Data, Medications, and Strategies Aligned with the 2030 Goal

The World Health Organization (WHO) has presented its updated Recommendations on the clinical management of HIV: recommendations for a public health approach, a document that redefines care for the nearly 40 million people living with HIV worldwide and guides health systems towards achieving the global goal of eliminating AIDS as a public health threat by 2030. According to the WHO, over 30 million people were on antiretroviral treatment at the end of 2024, which has led to a substantial reduction in mortality and transmission of the virus. Therefore, the WHO recommends as the preferred preventive regimen a three-month course of isoniazid plus rifapentine, a shorter option that facilitates adherence and allows for expanding prevention coverage within health systems. The new guidelines are primarily aimed at HIV program managers, health workers, laboratories, community organizations, and international agencies, and they seek to reduce mortality, HIV transmission, and tuberculosis, while strengthening the efficiency and sustainability of care services. With this updated framework, the WHO provides an evidence-based roadmap to improve treatment outcomes, expand access to care, and advance towards the global target of ending HIV as a public health problem this decade. The WHO states that all infants exposed to HIV should receive six weeks of prophylaxis, preferably with nevirapine, and that infants at higher risk should receive more intensive regimens. Likewise, women living with HIV who are on treatment can breastfeed for at least 12 months and up to 24 months or longer, provided they have support to maintain viral suppression and clinical follow-up. HIV and tuberculosis: an integrated strategy Tuberculosis remains the leading cause of death among people living with HIV. The evidence shows that this drug offers greater virological efficacy and a better safety profile compared to previous alternatives such as lopinavir/ritonavir and atazanavir/ritonavir. Additionally, the WHO introduces options for therapeutic simplification, such as the use of dolutegravir + lamivudine in stable individuals, and for the first time recommends long-acting injectable antiretrovirals, specifically cabotegravir + rilpivirine, for adults and adolescents who have difficulty adhering to daily oral treatments. Mother-child pair protection The recommendations reinforce strategies to prevent vertical HIV transmission, which continues to occur mainly during breastfeeding. However, challenges persist related to treatment failure, adherence, mother-to-child transmission, and co-infection with tuberculosis, which justify the update of the clinical guidelines. A scientific and global process The new recommendations were coordinated by the WHO's Department of HIV, Tuberculosis, Hepatitis and Sexually Transmitted Infections, under the leadership of Meg Doherty and Tereza Kasaeva, with technical coordination from Marco Vitori and Elena Vovc. The development of the guideline was funded by the Bill & Melinda Gates Foundation and Unitaid, and involved the participation of international experts such as Elaine Abrams, Alexandra Calmy, Pedro Cahn, Beatriz Grinsztejn, Graeme Meintjes, Lynne Mofenson and Francois Venter, among others. Key changes in antiretroviral therapy One of the main adjustments is the recommendation of darunavir/ritonavir (DRV/r) as the preferred protease inhibitor for individuals whose dolutegravir (DTG)-based treatment has failed.