Children and HIV/AIDS

© Francesco Zizola / Noor

“Our results in treating children are very good, but it’s an uphill battle. With better diagnostic tools, treatments that kids will swallow and that their bodies will respond to, many more young children could lead relatively normal lives.” Dr. Rachel Thomas, MSF, Kibera, Kenya


Children with HIV left behind
MSF has shown that children with HIV in its care respond well to treatments adapted to their needs. However the development of child-adapted anti-retroviral medicines (ARVs) and diagnostics has been scandalously slow.

Children: the most neglected victims of HIV/AIDS
Over 2 million children are infected with the HIV virus. Nearly 90% of them live in sub Saharan Africa. The vast majority of them don’t have access to care and treatment. Without treatment, half of all infected babies will die before their second birthday.

We need more simplified, child-adapted, quality and affordable paediatric drugs and diagnostic tools.

Paediatric AIDS: largely a disease for children in developing countries
The vast majority of children infected with HIV contract the virus from their mothers either during pregnancy, at birth or while breastfeeding. In developed countries, pregnant women with HIV are given ARVs so that they don’t pass on the virus to their unborn child but prevention of mother-to-child transmission efforts in developing countries have been far less successful.

Thus, paediatric AIDS is not a problem in rich countries. What this means is that pharmaceutical companies have not been concerned to develop paediatric treatments because there is no market incentive for them to do so. This leaves an enormous gap when it comes to trying to adequately diagnose and treat children with HIV/AIDS in developing countries.

MSF has been struggling since the beginning of its antiretroviral therapy (ART) programmes in 2000 to provide children with the best possible care, given the major constraints. Of the more than 100,000 people MSF provides with ART, roughly 7% are children (7,000).

Difficulties of testing for paediatric HIV
It’s impossible to diagnose whether a child under 18 months has HIV by the standard diagnostic test. This is because the standard test measures the amount of antibodies in the bloodstream but until 18 months old, an infant’s bloodstream carries its mother’s antibodies. So in order to identify a child as HIV positive or not, we need a test that can indicate whether the virus is present or not in the child's bloodstream. Such a test exists but is very expensive and cannot be carried out in remote settings at present. As a result, many children go undiagnosed or their diagnosis comes too late to treat them. MSF has been working with several partners to try to come up with solutions that could save many more childrens' lives.

Painfully slow progress on paediatric treatments
Until recently, there were no treatments specifically formulated for children with HIV. What that meant was that children were often treated with adult pills, caregivers breaking in half or even sometimes crushing adult tablets, or trying to dose with hard-to-measure syrups. This kind of approximate dosing does not lead to the best medical outcomes. Now, six years after fixed-dose-combination treatments (FDCs) revolutionized treatment for adults in developing countries, a few FDCs are now being produced specifically for children.

MSF has authorized these products for use in its own projects after a process of internal validation. However while the World Health Organization (WHO) has endorsed the use of these existing formulations, it still has not listed any of these products its pre-qualification programme. This has the practical effect that children across the developing world do not have access to these products.

We need to continue to press for companies to test their drugs in children and to produce paediatric versions of their drugs. And we need WHO to push through approval more rapidly of these and other paediatric products, so that national treatment programmes can more easily obtain them.

MSF is keeping up the pressure for:

  • Companies to develop paediatric formulations of AIDS drugs;
  • The WHO to approve new paediatric formulations as swiftly as possible so that they can be made available for countries to include in their AIDS treatment protocols;
  • The development and implementation of simplified HIV diagnostic techniques for children, including ‘dry blood spot’ testing technology; and for
  • WHO and UNICEF to provide clear and simple recommendations to manufacturers on needed formulations and dosages for children.

Read more

Children and HIV/AIDS Factsheet

New paediatric AIDS treatment data show good clinical results

MSF and HIV/AIDS

TB Co-infection

Registration Barriers

Push for Better Tools

Promoting Generic Competition

Pushing Prices Down

Patent Barriers

Need for Newer Drugs

What Needs to Happen