children living with HIV resid

This article is essential reading for everyone committed to Millennium Development Goal 4, a two-thirds reduction in mortality for children under five by 2015 – that has to be all of us. Clearly documented here is the history and current status of paediatric antiretroviral therapy – an estimated 38% of children in need were on antiretroviral therapy in 2008. Roll out started in industrialised countries but new paediatric infections in these countries have dwindled dramatically with the advent of effective prevention of mother-to-child transmission and safe supplies of blood and blood products. Many challenges face this field in low- and middle-income countries where the vast majority of children living with HIV reside – demand, logistics, funding, attitudes, formulation hurdles – all the factors underpinning low product utilization. UNITAID; the Global Fund to fight AIDS, Tuberculosis and Malaria; PEPFAR; the WHO pre-qualification programme; the USA Food and Drug Administration; Médecins sans Frontières; innovator pharmaceutical companies; generic companies – these are some of key players shaping the global paediatric antiretroviral market. Price negotiations need to ensure affordability along with sufficient profit to sustain prices and stabilize the market. Research is urgently needed at country level to understand how to facilitate uptake of new, improved formulations such as dispersible tablets which dissolve in a small amount of water – they are lighter to carry than syrups and suspensions, and as heat stable as solid formulations.