Older Kenyans with HIV face hidden dangers in standard treatment, studies warn
HIV drugs. Researchers point to Tenofovir disoproxil fumarate, a key drug in Kenya’s national HIV regimen, as a major concern.
What you need to know:
- Researchers urge replacing harmful HIV drug TDF with safer alternatives to protect ageing patients’ bones and kidneys.
- Findings call for rethinking HIV care in Africa’s elderly, expanding safer regimens and hepatitis B prevention.
New research has revealed that standard HIV treatment regimens may pose significant health risks for people aged 60 and above.
Findings from three studies, led by the University of Nairobi’s Centre for Epidemiological Modelling and Analysis (Cema), presented at the International Aids Society (IAS) Conference on HIV Science in Kigali last month, indicate gaps in care for older adults living with HIV.
The studies—B/F/TAF (Bictegravir, Emtricitabine, and Tenofovir alafenamide), Sungura, and Twiga—suggest it’s time to rethink conventional treatment protocols, particularly because of age-related vulnerabilities such as kidney damage, osteoporosis, and chronic diseases.
Researchers point to Tenofovir disoproxil fumarate (TDF), a key drug in Kenya’s national HIV regimen, as a major concern. TDF is known to contribute to bone loss and kidney damage, especially when combined with other risk factors like diabetes. A safer alternative, Tenofovir alafenamide (TAF), offers similar efficacy with far fewer side effects on bone and kidney health.
“Older people with HIV are a neglected population,” said Dr Loice Ombajo, infectious disease specialist and Cema co-director. “Our findings show that HIV treatments can be both effective and safer for ageing patients.”
In the B/F/TAF study, 520 participants, aged 60+, all on HIV treatment for over a decade, were randomised to either continue on Kenya’s standard regimen (TLD: TDF, Lamivudine, and Dolutegravir) or switch to B/F/TAF. After 96 weeks, those on B/F/TAF maintained viral suppression and showed better bone and kidney health. However, the absence of B/F/TAF in Kenya’s public health system created ethical concerns about switching participants back to the older regimen.
This led to two follow-up studies. Sungura tested a simplified two-drug regimen (Dolutegravir and Lamivudine, DTG/3TC). Among 197 participants, none experienced virologic failure after 24 weeks. However, many were excluded because of hepatitis B virus (HBV) exposure—an issue because dual therapy doesn't protect against HBV. Researchers emphasised the need to expand HBV screening and vaccination across Sub-Saharan Africa.
Twiga is a five-year observational study comparing HIV-positive and HIV-negative individuals aged 60+. Early results show older adults with HIV face more comorbidities, including kidney impairment, osteoporosis, and the challenges of taking multiple medications.
“This study will help us understand HIV’s long-term effects on ageing,” Dr Ombajo said. “It’s not just about survival—it’s about improving quality of life.”
According to the study, the three studies make a compelling case for revising HIV treatment protocols for Africa’s ageing population. Key recommendations include replacing tenofovir disoproxil fumarate in older patients given its link to bone and kidney damage; expanding access to newer regimens like B/F/TAF; increasing the use of dual therapy where appropriate, paired with robust HBV screening; and improving adult access to HBV vaccination across the region.
The research was conducted in collaboration with the Ministry of Health (Nascop), Kenyatta National Hospital, and Jaramogi Oginga Odinga Teaching and Referral Hospital, with support from Gilead Sciences and ViiV Healthcare.
