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AIDS care ignores children

July 13, 2004 By Apoorva Mandavilli This article courtesy of Nature News.

Companies fail to design drugs for kids.

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The global fight against AIDS is not addressing children, the very group that is hit hardest by the pandemic, says the medical charity Médecins Sans Frontières (MSF).

In recent years, there has been considerable progress in developing diagnostic tests and anti-AIDS drugs for adults. But doctors lack the simple tools needed to diagnose and treat children infected with the virus.

"Children are a discriminated minority, they are a marginalized community," David Wilson, medical coordinator of MSF in Thailand told the XV International AIDS Conference in Bangkok.

In 2003, an estimated 700,000 children under the age of 15 were newly infected with HIV. Most of these live in sub-Saharan Africa.

Around half of all children infected with HIV die before the age of two, and mortality rates are compounded by a lack of proper diagnostic tests. In children under 18 months, the standard test can give false positives by picking up antibodies from the mother.

Tests that identify genetic material from the virus are more accurate, but they are not readily available in developing countries and are about 20 times as expensive.

There are also few medications designed for children. In most cases, drugs made for adults are given to children in syrup form, but with little information about dosing or effectiveness. "Children who need treatment have to drink great amounts of foul-tasting syrup or swallow large tablets, and that's only if they are able to access treatment in the first place," says Wilson.

Most companies are developing syrups for children, but many need to be mixed with water and, in some cases, refrigerated. In some African countries, access to clean water is difficult and refrigeration impossible, says Fernando Pascual, an MSF pharmacist based in Geneva. The drugs "are not made for children in Africa", he says.

The drugs that are available are often expensive. Although adult treatment can cost around US$200 a patient each year, the best price for the same drugs for children can top US$1,300.

MSF says there is not enough of a market to entice pharmaceutical companies to design antiretroviral drugs for children. In the United States and Britain, fewer children are born infected with HIV each year. "If these companies are not adapting drugs for the 1,000 children in the United States and Europe, they will not do it for the 700,000 children in Africa," Pascual says.

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