12 Jan Antiretroviral treatment for children
Without antiretroviral treatment (ART), half of all children born with HIV will die before the age of two years. Although increasing numbers of children in resource-limited settings now have access to ART, important challenges remain.
The World Health Organization recommends the use of protease inhibitors for all children living with HIV who are under the age of three years. However, high costs and cold chain transport and storage problems make their use in low- and middle-income countries difficult.
The development of HIV drug resistance is another important problem in paediatric HIV treatment. Among children who fail their first-line treatment, more than 80% are resistant to one or more antiretroviral agents. In order to re-suppress the virus, these children need to be switched to an effective second-line regimen. Given that only a few antiretroviral drugs are currently available for second-line paediatric treatment in low- and middle-income countries, there are virtually no remaining options for children who become resistant to their second-line regimen. Addressing supply chain issues, adherence, and other concerns is critical to preserving ART effectiveness in children. Paediatric formulations of additional antiretroviral drug options are needed now for children living in resource-limited settings whose regimens are failing.