Since the publication in 2006 of Antiretroviral therapy for HIV infection in adults and adolescents: Recommendations for a public health approach, new evidence has emerged on when to initiate ART, optimal ART regimens, the management of HIV coinfection with tuberculosis and chronic viral hepatitis and the management of ART failure. This evidence formed the basis for the recommendations contained in the 2010 update, which outlines a public health approach to the delivery of ART for adults and adolescents in settings with limited health systems capacity and resources. The recommendations were based on the preparation GRADE evidence profiles, systematic and targeted reviews, risk-benefit analyses, consultations with PLHIV, technical reports, and assessments of impact, feasibility and cost.

This guideline revision was conducted in accordance with procedures outlined by the WHO Guidelines Review Committee and is based on the GRADE approach to evidence review. The process involved four separate working groups: the Internal WHO ART Guideline Working Group, the ART Guideline Drafting Group, the external ART Peer Review Panel and the full ART Guideline Review Committee.

The consensus recommendations, which emerged from consultations of the working groups, encourage earlier HIV diagnosis and earlier antiretroviral treatment, and promote the use of less toxic regimens and more strategic laboratory monitoring. The guidelines identify the most potent, effective and feasible first-line, second-line and subsequent treatment regimens, applicable to the majority of populations, the optimal timing of ART initiation and improved criteria for ART switching, and introduce the concept of third-line antiretroviral regimens.

The primary audiences are national treatment advisory boards, partners implementing HIV care and treatment, and organizations providing technical and financial support to HIV care and treatment programmes in resource-limited settings.

It is critical that national ART programme and public health leaders consider these recommendations in the context of countries' HIV epidemics, the strengths and weaknesses of health systems, and the availability of financial, human and other essential resources. In adapting these guidelines, care must be exercised to avoid undermining current treatment programmes, to protect access for the most at-risk populations, to achieve the greatest impact for the greatest number of people and to ensure sustainability. It is similarly important to ensure that the adaptation of these guidelines do not stifle ongoing or planned research, since the new recommendations reflect the current state of knowledge and new information for sustainability and future modifications of existing guidelines will be needed.