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New recommendations on HIV treatment for children require earlier diagnosis, new drug combinations for maximum impact
Keith Alcorn, 2013-07-02 02:00:00
New World Health Organization (WHO) guidelines recommending antiretroviral treatment for all children under the age of 5, and treatment for all older children and adolescents with CD4 counts below 500 cells/mm3 will, need to be backed-up by efforts to greatly improve early infant diagnosis, together with development of easier-to-take antiretrovirals for children, paediatric experts told the 7th International AIDS Society conference (IAS 2013) in Kuala Lumpur on Monday.
Two million children already eligible for antiretroviral therapy (ART) are still not receiving treatment in low- and middle-income countries, Maria Penezzata of the WHO told a satellite meeting on treatment access for children organized by the Drugs for Neglected Diseases Initiative, UNITAID and the Medicines Patent Pool.
The new WHO recommendations, issued on 30 June, will increase the number in need of treatment by around 750,000, but she expressed concern about the speed at which the number of children being treated is growing. “ART coverage increased by less than 10% between 2011 and 2012,” she told the meeting. In comparison, adult ART coverage grew at its fastest rate ever in the same period.
Although some countries in southern Africa have already achieved what UNAIDS defines as universal access – treatment for greater than 80 to 85% of those in need – global coverage of treatment stood at 34% in 2012.
The biggest obstacle to early treatment for children is the failure to diagnose HIV in the first weeks of life. The proportion of children exposed to HIV who receive HIV DNA testing ranges from 81% in Swaziland and 88% in South Africa to just 4% in Nigeria.
Children may not be tested because their health records fail to note that they have been exposed to HIV, but important opportunities for testing are also missed at immunisation clinics, attended by over 80% of mother-and-infant pairs in many countries in sub-Saharan Africa. A greater focus on integrating early infant diagnosis into immunisation clinics, together with better health information systems to ensure that HIV-exposed infants are not lost after delivery, would be significant steps forward in improving rates of early infant diagnosis, said Chewe Luo, Senior Adviser on HIV/AIDS at UNICEF.
Better integration of adult and infant HIV care would also help in initiation of more children on treatment. In Thailand, for example, there are 1016 clinics where adults can start ART, but only 616 clinics where children can start ART, and many children are still initiated on ART by a specialist physician at a hospital rather than a nurse at a local health clinic. More personnel trained in paediatric HIV care would allow children to start treatment at a wider range of treatment centres, said Dr Thanyawee Puthanakit of the Department of Paediatric Medicine at Chulangakorn University, Bangkok.
Greater awareness of HIV, its symptoms and its treatment in children among the community would also help to increase the number of children treated. Many parents believe that if a child born to parents with HIV is not sick within the first two years of life, there is little chance that the child has HIV, and so they do not seek testing for the child, said Dr Puthanakit.
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