New HIV Studies Highlight Urgent Necessitate for More Data to Optimize Treatment in Africa

New HIV studies presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2026) highlight critical evidence gaps that must be addressed to improve HIV treatment strategies across Africa. Researchers from the Centre for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi presented findings from the Ndovu and Sungura studies, examining treatment outcomes among children and adults with persistent viraemia while on dolutegravir-based regimens and older adults living with HIV.

Key Findings from the Ndovu and Sungura Studies

• Treatment Failure in Children and Adolescents: 41% of children and adolescents failed to suppress the virus after three months despite receiving enhanced adherence counseling, indicating a need for more effective interventions for this age group.
• Viraemia on Dolutegravir: Many individuals with two consecutive high viral load results while on dolutegravir (DTG) were still able to suppress the virus without changing treatment. This underscores the need for stronger data to determine whether adults with viraemia on DTG should switch to a protease inhibitor (PI) after two consecutive high viral loads without drug resistance testing, as per WHO guidance.
• Dual Therapy in Aging Populations: 100% of participants on dolutegravir/lamivudine (DTG/3TC) dual therapy achieved viral suppression at week 48 in an aging population living with HIV. This suggests the need for additional considerations when selecting antiretroviral therapy for adults aged 60 years and older, given the high prevalence of co-morbidities in this population.

Dolutegravir-Based Treatment: A Global Transformation

“Dolutegravir-based treatment has transformed HIV care globally,” said Dr. Loice Ombajo, Chief Investigator for the Ndovu study and co-director at CEMA University of Nairobi.

Second-Line Switch to Dolutegravir

A study conducted by Loice A. Ombajo, M.B., Ch.B., and colleagues from the University of Nairobi in Kenya, found that switching to dolutegravir as a second-line treatment for HIV infection was non-inferior to continuing a ritonavir-boosted PI-based regimen. The prospective, open-label trial involved patients who had viral suppression while receiving treatment containing a ritonavir-boosted PI. Participants were randomly assigned to switch to dolutegravir or continue their current regimen.

At week 48, the percentage of patients meeting the primary endpoint (plasma HIV type 1 RNA level of at least 50 copies/mL) was similar in both groups (5.0% in the dolutegravir group and 5.1% in the ritonavir-boosted PI group). No mutations conferring resistance to either dolutegravir or the ritonavir-boosted PI were observed at the time of treatment failure. The incidence of treatment-related grade 3 or 4 events was likewise similar between the two groups (5.7% and 6.9%, respectively).

The authors suggest that this trial provides information that could facilitate a transition from ritonavir-boosted PI-based regimens to dolutegravir-based regimens in approximately 75% of patients currently receiving second-line therapy, offering advantages in terms of cost, toxicity risk, drug-drug interactions, and pill burden. EATG

Implications for HIV Treatment in Africa

These findings collectively emphasize the need for more context-specific data to guide treatment and policy decisions for HIV patients in Africa. Further research is crucial to optimize interventions for children and adolescents experiencing DTG treatment failure, refine guidance on when to switch DTG-based regimens for adults with viraemia, and tailor antiretroviral therapy selection for older adults with co-morbidities.