HIV studies reveal promising treatment options

Studies presented by the Center for Epidemiological Modelling and Analysis (CEMA), University of Nairobi, Kenya, address key evidence gaps including how to safely simplify treatment for ageing populations, what next when resistance to HIV medicines develops and how mothers and children can be protected.

The studies were presented at the 26th International AIDS conference that took place in Rio de Janeiro in Brazil.

According to Dr Loice Ombajo, Principal Investigator and CEMA Co-Director, “The results we presented 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 first three abstracts are from the Ndovu study, 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 (DTG)-based treatment including patterns of DTG drug resistance.

“While resistance to dolutegravir (DTG) has historically been considered rare, increasing use of DTG based antiretroviral therapy (ART) across sub-Saharan Africa has led to increasing recognition of emerging drug resistance,” said Dr Ombajo.

The first study involved resistance testing results; enrolling 2,994 participants across 131 sites in Kenya, who were on DTG-based treatment for at least 6 months. Then, participants identified with major DTG-associated drug resistance mutations (DRMs) were enrolled into a nested clinical trial to generate evidence that will guide the optimal management of people experiencing DTG treatment failure.

Between 1 September 2025 and 2 April 2026, 72 participants were randomised to either continue on the standard-dose DTG (38 participants) or switch to a ritonavir-boosted darunavir (DRV/r)-based regimen (34 participants).

Early results demonstrated better viral suppression among participants receiving DRV/r. At one month, 24 of 30 of participants in the DRV/r arm had a drop in viral load, compared with 7 of 37 in the DTG arm. By month three, 20 of 24 of participants receiving DRV/r had achieved viral suppression, compared with 3 of 23 in the DTG arm.

“There is currently limited evidence to guide the management of dolutegravir (DTG) resistance among people living with HIV. These results reinforce the urgent need for accessible tools to detect DTG resistance and support timely, evidence-based treatment decisions, particularly in resource-limited settings.” Dr. Ombajo added.

These preliminary findings suggest that, in the presence of major DTG-associated drug resistance mutations, continuing standard-dose DTG is associated with a higher risk of virological failure and that switching to DRV/r is highly recommended. The results also highlight the urgent need for better tools to identify DTG resistance and determine when patients should be switched to alternative treatment, particularly in settings where drug resistance testing is not widely or routinely available.

The Ndovu study also disseminated findings on the characteristics and clinical outcomes of pregnant and breastfeeding women with persistent HIV viraemia (viruses present in the bloodstream) while receiving DTG-based treatment.

Infant infections account for about 10 per cent of new HIV infections globally with sub-optimal adherence to HIV treatment and resultant viraemia during pregnancy and breastfeeding being the most likely cause of the infection.

The findings, shared by Dr Ombajo, revealed that in a cohort of 109 pregnant and breastfeeding women, the majority of the women are 25 years old or older, have been on treatment for more than 1 year, and had high viraemia of more than 10,000 copies/mL. Enhanced adherence intervention resulted in more than half of the mothers achieving virological suppression within 3 months while on the same treatment, demonstrating the need for timely viral load testing to eliminate vertical transmission.

The fourth abstract was from Sungura Study; which looked at whether a simpler HIV treatment is safer for older people living with HIV.

The study followed 197 adults aged 60 years and above in Kenya who switched from a three-drug HIV treatment regimen (Bictegravir/Emtricitabine/Tenofovir Alafenamide) to a simpler two-drug combination of Dolutegravir and Lamivudine.

Researchers wanted to find out whether removing Tenofovir (a medicine that also helps protect against the Hepatitis B virus) would increase the risk of Hepatitis B returning in people who had been exposed to the virus before.

Among participants, who had previously been exposed to Hepatitis B, 98 per cent showed no signs of active infection, and none experienced a return of the virus or developed a new Hepatitis B infection. These findings suggest that the simpler two-drug HIV treatment is a safe option for older adults who have previously been exposed to Hepatitis B.

The significance of these findings extended beyond the conference presentations.

“Our participation at the International AIDS Conference provided an opportunity to share Africa's research with the global scientific community while contributing to international discussions on the future of HIV prevention, treatment and care.” Dr Ombajo says.