A study of three key findings has revealed that it could dramatically change the way older people living with HIV in Africa are treated.The findings were presented on July 15, 2025, at the International AIDS Society Conference on HIV Science held in Rwanda and co-hosted by the University of Nairobi’s Center for Epidemiological Modelling and Analysis (CEMA).
The findings of the studies presented revealed that there is a clear link between overlooked health risks, new treatment approaches and safer HIV care for older people.
The studies, called Bictegravir/Emtricitabine/Tenofovir Alafenamide for the Elderly [B/F/TAF], Sungura and Twiga, focused on people aged 60 and older, a population that is often excluded from HIV research despite being at high risk for diseases such as kidney disease, diabetes, high blood pressure, and bone disease.
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The researchers found that standard HIV treatments may cause more harm than good in this demographic, especially for bone and kidney health and that more age-appropriate options are needed and possible.
“Elderly people with HIV are a neglected population,” said Dr. Loice Ombajo, an infectious disease specialist and Associate Director at CEMA.
“B/F/TAF is a study targeting people aged 60 and over living with HIV. It helps us understand how aging, HIV, and chronic diseases interact in the African context. With the right partnerships and investment in research and development, we can deliver HIV treatments that are not only effective, but also safe, acceptable, and more appropriate for older adults,” the B/F/TAF study said.
The study included 520 people living with HIV who were aged 60 and over and had been taking antiretroviral drugs for more than 10 years.
Participants were randomly assigned to continue with the standard regimen (TLD – Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir) or switch to a newer combination called B/F/TAF. Over 96 weeks of follow-up, those on B/F/TAF showed significant viral suppression along with improved bone and kidney health outcomes.
The researchers identified a new problem 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 cause bone and kidney damage would be a health problem. This challenge led to two follow-up studies, Sungura and Twiga.
Sungura followed 197 participants from the BFTAF study who continued on a simplified two-drug regimen Dolutegravir and Lamivudine (DTG/3TC).
In this study, the researchers investigated whether the two drugs could be as effective as the traditional three drug regimen, especially in adults with multiple chronic diseases.
Initial results from Sungura at 24 weeks were promising. There were no cases of viral failure or participant dropout, and all participants maintained viral suppression.
The findings supported growing international evidence that dual therapy may be effective and safe for selected populations. However, the Sungura study also uncovered important insights into the management of hepatitis B (HBV) in older adults.
During the enrollment study of 227 individuals, most were found to be co-infected with HBV, and were therefore ineligible for dual therapy, which does not provide adequate HBV coverage.
Although no liver complications or HBV reactivation were observed over the 24-week period, the study emphasizes the importance of HBV screening before switching older adults to dual therapy and emphasizes the need to improve access to HBV vaccination for adults.
Unfortunately, access to HBV serology testing remains limited in much of sub-Saharan Africa. The third study, Twiga, is an ongoing five-year study tracking HIV-infected and HIV-negative individuals aged 60 years and older.
It was established to better understand how HIV affects aging, particularly in terms of comorbidities, medication burden, and long-term organ function. Researchers enrolled participants from previous BFTAF studies and compared them with 108 HIV-negative individuals of similar age and sex.
The study measures a variety of health indicators—including body mass index (BMI), blood pressure (BP), kidney function, bone mineral density (BMD), spine fractures, and frailty scores—to compare health trajectories over time.
Results to date show that older people living with HIV (PLWH) had more comorbidities, more medication use, and higher rates of kidney failure and osteoporosis compared with their HIV-negative counterparts. This knowledge provides sufficient evidence to modify treatment guidelines to better address the specific needs of older people.
“We plan to follow this cohort for five years to monitor new health developments such as co-infections, morbidity and mortality,” said Dr. Ombajo.
“By comparing people living with HIV and those without HIV over time, we aim to understand the true impact of HIV on aging.”
Together, the BFTAF, Sungura and Twiga studies provide a broad perspective on how HIV treatment can and must change to meet the needs of an aging population in Africa. The findings call for greater investment in age-appropriate care, a reassessment of the use of tenofovir in older patients, and expanded access to dual therapy, particularly for those without HBV.
The studies also emphasize the need for HBV testing capacity as a prerequisite for safe system reform and highlight the need to improve access to HBV vaccine.
These studies were made possible through a collaboration between the Department of Medicine and Surgery at the University of Nairobi, the Kenyan Ministry of Health through the National AIDS & STI Control Programme (NASCOP), and key health facilities in Kenya, including Kenyatta National Hospital and Jaramogi Oginga Odinga Teaching and Referral Hospital.
The work was also supported by Gilead Sciences and ViiV Health Services.
CEMA and its partners will continue to analyze longitudinal data and work with policymakers to ensure that the findings from these studies inform national and regional HIV treatment guidelines.
About CEMA
The Center for Epidemiological Modelling and Analysis (CEMA) is a research center at the University of Nairobi dedicated to improving health outcomes in Kenya and across Africa through data-driven decision-making.
It was established as a multidisciplinary consortium of infectious disease specialists, epidemiologists, computer scientists, and data analysts to collect and analyze clinical, epidemiological, and epidemiological data to guide Kenya’s response to the pandemic.
In our work, we recognize the critical interconnections between human, animal and environmental health essential for protecting public health and maintaining the balance of our planet’s ecosystems.
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