NAIROBI — New research from Kenya is reshaping how HIV is treated in aging populations across Africa. Findings from three major studies reveal that standard regimens may pose avoidable health risks for people aged 60 and older and offer evidence that safer, more personalized treatment is both possible and urgently needed.
The research, led by the University of Nairobi’s Center for Epidemiological Modelling and Analysis (CEMA), was presented at the International AIDS Society Conference in Kigali, Rwanda. It highlights key health concerns among older people living with HIV (PLWH), including rising rates of kidney disease, bone loss, and drug complications.
“These are people often left out of clinical research,” said Dr. Loice Ombajo, a lead researcher in the study. “But the data shows that older adults with HIV face real risks from current treatments. We now know we can do better.”
Study 1: B/F/TAF Yield results
The first study, known as B/F/TAF, enrolled 520 adults over 60 who had been on HIV treatment for more than a decade. Half remained on the national standard regimen Tenofovir Disoproxil Fumarate, Lamivudine, and Dolutegravir (TLD). The other half switched to a newer drug combination: Bictegravir, Emtricitabine, and Tenofovir Alafenamide (B/F/TAF).
After 96 weeks, those on B/F/TAF maintained strong viral suppression and showed improved bone density and kidney function. But the study revealed a new problem. B/F/TAF is not yet available in Kenya’s public health system. Returning participants to TLD now linked to potential harm posed ethical and medical challenges.
This prompted the launch of two follow-up studies to explore alternative solutions.
Study 2: Sungura explores Dual Therapy for Older Adults
The Sungura study followed 197 of the original participants, testing a simplified dual-drug regimen: Dolutegravir and Lamivudine (DTG/3TC). The trial ran for 24 weeks. All patients kept their viral loads suppressed, and none dropped out or developed resistance.
But a serious caveat emerged. Among 227 people screened for enrollment, a large number had prior exposure to the Hepatitis B Virus (HBV) which the two-drug regimen cannot treat. These individuals were excluded from the study. Researchers observed no HBV reactivations in the 24-week window but emphasized the risk of switching without proper HBV screening.
The study highlights the limited availability of HBV testing across sub-Saharan Africa and calls for urgent expansion of HBV vaccination access for adults.
Study 3: Twiga Tracks Long-Term Health Impacts of Aging With HIV
The third study, Twiga, is a five-year observational project tracking comorbidities in HIV-positive and HIV-negative individuals over 60. It compares 412 people who were in the B/F/TAF study with 108 HIV-negative peers of similar age and sex.
Preliminary data show that older PLWH have more health issues, take more medications, and suffer higher rates of kidney impairment and osteoporosis than their HIV-negative counterparts. Twiga also tracks blood pressure, frailty indicators, vertebral fractures, and long-term organ function.
“We are learning how HIV changes the aging process,” said Dr. Ombajo. “This helps us better tailor care, track co-infections, and adjust medication use over time.”
National implications and call to action
All three studies were conducted in collaboration with the Ministry of Health’s National AIDS and STI Control Programme (NASCOP), Kenyatta National Hospital, and other regional facilities. Support came from Gilead Sciences and ViiV Healthcare.
The findings point to several urgent needs:
- Revised national guidelines for HIV treatment in older adults.
- Reduced reliance on tenofovir disoproxil fumarate due to its links to kidney and bone damage.
- Expanded access to dual therapy where appropriate.
- Universal HBV testing before regimen changes.
- Wider rollout of HBV vaccination for adults.
The researchers argue that older patients must be given equal attention in HIV care, as they represent a growing demographic in the region’s epidemic.
“These studies are the start,” said Dr. Ombajo. “But policymakers must act. We cannot keep treating 60-year-olds the same way we treat 30-year-olds. The risks are different, and now we have the evidence to guide safer care.”
CEMA plans to continue analyzing long-term data and push for evidence-based updates to HIV treatment protocols for older adults across Africa.
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