These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

These consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring bring together existing and new clinical and programmatic recommendations across different ages, populations and settings, bringing together all relevant WHO guidance on HIV produced since 2016. It serves as an update to the previous edition of the consolidated guidelines on HIV. These guidelines continue to be structured along the continuum of HIV care. Information on new combination prevention approaches, HIV testing, ARV regimens and treatment monitoring are included. There is a new chapter on advanced HIV disease that integrates updated guidance on the management of important HIV comorbidities, including cryptococcal disease, histoplasmosis and tuberculosis. The chapter on general HIV care, contains a new section on palliative care and pain management, and up to date information on treatment of several neglected tropical diseases, such as visceral leishmaniasis and Buruli ulcer. New recommendations for screening and treating of cervical pre-cancer lesions in women living with HIV are also addressed in this chapter. Guidance on service delivery was expanded to help the implementation and strengthening the HIV care cascade. Importantly, this guidance emphasizes the need for differentiated approaches to care for people who are established on ART, such as reduced frequency of clinic visits, use of multi-month drug dispensing and implementation of community ART distribution. The adoption of these efficiencies is essential to improve the quality of care of people receiving treatment and reduce the burden on health facilities, particularly in resource limited settings.

These guidelines provide new and updated recommendations on the use of point-of-care testing in children under 18 months of age and point-of-care tests to monitor treatment in people living with HIV; the treatment monitoring algorithm; and timing of antiretroviral therapy (ART) among people living with HIV who are being treated for tuberculosis. WHO is currently in the process of collating all HIV normative guidance developed since 2016 in order to publish the third edition of the consolidated HIV guidelines in July 2021. This updated version will include the new clinical guidance presented here.

NPIN 21131: This report contains revised guidelines for the use of antiretroviral drugs in HIV-positive adults and adolescents that were developed by the Panel on Clinical Practices for the Treatment of HIV infection for the U.S. Department of Health and Human Services. These guidelines are based on feedback received during the 30-day comment period and further discussion among the panel members. The guidelines are intended for use by physicians and other health care providers and serves as a companion document to the therapeutic principles formulated by the National Institutes of Health Panel to Define Principles of Therapy of HIV infection. The report addresses the use of testing for plasma HIV RNA levels and CD4 T-cell counts, considerations for when to initiate therapy in established HIV infection, special considerations for therapy in patients with advanced stage disease, interruption of therapy, considerations for changing therapy and available therapeutic options, the treatment of acute HIV infection, considerations for antiretroviral therapy in adolescents, and considerations for antiretroviral therapy in pregnant women. The report is available in both English and Spanish.

These recommendations include approaches for differentiated service delivery (DSD) of antiretroviral therapy (ART) that are less intensive and provide person-centred services to improve both quality and retention in care. As a result many countries have introduced or are scaling up DSD ART models. Currently, countries and partners are seeking to strengthen monitoring of differentiated ART service delivery to address implementation gaps and crucially improve patient outcomes.

These guidelines provide new and updated recommendations and good practice statements in the following areas: starting ART, including initiating treatment outside the clinic and support for same-day ART start; frequency of clinical visits and ART refills; measuring adherence; tracing and re-engagement in care for all populations; psychosocial support for adolescents living with HIV; task sharing for diagnostic services; and service integration. This guideline seeks to provide support to Member States, programme managers, health workers and other stakeholders seeking to achieve national and international goals to end the HIV epidemic as a public health threat by 2030. WHO is currently in the process of collating all HIV normative guidance developed since 2016 in order to publish the third edition of the consolidated HIV guidelines in July 2021. This updated version will include the new service delivery guidance presented here.