Millions of children living with HIV/AIDS in developing countries need immediate access to treatment

There is an immediate need for the provision of antiretroviral therapy developed for children, including smaller pills and combination therapies, as well as enhanced medical training to provide care to HIV-positive children in developing countries, according to an American Academy of Pediatrics policy statement published on Monday in the April issue of the journal Pediatrics, the AP/San Francisco Chronicle reports (Tanner, AP/San Francisco Chronicle, 4/1).

Combination therapies that include three or more antiretroviral drugs could reduce AIDS-related mortality rates among children by at least fivefold and allow 90% of children living with the disease to survive to adulthood, according to AAP, Reuters reports.

At least 3.5 million HIV-positive children, mostly in sub-Saharan Africa, still lack access to treatment, the statement said.

"Lack of availability of appropriate antiretroviral drug formulations that are easily usable and inexpensive is a major impediment to optimal care for children with HIV," the statement said, adding, "The time and energy spent trying to develop liquid antiretroviral formulations might be better used in the manufacture of smaller pill sizes or crushable tablets, which are easier to dispense, transport, store and administer to children."

Although most pediatric HIV cases are the result of mother-to-child HIV transmission during pregnancy, delivery or breast-feeding, fewer than 10% of pregnant women worldwide are offered HIV tests, antiretroviral treatment and safe alternatives to breast-feeding before and immediately after giving birth, the statement said.

AAP also called for expanding training for medical personnel to teach them how to provide services for HIV-positive children (Reuters, 4/2).

"Appropriate testing technologies need to be made more widely available to identify HIV infection in infants," the statement said, adding, "Training of practitioners in the skills required to care for children with HIV infection is required to increase the number of children receiving antiretroviral therapy" (Pediatrics, April 2007).

The policy statement was endorsed by several international organizations, including the World Health Organization, the Indian Academy of Pediatrics, the Latin American Pediatric Association and Britain's Royal College of Pediatrics and Child Health (Reuters, 4/2).

"We hope that this outline ... will give some guidance to the pharmaceutical industry about where it might be best for them to put some of their energies," Peter Havens, chair of an AAP AIDS committee, said.

He added that the statement also seeks to increase awareness among lawmakers and that two federal measures promoting research and development of drugs for children are up for reauthorization this year.

"It's important for lawmakers to know this issue is important," Havens said (AP/San Francisco Chronicle, 4/1).