Nairobi — New HIV analysis introduced this week on the Convention on Retroviruses and Opportunistic Infections (CROI 2026) has revealed essential proof gaps that specialists say should be urgently addressed to strengthen HIV therapy methods throughout Africa.
Researchers from the Centre for Epidemiological Modelling and Evaluation (CEMA) on the College of Nairobi introduced findings from the Ndovu and Sungura research, which examined therapy outcomes amongst kids, adults with persistent viraemia, and older folks residing with HIV who’re on dolutegravir (DTG)-based regimens.
The research spotlight the pressing want for regionally generated, context-specific knowledge to information HIV therapy insurance policies and medical decision-making in African settings.
One Ndovu research centered on kids and adolescents experiencing persistent viraemia–the continued presence of HIV within the blood–despite adherence counselling. Paediatric DTG formulations, launched in sub-Saharan Africa in 2019, had initially supplied hope for improved outcomes.
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Nonetheless, findings from a big Kenyan cohort confirmed that 41 per cent of youngsters and adolescents with excessive viral masses whereas on DTG failed to realize viral suppression after three months, even after enhanced adherence counselling.
The researchers stated the findings expose a serious proof hole in figuring out efficient interventions for younger sufferers experiencing DTG therapy failure.
A second Ndovu evaluation examined adults with persistent viraemia on DTG-based regimens and located that many sufferers with two consecutive excessive viral load outcomes have been nonetheless capable of obtain viral suppression with out switching therapy.
Present steering from the World Well being Group (WHO) recommends switching to a protease inhibitor (PI)-based routine after two excessive viral load outcomes on DTG within the absence of drug resistance testing–a coverage extensively adopted in resource-limited settings.
Nonetheless, the Ndovu findings recommend such suggestions may end in pointless therapy switches, given the restricted supporting proof and the chance that some sufferers can re-suppress the virus with adherence assist alone.
In the meantime, the 96-week, open-label Sungura research evaluated the protection and effectiveness of switching adults aged 60 years and older from B/F/TAF (Bictegravir/Emtricitabine/Tenofovir Alafenamide) to DTG/3TC twin remedy.
At week 48, 100 per cent of members on DTG/3TC achieved viral suppression, demonstrating robust therapy effectiveness amongst older adults.
The research additionally highlighted the excessive burden of co-morbidities amongst older folks residing with HIV, together with kidney illness, diabetes, hypertension, and osteoporosis. Researchers emphasised that these circumstances should be rigorously thought of when choosing antiretroviral remedy for getting old populations.
One-size-fits-all method questioned
“Dolutegravir-based therapy has remodeled HIV care globally,” stated Dr. Loice Ombajo, Chief Investigator of the Ndovu research and Co-Director at CEMA.
“However our findings present that we nonetheless lack essential knowledge on interventions for key populations in Africa, together with kids, folks with persistent viraemia, and older adults above 60 years. With out these knowledge, therapy tips threat being both inadequate or overly aggressive.”
She added that the findings problem assumptions that uniform world therapy approaches are all the time applicable in African contexts.
“From the Ndovu outcomes, it’s clear {that a} one-size-fits-all method will not be optimum. We want higher instruments and knowledge to tell apart who really wants a therapy swap and who can safely proceed DTG with adherence assist,” she stated.
The Ndovu undertaking is a multi-country research underway in Kenya, Tanzania, Lesotho, and Mozambique, enrolling people with excessive viral masses whereas on DTG to raised perceive adherence challenges and potential drug resistance.
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As African international locations proceed increasing DTG-based therapy packages, researchers emphasised the necessity for sturdy native proof to maximise viral suppression whereas preserving future therapy choices.
“Knowledge saves lives. To finish HIV as a public well being risk in Africa, we should generate proof that displays the realities of the populations most affected,” Dr. Ombajo stated.
The Ndovu research have been funded by the Gates Basis, whereas the Sungura research acquired funding from ViiV Healthcare. All research have been carried out in partnership with Kenya’s Ministry of Well being by the Nationwide AIDS and STI Management Programme (NASCOP) and have been sponsored by the College of Nairobi.
The Centre for Epidemiological Modelling and Evaluation is a multidisciplinary analysis centre centered on enhancing well being outcomes by data-driven public well being analysis, bringing collectively infectious illness specialists, epidemiologists, laptop scientists, and knowledge analysts.