International pharmaceutical industries and governments are failing to develop and produce AIDS medicines and diagnostic tools suited to children, claimed Médecins Sans Frontières at the XV International AIDS Conference in Bangkok.
However, the organisation reported getting good clinical results in treating children by utilizing creative techniques to educate children and their caretakers about HIV and help them adhere to treatment.
"Children who need treatment have to drink great amounts of foul-tasting syrup or swallow large tablets, and that's only if they are even able to access treatment in the first place," said Dr. David Wilson, Medical Coordinator of MSF programs in Thailand.
"Commercial pharmaceutical companies do not bother to develop paediatric formulations of AIDS medicines because children are not an attractive market."
The large success of efforts to prevent transmission of the virus from mother to child in developed countries means that relatively few children are being born with HIV in wealthy countries. The resulting lack of a profitable market means that paediatric formulations are in short supply despite the growing need for them in developing countries. The only hope on the horizon is that some generic companies are developing fixed-dose first-line therapies.
The estimated worldwide number of children with HIV/AIDS was over 2.5 million in 2003. In the same year, 700,000 children under the age of 15 were newly infected with HIV/AIDS, 88.6% of whom live in sub-Saharan Africa. Their prognosis is not good. Approximately 50% of children with HIV/AIDS die before the age of two. MSF began treating children with ARVs in December 2000 and by March 2004 about 5% of MSF patients were children under 13.
Although MSF is not yet treating large numbers of children, MSF teams have created innovative tools, such as health diaries, treatment calendars, and fairy tales about "Devimmon," a witch that is a metaphor for HIV, to help children adhere to treatment.
MSF is committed to doing better for children but our efforts are frustrated by the lack of proper tools.
The first challenge is to know if children are HIV positive. Standard serological tests are not reliable in infants less than 18 months. In addition, monitoring CD4 is also difficult, since most of the commercially available CD4 machines are not adapted for use in young children.
The second critical challenge is the lack of paediatric formulations of ARVs, which makes determining and administering doses complex and burdensome. Currently, doses are determined according to weight or body surface and must be adjusted as the child grows.