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Low

In settings where malaria and/or severe bacterial infections are highly prevalent, cotrimoxazole prophylaxis should be continued regardless of CD4 cell count or WHO clinical stage.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

Co-trimoxazole prophylaxis is recommended for infants, children, and adolescents with HIV, irrespective of clinical and immune conditions. Priority should be given to all children younger than 5 years old regardless of CD4 cell count or clinical stage and to children with severe or advanced HIV clinical disease (WHO clinical stage 3 or 4) and/ or those with CD4 ≤350 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

In settings where malaria and/or severe bacterial infections are highly prevalent, co-trimoxazole prophylaxis should be continued until adulthood whether or not ART is being taken.

Status

Maintained

Recommended in favor

Conditional

Certainty of evidence

Moderate

In settings with low prevalence for both malaria and bacterial infections, cotrimoxazole prophylaxis may be discontinued for children 5 years of age and older who are clinically stable and/or virally suppressed on antiretroviral therapy for at least 6 months and CD4 >350 cells/mm3

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Co-trimoxazole prophylaxis is recommended for HIV-exposed infants from 4–6 weeks of age and should be continued until HIV infection has been excluded by an age-appropriate HIV test to establish final diagnosis after complete cessation of breastfeeding.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Very low

Routine co-trimoxazole prophylaxis should be administered to all HIV-infected people with active TB disease regardless of CD4 cell counts.

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

High

WHO recommends rapid initiation of antiretroviral therapy (ART) in people with mpox infection and HIV who are ART naïve or have had a prolonged interruption of ART

Status

Maintained

Recommended in favor

Strong

Certainty of evidence

Moderate

WHO guidelines on the management of advanced HIV disease

Recommendations

A package of interventions including screening, treatment and/or prophylaxis for major opportunistic infections, rapid antiretroviral Therapy initiation and intensified adherence support interventions should be offered to everyone presenting with advanced HIV disease.

CD4 testing is recommended as the preferred method to identify advanced HIV disease among people living with HIV.

In settings in which CD4 testing is not yet available, WHO clinical staging can be used to identify advanced HIV disease.

When cryptococcal antigen screening is not available, fluconazole primary prophylaxis should be given to adults and adolescents living with HIV who have a CD4 cell count <100 cells/mm3

When cryptococcal antigen screening is not available, fluconazole primary prophylaxis may be considered at a higher CD4 cell count threshold of < 200 cells/mm3

For adults, adolescents and children living with HIV suspected of having a first episode of cryptococcal meningitis, prompt lumbar puncture with measurement of cerebrospinal fluid (CSF) opening pressure and rapid cryptococcal antigen assay is recommended as the preferred diagnostic approach

In settings with ready access to and no contraindication for lumbar puncture: If access to a cryptococcal antigen assay is not available and/or rapid results are not available: Lumbar puncture with cerebrospinal fluid (CSF) India ink test examination is the preferred diagnostic approach.

In settings without immediate access to lumbar puncture or when lumbar puncture is clinically contraindicated: If a cryptococcal antigen assay is not available and/or rapid access to results is not ensured: Prompt referral for further investigation and treatment as appropriate.

(Treating people with cryptococcal meningitis) If no amphotericin formulation is available: 14 days of fluconazole (1200 mg daily, 12 mg/kg per day for children and adolescents) and flucytosine (100 mg/kg per day, divided into four doses per day)

(Treating people with cryptococcal meningitis) If flucytosine is not available: 14 days of liposomal amphotericin B (3–4 mg/kg per day) and fluconazole (1200 mg daily, 12 mg/kg per day for children and adolescents up to a maximum of 800 mg daily).

(Treating people with cryptococcal meningitis) If liposomal amphotericin B and flucytosine are not available: 14 days of amphotericin B deoxycholate (1 mg/kg per day) and fluconazole (1200 mg daily, 12 mg/kg per day for children and adolescents up to a maximum of 800 mg daily).

Fluconazole (800 mg daily for adults, 6–12 mg/kg/day for children and adolescents up to a maximum of 800 mg daily) is recommended for the consolidation phase (for eight weeks following the induction phase)

Fluconazole (200 mg daily for adults, 6 mg/kg/day for adolescents and children) is recommended for the maintenance phase (or secondary prophilaxys)

Routine use of adjunctive corticosteroid therapy during the induction phase is not recommended in treating HIV-associated cryptococcal meningitis among adults, adolescents and children

Immediate ART initiation is not recommended for adults, adolescents and children living with HIV who have cryptococcal meningitis because of the risk of increased mortality and should be deferred by 4–6 weeks from the initiation of antifungal treatment.

Among people living with HIV, disseminated histoplasmosis should be diagnosed by detecting circulating Histoplasma antigens

Treating people living with HIV for severe or moderately severe histoplasmosis: liposomal amphotericin B, 3.0 mg/kg, for two weeks is recommended. In settings in which liposomal amphotericin B is unavailable, deoxycholate amphotericin B, 0.7–1.0 mg/kg, is recommended for two weeks

Treating severe or moderately severe histoplasmosis among people living with HIV: In settings where liposomal amphotericin B is unavailable, deoxycholate amphotericin B, 0.7–1.0 mg/kg, is recommended for two weeks

As a good practice for people with renal failure, or at risk of renal injury, measures to prevent or treat toxicity are recommended

Treating mild to moderate histoplasmosis among people living with HIV: itraconazole 200 mg three times daily for three days and then 200 mg twice daily is recommended

(Treating mild to moderate histoplasmosis among people living with HIV, itraconazole:) Maintenance therapy: itraconazole 200 mg twice daily for 12 months is recommended

(Treating mild to moderate histoplasmosis among people living with HIV, itraconazole:) Maintenance therapy: Less than 12 months of therapy can be considered when the person is clinically stable, receiving antiretroviral therapy, has suppressed viral load, and the immune status has improved

Timing of antiretroviral therapy initiation: antiretroviral therapy should be initiated as soon as possible among people with disseminated histoplasmosis for whom central nervous system involvement is not suspected or proven

People living with HIV with TB and histoplasmosis coinfection should receive TB therapy according to WHO treatment guidelines

WHO suggests paclitaxel or pegylated liposomal doxorubicin for pharmacological treatment for people living with HIV with Kaposi’s sarcoma.

In HIV-infected adults, adolescents and children diagnosed with mild/moderate Kaposi sarcoma, immediate ART initiation is recommended.

In HIV-infected adults, adolescents and children diagnosed with severe symptomatic Kaposi sarcoma, immediate ART initiation in combination with systemic chemotherapy is recommended.

People living with HIV should be systematically screened for TB disease at each visit to a health facility

Among adults and adolescents living with HIV, C-reactive protein with a cut-off of > 5 mg/L may be used to screen for TB disease

Among adults and adolescents living with HIV, molecular WHO-recommended rapid diagnostic tests may be used to screen for TB disease

Adult and adolescent inpatients with HIV in medical wards where the TB prevalence is > 10% should be tested systematically for TB disease with a molecular WHO-recommended rapid diagnostic test

Among individuals younger than 15 years who are close contacts of someone with TB, systematic screening for TB disease should be conducted using a symptom screen including any one of cough, fever or poor weight gain; or chest radiography; or both

Among children younger than 10 years who are living with HIV, systematic screening for TB disease should be conducted using a symptom screen including any one of current cough, fever, poor weight gain or close contact with a TB patient

Infants aged < 12 months living with HIV who are in contact with a person with TB and who are unlikely to have TB disease on an appropriate clinical evaluation or according to national guidelines should receive TB preventive treatment.

All children living with HIV who have successfully completed treatment for TB disease may receive TB preventive treatment.

The following TB preventive treatment options are recommended regardless of HIV status: 6 or 9 months of daily isoniazid, or a 3-month regimen of weekly rifapentine plus isoniazid, or a 3-month regimen of daily isoniazid plus rifampicin

The following alternative TB preventive treatment options may be used regardless of HIV status: a 1-month regimen of daily rifapentine plus isoniazid or 4 months of daily rifampicin.

It is recommended that TB patients who are living with HIV should receive at least the same duration of TB treatment as HIV-negative TB patients

ART should be started as soon as possible within two weeks of initiating TB treatment, regardless of CD4 cell count, among people living with HIV. Adults and adolescents

ART should be started as soon as possible within two weeks of initiating TB treatment, regardless of CD4 cell count, among people living with HIV. Children and infants

Antiretroviral therapy is recommended for all patients with HIV and drug-resistant TB requiring second-line antituberculosis drugs, irrespective of CD4 cell count, as early as possible (within the first 8 weeks) following initiation of antituberculosis treatment

In patients with tuberculous meningitis, an initial adjuvant corticosteroid therapy with dexamethasone or prednisolone tapered over 6-8 weeks should be used

In patients with tuberculous pericarditis, an initial adjuvant corticosteroid therapy may be used

Co-trimoxazole prophylaxis is recommended for adults (including pregnant women) with severe or advanced HIV clinical disease (WHO stage 3 or 4) and/or with CD4 cell count ≤350 cells/mm3

In settings where malaria and/or severe bacterial infections are highly prevalent, cotrimoxazole prophylaxis should be initiated regardless of CD4 cell count or WHO stage

Co-trimoxazole prophylaxis may be discontinued in adults (including pregnant women) with HIV infection who are clinically stable on antiretroviral therapy, with evidence of immune recovery and viral suppression.

In settings where malaria and/or severe bacterial infections are highly prevalent, cotrimoxazole prophylaxis should be continued regardless of CD4 cell count or WHO clinical stage.

In settings where malaria and/or severe bacterial infections are highly prevalent, co-trimoxazole prophylaxis should be continued until adulthood whether or not ART is being taken.

In settings with low prevalence for both malaria and bacterial infections, cotrimoxazole prophylaxis may be discontinued for children 5 years of age and older who are clinically stable and/or virally suppressed on antiretroviral therapy for at least 6 months and CD4 >350 cells/mm3

Co-trimoxazole prophylaxis is recommended for HIV-exposed infants from 4–6 weeks of age and should be continued until HIV infection has been excluded by an age-appropriate HIV test to establish final diagnosis after complete cessation of breastfeeding.

Routine co-trimoxazole prophylaxis should be administered to all HIV-infected people with active TB disease regardless of CD4 cell counts.

WHO recommends rapid initiation of antiretroviral therapy (ART) in people with mpox infection and HIV who are ART naïve or have had a prolonged interruption of ART

CD4 testing is recommended as the preferred method to identify advanced HIV disease among people living with HIV.