Pediatric AIDS: A Neglected Disease

Without antiretroviral treatment, up to 80% of HIV-infected children die before their 5th birthdayEvery day 500 children die of AIDS in the world, most of them in low-income countries of Africa and Asia. This may seem like a relatively small number next to the 4,000 adult deaths every day due to AIDS. But if you think about it, this is a total of 210,000 children dying every year from a disease that can be treated. We know that treating HIV-infected children as early as possible gives them the best chance of having a healthy life. Without antiretroviral treatment, up to 80% of HIV-infected children die before their 5^th birthday. Perhaps the 32 million adults living with HIV/AIDS worldwide has overshadowed the pediatric AIDS epidemic. This has translated into less research, poor pediatric treatment services and inadequate antiretroviral treatment (ART) regimens for children. Pediatric AIDS has thus come to be considered as a neglected disease, in other words a forgotten disease of low-income populations.

There are very few antiretroviral treatment formulations suitable for children How did this happen?  In 2011 UNAIDS announced a plan for eliminating mother to child transmission of HIV by 90% by 2015. This led to great efforts to expand programs of prevention of mother to child transmission (PMTCT) throughout sub Saharan Africa, the region most affected by HIV. These PMTCT programs have resulted in healthier mothers and fewer HIV infections in children. But what about treatment for those children who were already HIV-infected or are missed by the PMTCT programs? In 2013, 30% of HIV-infected children worldwide needing ART were actually receiving it. This is a far cry from the 60% of eligible adults receiving ART.

Since pediatric AIDS has become very rare in industrialized countries, the demand for antiretroviral treatment formulations specifically tailored to children is predominantly in the poorest areas of the worldSo why aren’t more children receiving antiretroviral treatment? A wide array of different antiretroviral medicines exists for adults. This gives plenty of leeway to fine tune dosage and offers options in case of severe side effects or drug resistance. There are, however, very few ART formulations suitable for children. Taking a quarter or a half of an adult tablet and crushing it into water does not lend itself to accurate dosing. Limited antiretroviral medicines exist in syrup forms or doses easy to adapt to small growing children and there are few alternatives. Since pediatric AIDS has become very rare in industrialized countries, the demand for ART formulations specifically tailored to children is predominantly in the poorest areas of the world. There has thus been little incentive for the pharmaceutical industry to develop drugs primarily destined for sub Saharan Africa where over 80% of the 3.2 million HIV-infected children live. 

It will be some time until mother-to-child transmission of HIV in sub Saharan Africa is reduced to zero. Until then, there will be children infected with HIV in need of treatment and care. Responding to this urgency, the Pediatric HIV Treatment Initiative (PHTI) was launched in 2014 by several organizations seeking to ensure that all children living with HIV have access to adequate affordable treatment. This initiative brings together key players from research institutions, pharmaceutical companies and financing and development organizations. The newly formed PHTI will accelerate the development and delivery of treatment options for children living with HIV. What is the way forward? Stimulating research, creating incentives and formulating funding schemes solely focused on treatment of HIV-infected children is a very good start. It is time we made untreated pediatric HIV-infection a thing of the past.