Standard HIV treatment may cause bone, kidney harm in older persons – research

Researchers at the University of Nairobi (UoN), Centre for Epidemiological Modelling and Analysis (CEMA), have released results of three studies that could significantly transform the treatment of older adults living with HIV across Africa.

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

The studies coded named B/F/TAF, Sungura, and Twiga focused particularly on people aged 60 years and above, a population that is 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.”

The B/F/TAF study, which is short for Bictegravir/Emtricitabine/Tenofovir Alafenamide the 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 for HIV treatment, TLD – Tenofovir disoproxil fumarate, Lamivudine, and Dolutegravir, or switch to a newer combination calledB/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, as well as other national programs in Africa, 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.

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. Researchers say these findings support growing global evidence that dual therapy can be effective and safer for select populations.

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 regarding 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. Ombajo said that they plan to follow up with the study participants for five years to track new health developments such as co-infections, comorbidities, and mortality.

“By comparing HIV-positive and HIV-negative individuals over time, we aim to understand the true impact of HIV on ageing.”

She said the three studies offer a comprehensive view of how HIV treatment can evolve to meet the needs of ageing populations in Africa. The results call for greater investment in age-appropriate care and re-evaluation of the use of standard treatment tenofovir in older patients.

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