Children With HIV/AIDS Falling Through Treatment Scale-Up Efforts

According to Dr. Bernard Pécoul, Executive Director of the Drugs for Neglected Diseases initiative (DNDi), children with HIV/AIDS are falling through the cracks as 250,000 children died of HIV-related complications in 2010 or nearly 700 each day.

There are several reasons for this situation which includes lack of access for pregnant women to antenatal care, HIV testing, and antiretrovirals (ARVs) to prevent mother-to-child transmission and treat expecting mothers, as well as difficulties diagnosing HIV in infants. But one of the most significant and overlooked is the lack of suitable formulations of ARVs adapted for children, particularly babies and toddlers. The reason for this neglect lies with the success of the virtual elimination of HIV among newborns in wealthy countries.

Dr. Pécoul said that there is little profit to be made from developing treatments for the millions of children with HIV/AIDS, 90 percent of whom are the poorest of the poor in sub-Saharan Africa, and the lack of market incentive means pharmaceutical companies do not develop ARVs adapted to their needs. And without such treatment, half of the children born with HIV die before their second birthday.

Key existing pediatric ARV formulations taste bad, require impractical multiple liquid preparations and refrigeration, and have undesirable interactions with tuberculosis (TB) drugs. World Health Organization (WHO) recommends immediate ART for all HIV-positive children less than two years old, but the safety and correct dosing have not been established in very young children for the majority of ARVs approved for adults.

DNDi now aims to develop an improved first-line therapy for children under three years of age. This ARV combination therapy that is being developed needs to be easy to administer and better tolerated by children than current drugs, as well as stable in heat and is easily dissolvable in water or breast milk. The latter must also carry minimal risk for developing resistance and require minimum weight adjustments, and must be compatible with TB drugs.

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