Major update to US HHS treatment guidelines for HIV (September 2026)

4 October 2026. Related: Guidelines.

Simon Collins, HIV i-Base

On 30 September 2026, the US HHS panel published the latest update to the HIV guidelines for ART. [1]

These are internationally recognised for being the most frequently updated evidence-based guidelines on the treatment of adolescents and adults living with HIV.

Importantly, each section now highlights the main knowledge gaps that should be the focus of future research.

Selected main changes

A new section reviews the Principles of Antiretroviral Therapy and covers initial and subsequent ART and virologic failure. It also covers the important potential benefits of treatment optimisation for people who are stable on current ART, including benefits of combinations with easier dosing and reduced side effects.
Changes to the section on starting ART included that the dual combination of dolutegravir/lamivudine is now recommended as first-line ART irrespective of baseline viral load. However, this combination is not recommended as a switch option if current or archived M184V is either documented or suspected based on treatment history.
Previous tables on drug interactions have been replaced with a recommendation to use the University of Liverpool drug interaction checker.
The remaining information on drug interactions includes a very useful explanation of the potential mechanisms for interactions, especially for long-acting ARVs.
The renamed section on interrupting ART recognises that this sometimes occurs due to problems with access that are beyond the control of people living with HIV. However, the guidelines assume that viral load will rebound in everyone. (Actually, some people take several weeks or even months before viral load becomes detectable – or they remain undetectable for much longer in the context of post-treatment control).
This section includes updated guidance for people using injectable ART and covers participants in cure-related studies undergoing analytic treatment interruptions (ATIs).
The section on substance use disorders has an expanded discussion of polysubstance use, chemsex, unstable housing, opioid adulterants and other factors that affect HIV care outcomes. This includes use of long-acting ART.
The section on women and HIV updates the discussions about menopause, use of injectable CAB/RPV during pregnancy, and infant feeding options postpartum.
The section on the cost considerations of ART are important but are mainly focussed on accessing ART through the highly complex US health system. The guidelines emphasise that the costs bourne directly by people living with HIV should be a factor when prescribing ART, in order to maximise access to ART.

A detailed list of recent changes covers both additions and deleted text. [2]

The PDF file of the whole guidelines document also very helpfully highlights changes with a yellow background. [1]

comment

These guidelines are important reading for treatment providers and community activists alike, including outside the US.

This extensive update is also welcomed, especially given the uncertainty of continued funding for this project by the US Department of Health and Human Services.

One small point is that although there is a reference to an archive of previous guidelines, the URL only links to a PDF showing changes in the drug interaction tables.

Previously, the archive included all editions of this essential publication since 1998, but online access appears to have now been inexplicably deleted.

References

US Department of Health and Human Services (DHHS). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. (30 September 2026).
https://www.hiv.gov/blog/updates-to-the-guidelines-for-the-use-of-antiretroviral-agents-in-adults-and-adolescents-with-hiv-093026 (html pages)
https://clinicalinfo.hiv.gov/sites/g/files/mnhszr391/files/guidelines/documents/adult-adolescent-arv/guidelines-adult-adolescent-arv.pdf (PDF file)
US DHHS. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents With HIV. What’s new. (30 September 2026).
https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-arv/whats-new