New MSF data shows treatment of children works in resource poor settings
Medecins Sans Frontieres (MSF) - International MSF International - www.msf.org
2006-08-16
MSF and MSF Podcasts : Toronto - Two new studies released by Mdecins Sans Frontires (MSF) at the XVI International AIDS Conference in Toronto demonstrate good outcomes in antiretroviral treatment of children living with HIV/AIDS across a wide array of resource-poor settings, but that paediatric drug formulations are excessively overpriced, costing up to six times more than adult equivalents.
Globally, an
estimated 2.3 million children are living with HIV, the vast majority in
sub-Saharan
Africa
. Nine out of ten newly infected children acquire the virus through
mother-to-child transmission, largely because efforts to prevent mother-to-child
transmission are insufficent.
Far too few children
receive treatment - only 5% of the 660,000 in urgent need - and there are no
tests for diagnosing infants and very few adapted tools to treat children. MSF
stated that international organizations have been late to respond to the needs
of an increasing number of children living with HIV/AIDS and warned that
scaling-up treatment of children will be impossible without immediate action.
MSF presented
clinical data collected from the world's largest paediatric ART cohort in
resource-poor settings. Data released on 3,754 children under 13 in MSF
treatment programmes in 14 countries showed that children can be treated
effectively: 80% were alive and continuing therapy after 24 months on treatment,
with few adverse side effects. Significant gains in CD4 count and weight were
observed. In the absence of suitable paediatric formulations, most children were
treated with broken adult tablets.
We know that
treating children works, but with better tools we could be treating so many
more, said Dr Moses Masaquoi, of MSF in
Malawi
. And we see the number of children born with HIV constantly growing in
Africa
, because expecting mothers don't have access to antenatal care and children
born to HIV positive mothers are largely lost to follow-up.
This partly explains
the worrying fact that children under a year and a half represented less than 5%
of children on ART in MSF projects.
Diagnosing and
treating children remains a major challenge. Diagnosis difficult in
resource-poor settings because antibody-detection tests commonly used in adults
are not accurate for that age group.
Treatment is
difficult because there are very few appropriate paediatric dosages of
antiretroviral drugs, forcing caregivers to split adult tablets that are not
designed for partial intake - an option that is far from ideal.
For children
weighing less than 10 kg, even this strategy is impossible, as the only
treatment options are syrups that are difficult to measure, bitter tasting,
often need refrigeration, and are overpriced. Because the vast majority of
infected children live in poor countries, most pharmaceutical companies are
hardly investing in developing paediatric formulations.
MSF data presented
on pricing showed that pharmaceutical companies are charging excessively marked
up prices in resource-poor countries for paediatric formulations of ARVs. These
prices are not justified by the amount of active pharmaceutical ingredient (API)
the formulations contain.
API is the main
driver of the cost of drug production and therefore of the final price - it
typically accounts for more than half of what it costs to produce a drug. As an
example, the dose of zidovudine required to treat an adult costs US175 per
year, while treating a child under 10 kg with zidovudine syrup requires less
than a third the amount required of API, Costs based on the contents of API
should be US40. However the drug is marketed for US215, over 5 times more than
that.
WHO and UNICEF need
to issue a strong call for urgently needed formulations to serve as clear
guidance to manufacturers. Because such guidance was lacking, two companies have
started producing a long-awaited fixed-dose-combination, but in different
dosages.
Lack of
guidance from WHO is making the treatment of children even more confusing, and
some clear indications three years ago could have really helped avoid
this, said Fernando Pascual, pharmacist with MSF's Campaign for Access to
Essential Medicines.
MSF provides
antiretroviral treatment to more than 60,000 patients spread across 65 projects
in 32 countries, including to over 4,000 children. MSF has been caring for
people living with HIV/AIDS in developing countries since the mid 1990s, and
first began providing antiretroviral treatment in 2000 (in
Thailand
and
South Africa
).
MSF Briefing
Document for the XVI International AIDS Conference: TOO LITTLE FOR TOO
FEW: Challenges for effective and accessible antiretroviral therapy
available at http://www.accessmed-msf.org www.accessmed-msf.org and
http://www.msf.ca/aids2006 www.msf.ca/aids2006
Mdecins sans
Frontires (MSF) is an independent international medical humanitarian
organization assisting victims of armed conflict, epidemics, and natural or
man-made disasters. Founded in 1971, with national branch offices in 19
countries, MSF delivers aid through over 500 medical programs in nearly 80
countries around the world.
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