Child-Adapted Medicines, Diagnostics, and Treatment Strategies Urgently Needed
Mexico City, 5 August 2008 — Treating children and adolescents living with HIV effectively in resource-limited settings is possible, but adapted medicines, diagnostic tools, and treatment strategies are urgently needed to prevent more deaths, according to Médecins Sans Frontières (MSF). In "Running in Place," a briefing document released by MSF this week at the XVII International AIDS Conference in Mexico City, MSF exposes the formidable challenges the organization still faces in treating over 10,000 children under 15 years of age on antiretroviral therapy (ART) in over 50 projects around the world.
Over the last five years, MSF started nearly 4,000 children under five years of age on ART in 20 countries. An analysis of all children enrolled in these programs from April 2002 to January 2008 showed that 79% were still on treatment. Unfortunately, children less than 12 months of age in these programs were much less likely to survive, showing the critical need for earlier access to exposed infants.
"Children are not only fighting against AIDS, they are fighting against time. Without treatment, half of the children born with HIV will die before they reach their second birthday," said Dr Fernando Parreño, a pediatrician for MSF in Zimbabwe, where MSF is treating more than 1,700 children on ART. "As long as we are still struggling to implement more effective prevention of vertical transmission strategies, it is imperative that all children are diagnosed and started on treatment as early as possible after diagnosis, or too many children will continue to die."
In an MSF program in Homa Bay, Kenya, survival in children after three years of ART was similar to that reported elsewhere in adults. Despite this good result, viral suppression was not achieved in 50% of treated children. It is difficult to definitively attribute these specific results to poor adherence; however, there is no question that there is an urgent need for pediatric adapted fixed-dose combinations, and child- and context-appropriate adherence strategies.
"So few children are born with HIV in developed countries that research into pediatric formulations is not a priority for pharmaceutical companies," said Karen Day, Pharmacist Coordinator at MSF's Campaign for Access to Essential Medicines. "Most of the drugs currently available are ill-adapted for use in resource-limited settings as they are either powders that need to be mixed with water or bitter-tasting syrups that also require refrigeration. And for the newly approved drugs, we have no safety data for use in children.
The most positive outcomes in MSF's pediatric treatment programs have been where a complete package included treatment, care and specific measures for patient support, including treatment literacy, ARV preparation, counselling and social support. Positive outcomes have also been seen in decentralized, nurse-based pediatric HIV programs.
"Medicines alone are not enough to keep children living with HIV/AIDS alive," said Dr Helena Huerga of MSF in Kenya. "They and their caregivers need to receive psychosocial support along with their treatment and care, especially as they grow older and into adolescence and beyond." MSF is providing ART to over 140,000 people in 27 countries, 10,000 of whom are children.