Kids forgotten in AIDS treatment

As countries roll out anti-AIDS drugs to a growing number of people living with HIV/AIDS, the percentage of HIV-positive children on treatment remains disturbingly low. In a satellite meeting on Sunday ahead of the 14th International Conference on AIDS/STIs in Africa (ICASA) opening ceremony, Medecins Sans Frontieres (MSF) called for appropriate diagnostic tools and medicines adapted to children's needs. The medical humanitarian agency alleges that because most children with HIV/AIDS live in the developing world, there is little commercial interest in creating and marketing child-friendly treatments. "Children in the developing world don't represent a lucrative market," commented Dr Felipe Garcia de la Vega, a paediatrician working for MSF. According to the 2005 UNAIDS AIDS Epidemic update released last month, an estimated 2.3 million children under 15 years are HIV-positive - the majority living in developing countries. Although treatment for HIV is constantly evolving, generic antiretrovirals (ARVs) for adults typically consist of three drugs in a "fixed-dose combination" in one pill. Most adults on ARVs take standard doses of drugs in one or two pills twice a day. But treatment for children is not so simple. Pharmaceutical companies have not yet developed fixed-dose combination treatments in dosages appropriate for them, and physicians must often portion out a cocktail of three separate adult-dose medicines in different combinations as the child grows. Simplification means setting dose standards - including combinations of syrups and crushed or broken pills - by the weight of the child. This sometimes results in overdosing, with increased side effects, but that is generally preferred to underdosing, which can gradually lead to resistance to the medication. Mpumie Mantangana, a clinic manager at one of MSF's treatment sites in Khaelitsha, a Cape Town township in South Africa, admitted there were "lots of problems" when treating children, particularly when the caregivers had to be trained to provide precise dosages. She stressed the need for paediatric HIV/AIDS to be placed high on the international agenda, saying: "It's an emotional issue [especially because] these kids don't have anybody to shout for them." Paediatric formulations are also more expensive than adult treatment, Garcia de la Vega noted. Treating a child for one year could be as much as US $816, while the same triple-drug regimen for adults can cost only $182. Nevertheless, there are signs of hope. Pharmaceutical companies Cipla and Ranbaxy are developing low-dose fixed combination ARVs for children, which should be available soon.