Kenya’s HIV treatment program appears to be safer than many countries when it comes to drug resistance, thanks to its reliance on tenofovir-based regimens. Recent findings show that resistance to dolutegravir (DTG), the backbone of Kenya’s first-line HIV therapy, is far less likely when combined with tenofovir compared to older drugs such as zidovudine or abacavir.
Dolutegravir has long been hailed as a game changer in the global HIV response because of its high barrier to resistance. However, experts note that when used on its own, HIV can still adapt. For this reason, global health guidelines recommend that DTG is always combined with two other drugs from different classes to ensure long-term effectiveness.
The findings highlight that the risk of resistance depends significantly on the companion drugs used. Patients taking zidovudine were found to be nearly 20 times more likely to develop resistance compared to those on tenofovir, while those on abacavir were more than five times more likely. The difference is linked to the drugs’ half-lives, or how long they remain active in the body. Dolutegravir binds to HIV for more than 70 hours, and tenofovir also stays in cells for several days. In contrast, abacavir and zidovudine fade much faster. When doses are missed, dolutegravir may end up working alone, giving the virus a chance to adapt.
Kenya introduced the TLD combination—tenofovir, lamivudine, and dolutegravir—in 2019 as the national standard for adults and adolescents. According to the Ministry of Health’s HIV treatment guidelines, TLD remains the preferred first-line therapy due to its durability and effectiveness.
Children, however, face a more complex situation. Tenofovir is not recommended for those under 30kg because of potential bone and kidney side effects. Instead, abacavir is paired with lamivudine and dolutegravir, and zidovudine may be used if abacavir causes adverse reactions. This makes children more vulnerable to developing resistance, limiting their treatment options early in life.
Drug resistance poses a serious challenge for HIV management. Once the virus adapts, standard regimens stop working, forcing patients to switch to second-line or third-line therapies that are more expensive, harder to tolerate, and less accessible. For children, early resistance can mean exhausting available treatments before adulthood, leading to lifelong struggles with more complex drug regimens.
Kenya’s reliance on tenofovir-based therapy has provided strong protection for most patients, but ongoing vigilance is needed to safeguard children and ensure that resistance does not undermine progress in the fight against HIV.
