African-Led HIV Research Breaks New Ground on Drug Resistance and Aging Patients

Groundbreaking Studies Out of Kenya Reshape HIV Treatment Thinking

New research led by Kenyan scientists is offering important evidence on how to manage HIV treatment failure, protect pregnant and breastfeeding women, and simplify treatment for older people living with HIV. The studies were presented at the 26th International AIDS Conference, which took place in Rio de Janeiro, Brazil. The findings represent a major step forward — not just for Africa, but for global HIV care — by addressing populations that have long been left out of mainstream research.

The studies were led by the Centre for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi, and researchers said the evidence could help inform HIV treatment policies in Kenya and other African countries. Dr. Loice Ombajo, Principal Investigator and CEMA Co-Director, said the results "showcase African-led research generating evidence to improve HIV treatment policies for populations often underrepresented in global research including older adults, people experiencing treatment failure including pregnant and breastfeeding women."

The Ndovu Study: When the Leading HIV Drug Starts to Fail

Dolutegravir, often referred to as DTG, is widely used in HIV treatment because it is effective, generally well tolerated, and has historically had a high barrier to drug resistance. But that picture is changing. Dr. Ombajo noted that "while resistance to dolutegravir has historically been considered rare, increasing use of DTG-based antiretroviral therapy across sub-Saharan Africa has led to increasing recognition of emerging drug resistance."

The Ndovu study is a multi-country prospective cohort study in Kenya, Tanzania, Mozambique, and Lesotho examining the optimal approach in the management of people experiencing treatment failure while on dolutegravir-based treatment, including patterns of DTG drug resistance. Between September 2025 and April 2026, 72 participants were randomized to either continue on the standard-dose DTG or switch to a ritonavir-boosted darunavir regimen. Early results demonstrated better viral suppression among participants receiving the alternative drug, with 80% of that group showing a drop in viral load at one month, compared with just 19% in the DTG arm. That's a striking gap — and one that could reshape how doctors respond when first-line treatment stops working.

The Sungura Study: Simplifying Treatment for Older Adults

The Sungura Study, a 96-week, open-label study conducted at two Kenyan sites, evaluated the efficacy and safety of switching older adults from a three-drug regimen to a two-drug combination of dolutegravir and lamivudine among adults over 60 years of age. The study followed 197 adults aged 60 and above in Kenya, with participants switching from a three-drug regimen containing bictegravir, emtricitabine, and tenofovir alafenamide to a simpler two-drug combination.

The findings suggest that the simpler two-drug HIV treatment is a safe option for older adults who have previously been exposed to Hepatitis B. This matters enormously in practice. Older patients on HIV treatment often carry other health conditions and take multiple medications, making simpler regimens not just convenient but potentially safer over the long term. Reducing lifetime exposure to medications could benefit patients who may remain on HIV treatment for decades — as one expert noted, "if we can reduce the number of medications that a person gets exposed to over this lifetime of treatment, we can potentially reduce the side effects associated with that third drug."

Why African-Generated Evidence Matters for Global Policy

The researchers stressed that studies conducted within African health systems are especially important because treatment decisions should reflect the realities faced by patients and healthcare workers in the region — including limited access to resistance testing, differences in healthcare infrastructure, and the needs of communities most affected by HIV. Dr. Ombajo was also invited to present the Ndovu study findings at a World Health Organization pre-conference Think Tank on HIV treatment, where the emerging evidence contributed to ongoing discussions on updating global guidance for people living with HIV who experience treatment failure despite DTG-based therapy.

The Ndovu studies were funded by the Gates Foundation, while the Sungura study was funded by ViiV Healthcare, and all studies were conducted in partnership with Kenya's Ministry of Health through the National AIDS/STI Control Program and sponsored by the University of Nairobi. With drug resistance quietly rising across the continent and an aging HIV-positive population requiring more nuanced care, the work coming out of CEMA signals that the next chapter of the HIV treatment story will increasingly be written in Africa — by Africans.