WHO Makes First Major HIV Treatment Update Since 2021

The World Health Organization (WHO) released updated recommendations on HIV clinical management in January 2026, introducing revisions to antiretroviral therapy, prevention of vertical transmission, and tuberculosis prevention. The changes aim to improve treatment outcomes and reduce HIV-related mortality, reflecting new clinical evidence obtained since the last consolidated WHO HIV guidelines of 2021. It is intended to inform national policies ahead of a comprehensive update expected in 2026.

“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,” says Tereza Kasaeva, Director of the Department of HIV, TB, Viral Hepatitis and STIs, WHO. She says the guidance is designed to simplify treatment, improve adherence, and address persistent gaps in prevention that continue to affect HIV outcomes worldwide.

The updated WHO recommendations are being released as health systems confront overlapping pressures, including uneven access to medicines, supply disruptions, and rising demand for complex therapies. While global access to antiretroviral therapy has expanded, WHO has warned that treatment failure, adherence challenges, and co-infections such as tuberculosis remain major contributors to preventable deaths among people living with HIV.

In the Americas, these challenges reflect broader regional trends identified by the Pan American Health Organization (PAHO) in its 2025 year-end assessment. In the document, PAHO reported progress in disease surveillance, vaccination, emergency response, and health system strengthening, while warning that structural access gaps, mental health pressures, and climate-related risks continue to strain public health systems. These factors directly affect HIV programs, particularly in ensuring continuity of care, reliable medicine supply, and integration with TB prevention and maternal health services.

Jarbas Barbosa, Director, PAHO, said in a year-end message that health remains a foundation for development, economic stability, and social resilience. He said PAHO’s Strategic Plan 2026–2031, approved by member states in September, reflects a commitment to reducing inequities, lowering maternal mortality, and eliminating selected communicable diseases. WHO’s updated HIV guidance aligns with this approach by emphasizing standardization of care, simplified regimens, and integration across services.

A central element of the updated WHO guidance is the optimization of antiretroviral therapy. Dolutegravir-based regimens remain the preferred option for initial and subsequent HIV treatment across most populations. When a protease inhibitor is required, WHO now recommends darunavir boosted with ritonavir as the preferred option for adults, adolescents, and children, replacing earlier preferences for atazanavir/ritonavir and lopinavir/ritonavir. WHO said the change is supported by evidence showing improved safety and efficacy, as well as programmatic advantages.

The guidance also introduces greater flexibility in managing treatment failure. WHO now supports the recycling of tenofovir, either as tenofovir disoproxil fumarate or tenofovir alafenamide, in subsequent regimens for adults and adolescents, even if the drug was part of a previously failing regimen. For children, abacavir may also be reused. WHO said this approach avoids routine switches to zidovudine, which is associated with higher toxicity, while offering cost and supply-chain advantages for national HIV programs.

Treatment simplification is another priority. WHO recommends oral dual-drug regimens combining dolutegravir and lamivudine for selected patients who are clinically stable, have undetectable viral loads and do not have active hepatitis B infection. In addition, the organization has, for the first time, recommended long-acting injectable antiretroviral therapy as a switching option. Injectable cabotegravir and rilpivirine administered every two months may be used for adults and adolescents who are stable on oral therapy but face challenges adhering to daily pills.

The growing use of specialized HIV therapies has implications for medicine distribution and dispensing models, particularly in middle-income countries. Marcos Pascual, General Director,  Asesoría en Farmacias, says specialized medications used for conditions such as HIV, cancer, and autoimmune diseases are not only costly but require specialized logistics and handling. He says these treatments often involve cold-chain requirements, strict storage controls, and continuous clinical monitoring to assess tolerance and effectiveness.

In Mexico, the regulatory framework governing these medicines intersects with WHO’s emphasis on optimized and simplified HIV treatment. Article 226 of Mexico’s General Health Law classifies medicines into six groups, ranging from controlled narcotics and psychotropic substances to prescription-only and free-access products. Many highly specialized medicines, including antiretrovirals and oncology drugs, fall under pharmaceutical specialties authorized by the Ministry of Health, particularly biotechnological products produced using molecular biotechnology techniques.

The Parliamentary Gazette of April 23, 2019, defines highly specialized medications as those requiring specialized medical supervision, specific storage conditions, and individualized dosing, with priority given to diseases such as cancer. Pascual says that many of these medicines were previously covered by the Catastrophic Expense Protection Fund, which has since been eliminated, increasing pressure on public supply systems.

WHO’s updated recommendations also place renewed emphasis on preventing vertical transmission of HIV. Maternal viral suppression remains the priority, while infant prophylaxis is now more explicitly risk-stratified. All HIV-exposed infants should receive six weeks of postnatal prophylaxis, preferably with nevirapine. Infants at higher risk should receive six weeks of triple-drug prophylaxis as presumptive therapy, followed by extended single-drug prophylaxis if breastfeeding continues before maternal viral suppression is confirmed. WHO also reaffirmed support for breastfeeding among virally suppressed mothers on effective therapy.

Tuberculosis prevention is another core element of the guidance. WHO now recommends three months of weekly isoniazid plus rifapentine as the preferred tuberculosis preventive treatment for adults and adolescents living with HIV, citing higher completion rates and lower hepatotoxicity compared with longer regimens. Longer isoniazid-only regimens remain alternatives based on programmatic needs.

In Mexico and other countries in the region, supply constraints underscore the importance of integrated planning. In March 2025, shortages of cancer medicines triggered public protests and highlighted challenges linked to the transition to IMSS-Bienestar, including reduced spending and contract breaches by suppliers. Under the consolidated purchasing model for 2025–2026, the government has allocated about MX$123 billion (US$6.6 billion), for cancer treatments, representing 20% of the total medicines budget and covering the purchase of more than 25 million units.

WHO says its updated HIV recommendations are intended to help countries standardize treatment across populations, reduce pill burden, integrate TB prevention into routine HIV care, and promote equitable access to effective medicines. In regions such as the Americas, these objectives intersect with PAHO-led efforts to strengthen surveillance, pooled procurement, and health system resilience as countries work to sustain progress toward ending AIDS as a public health threat amid broader system pressures.