Older Kenyans living with HIV left waiting for safer treatment

Kenya's National Aids and STI Control Programme (Nascop) has temporarily suspended the transition of new patients to a safer antiretroviral drug for the elderly and those with kidney complications after an anticipated shipment failed to arrive on schedule.

This is according to Dr Andrew Mulwa, Nascop's Chief Executive Officer, who said the World Health Organisation changed its treatment guidelines last year, recommending that HIV-positive patients who are elderly or living with kidney disease be moved to a molecule that is gentler on the kidneys.

For years, the standard first-line HIV treatment recommended by the Ministry of Health has been a daily, single-tablet regimen combining Dolutegravir (DTG), Tenofovir Disoproxil Fumarate (TDF) and Lamivudine (3TC), commonly known as TLD.

Kidney function

However, long-term exposure to TDF, the tenofovir component in TLD, carries a well-documented risk of nephrotoxicity (kidney damage) and bone density loss. This risk becomes significantly more pronounced in older adults because of natural, age-related declines in kidney function and a higher prevalence of comorbidities such as hypertension and diabetes.

To address this, the WHO and updated national guidelines, including Nascop's, now recommend transitioning patients with established renal impairment, or those at high risk, such as the elderly, to Tenofovir Alafenamide (TAF), a safer, newer prodrug formulation of tenofovir. Because TAF targets HIV-infected cells more efficiently, it can be given at a much lower dose, reducing active drug exposure in the bloodstream by up to 90 per cent and preserving kidney function and bone health.

"We asked them to give a molecule that is safer to the kidneys," Dr Mulwa said, adding that the programme had been transitioning eligible patients during their routine clinic visits.

Also read: Why 20,000 Kenyans still die of Aids

According to the Nascop boss, patients currently on TLD who fall into the elderly or kidney-risk category have been moved to a newer combination known as TAF-LD, with the switch specifically targeting patients over 60 and those with kidney disease. However, a change in the procurement arrangement with the United States government, which has shifted to a government-to-government supply model, has disrupted the delivery timeline for the new drug.

"There is a supply that was supposed to come in June, last month. And they said it will be delayed for two months," Dr Mulwa said. As a result, Nascop has advised county health teams not to begin switching new patients onto the drug for now, though patients already on TAF-LD will continue receiving it without interruption.

"We advise the counties not to switch new patients. So those who have the drug can continue," he said, adding that the pause is temporary and that eligible patients will resume being switched to TAF-LD by the end of July, once fresh supplies arrive. Nascop said it had alerted counties to the situation as far back as April, through its regular monthly supply-chain planning meetings.

The push to move older patients to safer drugs is backed by research. A large clinical trial conducted in Kenya between March and July 2022 found that switching older people living with HIV to a newer antiretroviral combination improves bone density and kidney function compared with the standard first-line treatment used across much of Africa.

Largest trial

The findings were published on November 20, 2025, in the journal Open Forum Infectious Diseases, an Oxford Academic publication.

The trial, known as the B/F/TAF-Elderly Study, followed 520 patients aged 60 and above being treated at Kenyatta National Hospital (KNH) and Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu. Researchers led it from the University of Nairobi in collaboration with international HIV specialists, and it is the largest trial of its kind to focus specifically on older HIV patients in Africa.

Older people living with HIV face a higher burden of other illnesses, including heart disease, kidney disease and bone loss, than younger patients. Researchers tested whether switching patients to a newer, once-daily pill combining bictegravir, emtricitabine and tenofovir alafenamide (B/F/TAF), sold commercially as Biktarvy, would work as well as, and be gentler on the body than, staying on the older regimen. Participants were split evenly between those who switched to B/F/TAF and those who stayed on their existing treatment, and were followed for 48 weeks.

The newer combination worked just as well at suppressing HIV as the standard regimen: fewer than two per cent of patients on B/F/TAF had a detectable virus after 48 weeks, compared with under three per cent of those who stayed on the older treatment, meeting the study's benchmark for equivalence.

Also read: HIV drug to be made locally

Patients switched to B/F/TAF also saw a small but meaningful improvement in bone density in the lower spine and hip, while those on the older regimen showed almost no improvement. This mattered because nearly a third of participants already had osteoporosis at the start of the study, and one in five had an undiagnosed spinal fracture picked up on X-ray.

Kidney function also improved among patients on the newer drug, while it declined slightly in those who remained on the standard regimen. Fifteen patients on the older treatment had to stop altogether because their kidney function had worsened too much, compared with essentially none on B/F/TAF. Rates of serious side effects were similar between the two groups, though patients on the newer drug were somewhat more likely to develop mildly elevated cholesterol and to gain a small amount of weight. Researchers said these differences did not translate into any significant change in patients' overall long-term cardiovascular risk.

The study's authors noted that access to bone-density scanning is extremely limited in Kenya, with only one functioning scanner in the country at the time of writing, located at a private hospital. This means osteoporosis in HIV patients often goes undetected until a fracture occurs. They argued that their findings support wider adoption of TAF-based treatment for older patients even without routine bone scanning, since the drug appears to protect bone and kidney health regardless.

Viral load

The Nascop CEO also disclosed a backlog in viral load testing, caused by a delay in the arrival of testing reagents. Viral load samples are not processed at local facilities but are sent to central laboratories for analysis.

Kenya currently holds roughly 186,000 pending samples against a testing capacity of just over 300,000. Supplies expected from the US government are due by the end of the month, alongside additional stock secured through an emergency government procurement process.

"If we continue without new supplies in three months, there will likely be a shortage," Dr Mulwa said, adding that the supply chain, while functional, "is not healthy" following the missed June delivery.

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