e-alliance ::

Background information on pediatric AIDS

The proportion of children living with HIV who are receiving treatment is far smaller than the proportion of adults living with HIV receiving it. For adults the percentage is 30%, but for children it is only 15%. Children's deaths are sometimes seen as more unavoidable, and medicines for children are less profitable.

HIV-positive children and adults need antiretrovirals to treat HIV. But children need medicines, which are differently formulated compared to those for adults: all children need smaller volumes of the active ingredient than adults; they require products that are easy to administer by parents, grandparents or other caregivers; and babies, young children and very sick children need medicines that can easily be swallowed. Problems here include:

(a) Difficulty in diagnosing HIV in infants, given the limited availability of the testing equipment necessary for children less than 18 months of age.

As babies acquire their mother’s antibodies, regular diagnostic tests that detect HIV antibodies can only say if the mother has HIV, but they cannot see if the virus has been transmitted to the baby. Alternative diagnostic tests, which look directly for the virus, are available but require expensive laboratory equipment, complex testing, reliable electricity supplies and highly trained staff. One development is a technique, called dried blood spot testing, that allows blood to be taken to a laboratory for testing, but this still relies on the existence of an equipped laboratory within reach of transport links.

As half of all children born with HIV die before they are two years old unless they get treatment, diagnosis is needed far earlier. What is urgently needed is a simple, cheap diagnostic test that can be carried out on the spot.

The limited coverage of programs to prevent mother-to-child transmission (PMTCT) also must be vastly improved. If a woman already is living with the virus, then her baby may become infected during pregnancy or delivery. HIV can also be transmitted through breast-milk. MTCT can be reduced to less than 2 per cent by a short-course of antiretroviral medicines combined with an elective caesarean section and avoidance of breastfeeding, when appropriate. However, only about a third of pregnant women have access to these services, much less long-term access to HIV treatment with anti-retrovirals.

(b) Once diagnosed, regular testing is needed to see when a child living with HIV needs to start treatment.

(c) There are few pediatric ARV formulations to treat HIV in children, especially infants, and suitable to poor settings. Trying to divide pills intended for adults into dosages for children can lead to dangerously imprecise dosing. Syrup formulations often need refrigeration, which is not available in many regions, and are still hard to dose correctly. For all but the youngest of babies, small solid pills of the appropriate dosage are preferable.

(d) Some formulations for children may not have been marketed outside of rich countries and thus are not available elsewhere.

(e) Some formulations for children, including some recently developed pediatric Fixed Dose Combinations, the three-in-one pill combinations which make treatment far easier, have not been submitted for registration by pharmaceutical and generic companies, approved by regulatory authorities, and qualified by WHO. Pharmaceutical companies and regulatory authorities need to speed up the processes of registration. Generic suppliers have now begun to manufacture a number of pediatric fixed dose combinations. However, of those only one has been approved by the USFDA and qualified by WHO, while others can only be used in few countries. By contrast, the treatment of adults is greatly simplified by the wide availability of fixed dose combinations.

(f) Where formulations are available, they are often more expensive than adult formulation and treatment is often started too late to be effective.

(g) Even where medicines, such as basic antibiotics, are available and affordable, many treatment programs are not yet sufficiently informed and focused on treatment for children and are thus not providing access to medicines.

(h) For many drugs no tests have been done on their effects on children.

Learn more:

  • Preferred antiretroviral medicines for treating and preventing HIV infection in younger children report by WHO Pediatric Antiretroviral Working Group - PDF (EN)
  • Children and AIDS Second stocktaking report UNICEF UNAIDS WHO, April 2008 - PDF (EN)
  • Keep The Promise - To Children Living with HIV and AIDS A briefing paper by the Ecumenical Advocacy Alliance, 18 June 2007 - PDF (EN, FR)
  • Children and HIV/AIDS Medecins Sans Frontieres - PDF (EN)
  • Paediatric AIDS drugs: what's urgently needed Medecins Sans Frontieres - PDF (EN)
  • Children left out: global community failing to scale up the prevention and treatment of pediatric HIV/AIDS Global AIDS Alliance - PDF (EN)
  • Children left behind: global stakeholders failing to adequately prevent or treat pediatric HIV/AIDS Global AIDS Alliance - PDF (EN)
  • Big Pharma and small patients: treating children with HIV - the role of faith-based investors. Interfaith Center on Corporate Responsibility - PDF (EN)
  • HIV/AIDS: treatment for children UNICEF - PDF (EN)
  • Children - the missing face of AIDS: a call to action UNICEF - PDF (EN)
Prescription for Life Resource Guide
Keep the Promise Resource