NAIROBI, Kenya — Groundbreaking research from the University of Nairobi’s Center for Epidemiological Modelling and Analysis (CEMA) has unveiled safer and more effective HIV treatment options specifically for older adults across Africa.
The findings, presented at the International AIDS Society Conference on HIV Science in Rwanda, illuminate previously overlooked health risks, introduce innovative treatment approaches, and chart a path toward more personalized HIV care for aging populations.
Three pivotal studies – B/F/TAF, Sungura, and Twiga – collectively underscore a significant gap in current HIV research.
They highlight that adults aged 60 years and above living with HIV are often excluded from studies, despite facing a heightened risk of comorbidities such as kidney disease, diabetes, hypertension, and osteoporosis.
Researchers discovered that standard HIV treatments may, in fact, cause more harm than good to this demographic, particularly impacting bone and kidney health, emphasizing the urgent need and feasibility of more age-appropriate alternatives.
“Older people with HIV are a neglected population,” stated 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 – A safer regimen emerges
The B/F/TAF study (short for Bictegravir/Emtricitabine/Tenofovir Alafenamide for the Elderly) enrolled 520 individuals aged 60 years and older living with HIV, all of whom had been on antiretroviral treatment for over a decade.
Participants were randomly assigned to either continue with the national standard regimen (TLD – Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir) or switch to a newer, single-tablet combination known as B/F/TAF (Bictegravir, Emtricitabine, and Tenofovir alafenamide).
Over 96 weeks of follow-up, those receiving B/F/TAF demonstrated robust viral suppression coupled with notable improvements in both bone and kidney health outcomes.
However, a new challenge arose at the study’s conclusion: B/F/TAF was not yet available within Kenya’s national program. Reverting participants to TLD, which had shown potential harm to bone and kidney function in this demographic, would have presented a significant medical dilemma.
This critical challenge directly led to the initiation of two subsequent follow-up studies: Sungura and Twiga.
Study 2: Sungura – exploring the efficacy of dual therapy
The Sungura study tracked 197 participants from the original B/F/TAF trial who continued on a simplified two-drug regimen: Dolutegravir and Lamivudine (DTG/3TC).
This investigation aimed to determine if dual therapy could be as effective as traditional three-drug treatments, particularly for older adults managing multiple chronic illnesses.
Preliminary results from Sungura at 24 weeks proved promising, with no instances of virologic failure or participant dropout, and all participants maintaining viral suppression.
These findings lend further support to the growing global evidence that dual therapy can be both effective and safer for carefully selected patient populations.
Nonetheless, the Sungura study also yielded significant observations regarding the management of Hepatitis B (HBV) in older adults.
During the enrollment screening of 227 individuals, a substantial number were found to have been exposed to Hepatitis B Virus (HBV), rendering them ineligible for dual therapy, which lacks sufficient HBV coverage.
Although no liver complications or HBV reactivations were observed during the 24-week period, the study emphatically underscores the importance of comprehensive HBV screening before transitioning older adults to two-drug regimens and highlights the urgent 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 in aging
The third study, Twiga, is an ongoing five-year observational study meticulously tracking comorbidities in both HIV-positive and HIV-negative individuals aged 60 and above.
Initiated to gain a deeper understanding of how HIV influences the aging process, particularly in relation to comorbidities, medication burden, and long-term organ function, the study enrolled participants from the original B/F/TAF study and matched them with 108 HIV-negative individuals of similar age and gender.
The research measures a comprehensive array 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.
To date, findings from Twiga reveal that older people living with HIV (PLWH) exhibit a higher prevalence of comorbidities, increased medication use, and elevated rates of kidney impairment and osteoporosis compared to their HIV-negative counterparts.
These insights provide compelling evidence advocating for a revision of current treatment guidelines to better address the specific and complex 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,” Dr. Ombajo explained. “By comparing HIV-positive and HIV-negative individuals over time, we aim to understand the true impact of HIV on ageing.”
Call for greater investment in age-appropriate care
These collaborative studies were conducted in partnership with Kenya’s Ministry of Health through the National AIDS & STI Control Programme (NASCOP), Kenyatta National Hospital, and Jaramogi Oginga Odinga Teaching and Referral Hospital, with additional support from Gilead Sciences and ViiV Healthcare.
The research unequivocally highlights the urgent need for:
- Age-sensitive HIV treatment guidelines.
- Cautious and informed use of tenofovir in older populations.
- Expanded access to dual therapy, particularly for individuals without HBV co-infection.
- Increased investment in HBV vaccination for adults.
- Enhanced capacity for HBV screening as a prerequisite for safe regimen adjustments.
The B/F/TAF, Sungura, and Twiga studies collectively offer a comprehensive view of how HIV treatment can and must evolve to effectively meet the unique needs of Africa’s aging populations.
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The results strongly advocate for greater investment in age-appropriate care, a reevaluation of tenofovir use in older patients, and expanded access to dual therapy, especially for those without HBV.
The studies also underscore the critical importance of robust HBV screening capacity as a prerequisite for safe regimen adjustments and emphasize the necessity of improved access to HBV vaccination.
CEMA and its collaborators are committed to continuing the analysis of long-term data and working closely with policymakers to ensure that the findings from these pivotal studies directly inform and shape national and regional HIV treatment guidelines across Africa.
The Centre for Epidemiological Modelling and Analysis (CEMA), a research center at the University of Nairobi established during the COVID-19 pandemic, adopts an integrated approach to research, encompassing human, environmental, and animal health.
Its core mission is dedicated to improving health outcomes in Kenya and throughout Africa through data-driven decision-making.
