New guidelines aim to assist countries in bolstering their HIV programs, reducing mortality, and moving towards the elimination of AIDS as a public health threat.
MADRID (EUROPA PRESS) – The World Health Organization (WHO) has released updated recommendations on the clinical management of the human immunodeficiency virus (HIV), endorsing dolutegravir-based (DTG) regimens as the preferred choice for both initial and subsequent treatment of the infection.
The revised guidelines are designed to empower nations to enhance their HIV programs, lower death rates, and progress towards eliminating AIDS as a public health hazard. The guide incorporates significant advancements in treatment and accommodates recent evidence concerning optimized antiretroviral regimens, management of vertical transmission, and tuberculosis prevention in individuals with HIV.
“These updated recommendations reflect WHO’s commitment to ensuring that individuals with HIV have access to the most effective, safe, and feasible treatment options,” stated Tereza Kasaeva, Director of the Department of HIV, Tuberculosis, Viral Hepatitis, and STIs at WHO.
According to the guide, for patients who do not respond to dolutegravir-based regimens and require a protease inhibitor (PI), the recommended first choice is darunavir/ritonavir, as opposed to previously preferred treatments such as atazanavir/ritonavir or lopinavir/ritonavir. The guidelines also support the reuse of tenofovir and abacavir in later regimens based on improved outcomes, programmatic benefits, and potential cost savings.
Furthermore, the guidelines advocate for the use of long-acting injectable antiretroviral therapy under specific circumstances, such as for adults and adolescents who struggle with adhering to daily oral regimens. For selected individuals who are clinically stable, the guidelines recommend simplified oral two-drug regimens.
VERTICAL TRANSMISSION AND TUBERCULOSIS
The WHO has noted that HIV infections continue to occur in infants, particularly during breastfeeding, although significant strides have been made in eliminating so-called vertical transmission.
In this light, the organization continues to recommend that mothers with HIV exclusively breastfeed for the first six months, and that breastfeeding continue up to 12 months and possibly up to 24 months or more, alongside effective maternal antiretroviral therapy and appropriate complementary feeding.
Additionally, it is advised that all infants exposed to HIV receive six weeks of postnatal prophylaxis, preferably with nevirapine, while infants at greater risk should receive enhanced triple prophylaxis. Extended infant prophylaxis can be used until maternal viral suppression is achieved or breastfeeding is discontinued.
Moreover, tuberculosis remains one of the leading causes of death among people living with HIV. To improve the uptake and completion of preventive treatment in such cases, a new recommendation suggests a weekly regimen of isoniazid and rifapentine (3HP) for three months, with daily isoniazid regimens (6H) for six months and (9H) for nine months as alternatives, depending on clinical and programmatic needs.
All these recommendations will be incorporated into the next edition of the WHO’s consolidated HIV guidelines and are intended to inform national HIV programs, healthcare providers, partners, and communities worldwide.
