What We're Reading: Pediatric AIDS as a Neglected Disease
August 19, 2011
In the wake of this year’s largest international AIDS conference, we’ve been reading several articles highlighting the need for better AIDS medicines for children.
An HIV-positive mother in Uganda receives her medications
from a nurse. (Photo: EGPAF/James Pursey)
One headline in this week’s The New England Journal of Medicine
particularly caught our eye:
“Pediatric HIV – A Neglected Disease?”
The editorial outlines
some of the unique challenges faced by children living with HIV and AIDS, including fewer options to treat the disease.
The article points out that there are currently many more medicines for adults living with HIV than there are for children. One of the main reasons: Since children represent a small population and limited market share, pharmaceutical companies are less inclined to manufacture AIDS drugs specifically for pediatric use.
This is what spurred Elizabeth Glaser to create the Pediatric AIDS Foundation
in 1988, to ensure that children had equal access to lifesaving AIDS medicines.
Children living with HIV and AIDS also face another significant challenge – geography.
According to an article published last week
in The Journal of the American Medical Association
, children’s access to AIDS medicines may vary depending on where in the world they live.
In the U.S., where protocols to prevent HIV transmission from mothers to babies were widely implemented in the 1990s, new cases of pediatric HIV infections have been virtually eliminated. As a result, there is less demand for drugs to treat HIV in children in the U.S.
However, in low- and middle-income countries in Africa and other regions, hundreds of thousands of children continue to contract HIV every year. Without proper and immediate treatment, half of these children will die before their second birthdays.
But despite the urgent need, less than one-third of children who need AIDS treatment actually receive it.
Yesterday, Voice of America profiled a new initiative
, led by the Drugs for Neglected Diseases initiative (DNDi)
, which is tackling pediatric drug development issues. The article underscores that while drugs are available to prevent mother-to-child-transmission of HIV (PMTCT), not enough pregnant women worldwide are receiving them. And for those infants who are infected with HIV, there are not enough formulations of antiretroviral drugs that are suitable and palatable for children.
This is what prompted DNDi to declare pediatric AIDS a neglected disease, and children living with HIV/AIDS a neglected population. DNDi launched a program in July at the 6th International AIDS Society (IAS) conference in Rome to address the unmet treatment needs of children.
According to DNDi
, pediatric AIDS drugs need to be “easy to administer and better tolerated by children than current drugs, as well as heat stable, easily dispersible, and dosed once daily or less.”
In her Global Health blog, Sarah Boseley of The Guardian
reports the practical difficulties in developing pediatric drug formulations for children living with HIV. Important issues, such as minimizing children’s risk of developing drug resistance, adjusting for children’s growth and weight variations for proper dosing, ensuring compatibility with pediatric tuberculosis treatments, and minimizing costs must be considered.
While research and drug development will go a long way to provide better pediatric HIV medicines, the widespread implementation of programs to prevent and treat HIV in children will need continued attention and resources.
Over the past decade, there has been considerable success in scaling up PMTCT programs in sub-Saharan Africa, where more than 90 percent of new pediatric infections occur. Still, only about half of pregnant women in need have access to these lifesaving services.
Improved clinical research, drug and vaccine development, and service delivery will all be necessary to eliminate new cases of HIV in children, and effectively treat those living with the virus.
Only with concerted efforts in each one of these areas will we reach the day when pediatric AIDS is no longer considered a neglected disease, and in fact, a rare one.
Jen Pollakusky is a Senior Public Policy and Advocacy Officer for Africa, based in Washington, D.C.