2026 WHO Update:
Recommendations on HIV Clinical Management
By Dr. José M. Zuniga
On 7 January 2026, the World Health Organization (WHO) unveiled updated recommendations on clinical management of HIV that reflect major advances in treatment science, simplification of care, and stronger preventive strategies. These evidence-informed changes are designed to improve outcomes for people living with HIV, reduce new pediatric infections, and accelerate progress towards closing critical tuberculosis (TB) prevention gaps.
Optimizing Antiretroviral Therapy (ART)
- One of the most impactful updates confirms that dolutegravir-based regimens remain the preferred option for both initial and subsequent HIV treatment. This reflects the strong evidence of dolutegravir’s effectiveness, tolerability, and high barrier to resistance.
- For individuals whose treatment regimen fails, the updated guidance now recommends darunavir/ritonavir as the preferred protease inhibitor option, replacing previous preferences for atazanavir/ritonavir or lopinavir/ritonavir. This change aligns with current evidence showing better outcomes and tolerability.
- Another notable shift is the support for reusing tenofovir and abacavir in subsequent regimens when clinically appropriate. This flexibility can improve programmatic efficiency and potentially lower costs without compromising treatment success.
- Importantly, WHO now endorses long-acting injectable ART for specific groups – particularly adults and adolescents who struggle with daily oral regimens. These long-acting options can ease the burden of adherence and offer a life-changing alternative for many.
- Additionally, the guidelines endorse oral two-drug ART regimens as treatment-simplification options for select clinically stable individuals, providing more choices in care delivery while maintaining high standards of effectiveness.
Strengthening the Prevention of Vertical Transmission
- Despite progress in eliminating mother-to-child HIV transmission, new infant infections still occur, especially during breastfeeding. The updated WHO recommendations reinforce a person-centered approach that balances maternal choice with infant health.
- Key elements include continued support for exclusive breastfeeding for the first six months, with extended breastfeeding up to 12 months – and potentially beyond – alongside effective maternal ART and appropriate complementary feeding.
- All infants exposed to HIV should receive six weeks of postnatal prophylaxis, preferably with nevirapine, while those at higher risk are advised to receive enhanced triple-drug prophylaxis. Extended prophylaxis can continue until maternal viral suppression is achieved or breastfeeding is completed.
Prioritizing TB Prevention
- TB remains a leading cause of death among people living with HIV. To address this critical gap, WHO now recommends three months of weekly isoniazid plus rifapentine (3HP) as the preferred TB preventive therapy regimen for adults and adolescents living with HIV, emphasizing shorter, more tolerable treatment courses to improve uptake and completion.
- Other WHO-recommended TB preventive regimens remain available as alternatives based on individual and programmatic needs. These updated TB prevention strategies aim to simplify service delivery and reduce mortality.
A Forward-Looking, People-Centered Approach
WHO’s updated recommendations – to be integrated into the forthcoming consolidated HIV guidelines – prioritize simplicity, choice, and evidence-based care. By expanding effective treatment options, simplifying regimens, and strengthening preventive interventions, the guidance equips countries, clinicians, and communities to deliver better, more equitable HIV care and move closer to ending AIDS as a public health threat.
Dr. José M. Zuniga is President/CEO of IAPAC and the Fast-Track Cities Institute.
Access the WHO Updated Recommendations on HIV Clinical Management: Recommendations for a Public Health Approach (2026): https://www.who.int/publications/i/item/9789240119468
