HIV treatment for children

HIV treatment for children

HIV treatment for children slows the progress of HIV infection and allows infected children to live much longer, healthier lives. Yet, almost three-quarters of the children who could be benefiting from this therapy in low and middle-income countries are not receiving it.³⁵

Children ideally need to be given drugs in the form of syrups or powders, due to difficulties in swallowing. However, drug treatments involving syrups for children are generally more expensive. As a result, carers are often forced to break adult tablets into smaller doses, running the risk that children are given too little or too much of a drug. Studies suggest that breaking down adult tablets into smaller doses can work effectively although this should only really be seen as a last resort.³⁶

Although the cost of first line therapy for children has reduced dramatically due to the availability of generic drugs ($50 a year on average in 2009 compared to about $20,000 a few years before)³⁷, when a child develops drug resistance and needs to begin a second course of drugs, treatment becomes far more expensive. More drugs suitable for children are qualified by the WHO every year, but without access to cheap generic versions of them the majority of HIV infected children will not benefit. The latest WHO guidelines recommend children start treatment as early as possible after diagnosis and suggest that where necessary they receive a complex set of drugs including protease inhibitors to reduce the likelihood of drug resistance. However, this will require more resources and higher levels of funding.³⁸

“More drugs suitable for children are qualified by the WHO every year, but without access to cheap generic versions of them the majority of HIV infected children will not benefit.”

Another major problem for children living with HIV is childhood illnesses, such as mumps and chickenpox. These illnesses can affect all children, but since children living with HIV have such weakened immune systems they may find that these illnesses are more frequent, last longer, and do not respond as well to treatment. Opportunistic infections, such as tuberculosis and PCP (a form of pneumonia), are also a serious risk to the health of children living with HIV.

Opportunistic infections can be prevented using drugs such as cotrimoxazole: a cheap antibiotic that has been proven to significantly reduce the rate of illness and death among HIV-positive children. Countless lives could be saved if cotrimoxazole were made more widely available, but at the moment it is estimated that only 14 percent of children who could be benefiting from the drug are receiving it.³⁹

One of the greatest challenges when it comes to treating children with HIV is loss to follow up. This is when a patient tests HIV positive but does not return to a health facility to receive treatment. Some of the reasons children are lost to follow up include "clinical organization and data flow of results, lack of caregiver contact information, stigma and counselling challenges, the burden on patients to return for results, and weak follow-up within clinics."⁴⁰ In certain parts of West Africa it has been found that 25 percent of children who were tested early and began to receive treatment stopped treatment after 18 months. One suggested reason for this was the price of user fees demanded for laboratory tests for infants. Generally, however children's adherence to treatment has been found to be "as good or better" in low and middle-income countries compared to richer countries, although it should be noted that this is highly variable even within countries.^{41 42 43}