New HIV studies offer hope for safer, more tailored treatment for older adults in Africa

Research from The University of Nairobi, Center for Epidemiological Modelling and Analysis (CEMA) has revealed safer and more effective HIV treatment options for older adults across Africa.

The research findings which were unveiled at the International AIDS Society Conference on HIV Science in Rwanda and shed light on overlooked health risks, new treatment approaches, and a path to safer, more personalised HIV care for ageing populations.

The three studies, B/F/TAF, Sungura, and Twiga underscored a major gap in HIV research spotlighting on adults aged 60 years and above living with the HIV virus who are often left out of HIV research despite facing greater risk of comorbidities such as kidney disease, diabetes, hypertension, and osteoporosis.

Researchers found that the standard HIV treatment may cause more harm than good in this demographic, particularly to bone and kidney health, and that more age-appropriate options are both needed and feasible.

“Older people with HIV are a neglected population,” said Dr. Loice Ombajo, an infectious disease specialist and Co-Director at CEMA. “The B/F/TAF is a study focused on people aged 60 and above living with HIV. It helps us understand how ageing, HIV, and chronic illnesses intersect in African settings. 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.”

Study 1: B/F/TAF Trial

The B/F/TAF study (short for Bictegravir/Emtricitabine/Tenofovir Alafenamide for the Elderly) involved 520 people living with HIV who were 60 years and older and had been on antiretroviral treatment for over 10 years.

These participants were randomly assigned to continue with the national standard regimen (TLD – Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir) or switch to a newer combination called B/F/TAF (Bictegravir, Emtricitabine, and Tenofovir alafenamide).

Over 96 weeks of follow-up, those on B/F/TAF showed strong viral suppression along with improved bone and kidney health outcomes.

However, researchers faced a new dilemma at the end of the study. Since B/F/TAF was not yet available in Kenya’s national program, returning participants to TLD now shown to pose potential harm to bone and kidney function would have been medically problematic. This challenge led to two follow-up studies: Sungura and Twiga.

Study 2: Sungura – Exploring Dual Therapy

The Sungura study followed up on 197 participants from the BFTAF study who continued on a simplified two-drug regimen—Dolutegravir and Lamivudine (DTG/3TC). In this study, the researchers examined whether dual therapy can be just as effective as traditional three-drug treatments, especially for older adults dealing with multiple chronic illnesses.

Preliminary results from Sungura at 24 weeks were promising. There were no cases of virologic failure or participant drop-out, and all participants maintained viral suppression. These findings support growing global evidence that dual therapy can be effective and safer for select populations.

However, the Sungura study also uncovered significant observations about managing hepatitis B (HBV) in older adults. During the enrollment screening of 227 individuals, many were found to have been exposed to Hepatitis B Virus (HBV), therefore were not eligible for dual therapy, which lacks sufficient HBV coverage.

Although no liver complications or HBV reactivations were observed in the 24-week period, the study underlines the importance of HBV screening before switching older adults to two-drug regimens and puts emphasis on the need to improve access to HBV vaccination for adults. Unfortunately, access to HBV serology testing remains limited across much of sub-Saharan Africa.

Study 3: Twiga – Long-Term Tracking of Comorbidities

The third study, Twiga, is an ongoing five-year observational study tracking comorbidities in both HIV-positive and HIV-negative individuals aged 60 and above. It was initiated to better understand how HIV influences ageing, especially in relation to comorbidities, medication burden, and long-term organ function.

Researchers enrolled participants from the original BFTAF study and matched them with 108 HIV-negative individuals of similar age and gender. The study measures a wide range of health indicators including body mass index (BMI), blood pressure (BP), kidney function, bone mineral density (BMD), vertebral fractures, and frailty markers to compare health trajectories over time.

Findings to date reveal that older people living with HIV (PLWH) had more comorbidities, more use of medication, and higher rates of kidney impairment and osteoporosis compared to their HIV-negative peers. These insights provide compelling evidence for revising treatment guidelines to better address the specific needs of the older population.

“We plan to follow this cohort for five years to track new health developments such as co-infections, comorbidities, and mortality,” said Dr. Ombajo. “By comparing HIV-positive and HIV-negative individuals over time, we aim to understand the true impact of HIV on ageing.”

These studies run in collaboration with Kenya’s Ministry of Health through the National AIDS & STI Control Programme (NASCOP), Kenyatta National Hospital, Jaramogi Oginga Odinga Teaching and Referral Hospital, and with support from Gilead Sciences and ViiV Healthcare.

They highlight the need for: Age-sensitive treatment guidelines, cautious use of tenofovir in older populations, expanded access to dual therapy and HBV testing as well as investment in HBV vaccination for adults.

The BFTAF, Sungura, and Twiga studies offer a comprehensive view of how HIV treatment can and must evolve to meet the needs of ageing populations in Africa.

The results call for greater investment in age-appropriate care, reevaluation of tenofovir use in older patients, and expanded access to dual therapy, especially for those without HBV. The studies also emphasise the need for HBV screening capacity as a prerequisite for safe regimen adjustments and highlight the need for improved access to HBV vaccination.

CEMA and its collaborators aim to continue to analyse long-term data and work with policymakers to ensure findings from these studies help shape national and regional HIV treatment guidelines.

The Centre for Epidemiological Modelling and Analysis (CEMA) is a research centre at the University of Nairobi, formed during the COVID-19 pandemic, which integrates human, environmental, and animal health in its research approach. It is dedicated to improving health outcomes in Kenya and across Africa through data-driven decision-making.