WHO 2025 guideline update: HIV
What’s new in advanced HIV disease care?
Important changes to early identification, clinical care, and post-discharge outcomes are outlined in the World Health Organization’s (WHO) 2025 update on the management of advanced HIV disease (AHD).1
Prioritized CD4 testing for AHD
The guideline designates CD4 testing as the preferred method for identifying AHD, defined as a CD4 count ≤200 cells/mm³. This formalizes CD4 testing as the primary diagnostic approach, replacing previous reliance on WHO clinical staging.
WHO notes that CD4 testing outperforms clinical staging in routine practice. Clinical staging may still be used where CD4 testing is unavailable, but only conditionally, reflecting very low–certainty evidence for its sensitivity and specificity.
New focus on hospital discharge and follow‑up
To address persistently poor outcomes after hospitalization, WHO introduces new post-discharge interventions that are conditionally recommended for people with HIV. Evidence shows high rates of readmission following discharge, highlighting gaps in continuity of care.
Based on low-certainty evidence, WHO advises programs to consider a package of interventions to reduce readmissions and improve linkage to outpatient care, including:
- Pre‑discharge goal setting
- Medication review
- Transitional care planning
- Telephone follow‑up
- Home visits
- Individualized support strategies
Updated tuberculosis diagnostic approach
WHO now recommends concurrent tuberculosis (TB) testing in adults, adolescents, and children with symptoms of AHD or TB. The initial diagnostic step combines low‑complexity nucleic acid amplification tests on respiratory samples with urine lateral flow lipoarabinomannan (LF-LAM) testing.
This replaces earlier single-test recommendations and reflects the high burden and mortality of TB in AHD, where diagnosis is frequently missed at low CD4 counts. WHO notes that concurrent testing improves diagnostic access and enables earlier detection in this high-risk population.
Kaposi’s sarcoma treatment update
For the first time since 2014, WHO has updated its pharmacologic guidance for HIV-associated Kaposi’s sarcoma. The 2025 guideline suggests the use of paclitaxel or pegylated liposomal doxorubicin for the treatment of people living with HIV and Kaposi’s sarcoma, based on low-certainty evidence.
While antiretroviral therapy (ART) remains first-line treatment for all people with HIV, the update expands treatment options beyond ART alone and previously recommended chemotherapy regimens.
Mpox management emphasizes rapid ART
The 2025 update strengthens guidance on mpox management in people with HIV, emphasizing rapid ART initiation, including same-day start. Evidence shows that individuals with AHD face higher risks of severe disease, hospitalization, and mortality from mpox.
Based on moderate-certainty evidence, this recommendation reinforces rapid ART initiation as a core component of mpox management.
Program‑level monitoring requirements
WHO introduces an updated minimum dataset for national HIV programs to strengthen monitoring of AHD. This dataset includes CD4 results, opportunistic infection diagnostics, TB preventive treatment status, and ART initiation timelines. These elements are intended to standardize reporting, support early identification of AHD, and enable targeted program-level interventions.
Reference
- WHO, 2025. WHO guidelines on the management of advanced HIV disease. https://iris.who.int/server/api/core/bitstreams/68dfe26f-ad54-4f60-b92f-b943b1a0d82c/content
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