Health
University of Nairobi Study Urges Shift in HIV Treatment for Older Adults in Africa
Groundbreaking research from the University of Nairobi’s Centre for Epidemiological Modelling and Analysis (CEMA) is calling for urgent changes in the treatment of older adults living with HIV, following revelations that standard therapies may be doing more harm than good in ageing populations.
The findings, released during the International AIDS Society Conference on HIV Science in Kigali on Tuesday, highlight the need for safer, more personalised HIV care for people aged 60 and above. Researchers presented results from three studies — B/F/TAF, Sungura, and Twiga — which collectively reveal that existing treatment regimens can have adverse effects on bone and kidney health in older individuals, and that alternative approaches are both viable and potentially safer.
“Older people with HIV are a neglected population,” said Dr. Loice Ombajo, infectious disease specialist and Co-Director at CEMA. “With the right partnerships and investment in research and development, we can deliver HIV treatment that is not only effective, but also safe, acceptable, and better suited for older adults.”
The B/F/TAF study, which involved 520 individuals aged 60 and above who had been on HIV treatment for over a decade, compared outcomes between those who remained on the standard national regimen (TLD) and those who switched to a newer combination, B/F/TAF — Bictegravir, Emtricitabine, and Tenofovir alafenamide. After 96 weeks of monitoring, those on B/F/TAF showed strong viral suppression along with marked improvements in kidney and bone health.
However, the researchers faced a practical dilemma: B/F/TAF is not yet available in Kenya or most national treatment programs across Africa. Returning participants to TLD, now shown to carry a higher risk to kidney and bone function in older adults, posed ethical and medical challenges.
This led to two follow-up studies. The Sungura study followed 197 B/F/TAF participants who transitioned to a simplified two-drug regimen of Dolutegravir and Lamivudine (DTG/3TC). At 24 weeks, participants continued to exhibit viral suppression, with no treatment failures or dropouts. The results bolster growing global evidence that dual therapy can be effective for select populations, especially those managing multiple chronic conditions.
Meanwhile, the Twiga study — a five-year observational project — is tracking long-term health outcomes in both HIV-positive and HIV-negative individuals aged 60 and above. Participants from the original B/F/TAF study were matched with HIV-negative peers of similar age and gender to monitor differences in comorbidities, medication burden, bone health, kidney function, and frailty.
Early findings from Twiga indicate that older people living with HIV have more chronic illnesses, take more medications, and suffer higher rates of kidney impairment and osteoporosis compared to their HIV-negative counterparts. Researchers believe these insights could shape future treatment guidelines to better serve the ageing HIV-positive population.
Dr. Ombajo emphasised the importance of long-term data, saying the team will follow participants for five years to monitor the emergence of new comorbidities, co-infections, and mortality patterns.
“By comparing HIV-positive and HIV-negative individuals over time, we aim to understand the true impact of HIV on ageing,” she said.
The research presents a compelling case for revisiting the use of tenofovir-based treatments in older patients and investing in age-specific HIV care strategies. As the African population of people living with HIV continues to grow older, experts say the continent must urgently adapt its clinical approach to avoid undermining the health and quality of life of a vulnerable and often overlooked demographic.
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