HIV treatment for children and young people
What is paediatric treatment and how is it different to adult ARVs?
HIV is just as much of a health issue for young people as it is for adults. But it’s also just as manageable, and because young people are usually fitter, they can often seem to cope with it, and the side-effects of treatment, better. Most children get HIV from their mother during pregnancy, labour, birth, or breastfeeding.
The progression of HIV infection is different in babies and children, compared to adults, because their bodies are still growing and changing, and they don’t yet have a fully developed immune system. This means HIV can progress much quicker than in adults, who are more able to fight it off. Before people became more aware of HIV, and realised it could be passed from mothers to new babies, many of those born with the virus died within the first few years of life.
However, treatment for HIV in children is available and works very well, if it’s taken according to the same quite strict guidelines that apply for adults, that is if they adhere correctly to the drugs. Though many of the drugs that adults and children use are the same, the dosages are often different. This is because the amount of some drugs taken are calculated according to the child’s body weight, so the amount would be less than for an adult. But other drugs are required in larger doses, because children’s bodies process drugs quicker, so the doses need to be worked out carefully. Specific ARVs for children are also available, but there are far less different options than for adult ARVs.
So why aren’t more children getting treatment?
Two reasons for this are that there are less HIV drugs available for children, and there are still many social barriers in the way.
Regarding the availability of treatments, there are several reasons for this. For example, the impact of HIV on adults was realised first, so the development of treatments focused on them as a priority. ARVs for young people have always therefore lagged behind.
Another reason is that, until recently, drug companies haven’t been interested in developing HIV treatments for children because, unlike adult ARVs, which can be sold in rich countries for a large profit, 90% of children with HIV live in sub-Saharan Africa, where treatment effectively has to be paid for by governments or donor agencies, so there is little profit to be made.
There are also several reasons social why children are less likely to be getting HIV treatments that are available than adults.
HIV positive mothers are frequently stigmatised, abused, and neglected, and are therefore unable to care for their children properly. If their parents die, orphans are most often cared for by relatives, but can also suffer neglect or abuse as a result of them or their mother being HIV positive. Children are often shunned due to stigma, and if others don’t take up the responsibility to care, can be left without any support, even on the streets.
In some countries, because children tend to look healthy, people don’t believe they can have HIV, and therefore don’t seek testing and treatment. Sometimes parents can overcome the fear of stigma to get their children tested, but then are too scared to tell the child they are HIV positive.
Even if children do manage to get treatment, the prevailing economic conditions remains high hurdles to making it work. Although the drugs are theoretically free from state clinics, people need transport to get there, often many miles away, and they need nutritious food if the drugs are to work. Many people don’t have the money for pay for either.
How many young people are getting treatment?
It’s hard to obtain accurate figures for the number of young people being treated, or needing treatment, for HIV, but the current situation in Kenya is representative of many other countries in Southern Africa. In Kenya 150,000 children are HIV positive, and 60,000 of them urgently need treatment. About 20,000 are getting ARVs, but 40,000 aren’t and are likely to die unless they can. In other regions, the total number and the proportion not getting ARVs is almost certainly less, but children face similar barriers to HIV treatment all over the world.
Pills in doses specifically for children are now available, as are syrups for those too young even to swallow tablets. But because they are far less widely available, the best that clinics can do in many areas is break up adult tablets, and give them to children in pieces. The medicine is also unevenly distributed within the tablet, so the actual dosage in each case in unclear. The effectiveness of the treatment is therefore reduced.
What’s being done to help more children?
One of the relative success stories of HIV prevention is the spread of PMTCT – Prevention of Mother to Child Transmission. Where drugs and staff are available, babies can be born to HIV positive mothers with almost 100% certainty that they won’t contract the virus from their mother. As this mode of transmission is the most common for children, this is a big step forward. However, PMTCT is still not yet widely available is precisely those areas it is most needed, so many children are still needlessly born with HIV. Ensuring that PMTCT programmes real the least developed countries, and the rural areas in those countries, would probably be the biggest single achievement in reducing HIV in children.
For those children requiring treatment, a patent pool would help to speed up the development of paediatric ARVs, and reduce their cost, but progress towards creating a pool has been slow. It’s encouraging that GlaxoSmithKline have recently announced support for the idea, but if and how it will work in practise is still unclear. For more details on patent pools, see that specific issue.
Lushomo’s members are lucky to live in Lusaka, and have relatively good access to ARVs, but their cousins away from the major cities aren’t so lucky.
