Childhood HIV is in danger of becoming a neglected disease, say experts

BMJ 2012; 345 doi: (Published 30 November 2012) Cite this as: BMJ 2012;345:e8213
  1. Anne Gulland
  1. 1London

The success in reducing the number of children born with HIV is in danger of leaving children who already have the disease with poor access to treatment, experts in HIV and AIDS have warned.

Denis Broun, executive director of Unitaid, a not for profit organisation that purchases drugs for the treatment of HIV and AIDS and other diseases, has welcomed news that the number of new infections in children is falling. But he said that because fewer children are born with the virus, drug companies would no longer have an incentive to manufacture treatments and that childhood HIV might become a neglected disease.

A report by UNAIDS, the joint United Nations programme on HIV and AIDS, released a week before world AIDS day on 1 December, said that the annual number of new HIV infections among children worldwide had fallen from 560 000 in 2003 to 330 000 in 2011.1 However, it said that only 28% of children who needed antiretrovirals got them, whereas the proportion in adults is 50%.

Broun said, “As the prevention of mother to child transmission becomes more successful and we have fewer children born with HIV, that will no longer represent a market that is important enough for pharmaceutical companies.”

The market for paediatric formulations of HIV drugs is small, with currently only 12 manufacturers. Some firms have already said in private that if orders were not big enough and were not predictable they would pull out.

Broun said that the ideal scenario would be to keep a nucleus of three to five manufacturers. “The first thing is to try to recruit children into some kind of single market. Rather than having a country ordering paediatric drugs for 10 or 20 children it would be better to pool all these orders into one single order to make the market attractive enough,” he said.

He added that Unitaid was taking steps to act as such a “clearing house” for purchasing drugs for children.

Kate Iorpenda, senior adviser on HIV and children at the International HIV and Aids Alliance, said that, in the worldwide push to stop transmission from mothers to their babies—“the mantra of the AIDS-free generation”—children already infected with HIV were in danger of being forgotten.

She said that paediatric HIV drugs were not a profitable market for drug companies and that there was a lack of drugs that were “appropriate, affordable, and palatable.”

She explained, “For many countries there’s a huge issue around the cost of paediatric HIV drugs. These are more complex formulations—adult treatments adapted for use in children—and you need different levels of drug, depending on the body mass of the child.”

Many people did not have access to staff trained in the administration of paediatric drugs, she added.

Cost to the family was also a factor, said Iorpenda. Although they might get the drugs for free, families might face other costs associated with treatment, such as travel, registering with a doctor, and other drugs, such as antibiotics. If a whole family was infected with HIV the costs would be even higher, she added.

Emma Seery, head of development finance and public services at the charity Oxfam, said that it was “outrageous” that children’s access to HIV drugs depended on there being a viable market. Oxfam is urging international donors to honour their commitments on foreign aid. The UNAIDS report said that seven million people, 1.4 million of whom were children, do not have access to antiretrovirals. Oxfam blamed this on a $1bn shortfall in the budget of the Global Fund to Fight Aids, Malaria and Tuberculosis.

“It’s very important for the UK to keep its promises on donations and to keep up the pressure on other countries. We’re worried about donors who are rolling back their support,” said Seery.


Cite this as: BMJ 2012;345:e8213


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