First major study of young people with HIV questions the suitability of anti-retroviral drugs for young sufferers
One in eight children born with HIV becomes resistant to the three main classes of drugs used to suppress the virus within five years of starting treatment.
The first major study of drug resistance in young people, which looked at 1,000 European children born with HIV, raises questions about the suitability of anti-retroviral drugs for the young.
Drugs fail because the virus becomes resistant to them. This can happen if people take them erratically or stop taking them. Resistance sets in with adults, but more slowly.
But part of the problem, say Nathan Ford and Alexandra Calmy, is that the drugs available are not tested on children or turned into formulations that are easy for children to take. The doctors work for Médecins sans Frontières, which treats some of the 2 million children living with HIV, who were infected during childbirth – most of them in the developing world. Half of the children born with HIV die before their second birthday, they point out.
Even in the US and Europe, drugs for children with HIV are limited. "Of the 22 antiretroviral drugs currently approved by the US food and drug administration, five are not approved for use in children and six are not available in paediatric formulations," they write in a commentary published with the study in the Lancet medical journal.
"Additionally, treatment has to be constantly adjusted for bodyweight, and most paediatric antiretrovirals are formulated as syrups (often in large volumes) which are difficult to administer and store." Some of the drugs, they add, "are extremely unpalatable".
Half of the children born with HIV already die before their second birthday, they point out. To give more children a chance of staying alive, fixed-dose combinations of a three-drug cocktail are needed, in tablet form. They call on "drug developers, clinical trial investigators and drug regulators" to prioritise the production of better HIV drugs for children.
The study was carried out mostly in the UK, Ireland, Spain, the Netherlands and France, with smaller numbers also from Denmark, Italy and Belgium. The children were all younger than 16 and had started treatment with three or more drugs between 1998 and 2008.
The failure rate in the three main classes of drugs – known as nucleoside or nucleotide reverse transcriptase inhibitors (NRTIs), non-NRTIs (NNRTIs), and protease inhibitors – was 12% within five years of starting. There were problems even with young children, where the parent or carer would be responsible for giving the medicine, but the failure rate was higher in older children.
"Drug adherence is a challenge for children and young people with any chronic disease. For those with HIV infection, there are additional factors, including coming to terms with disclosure of their HIV status, secrecy and guilt among adult family members and dealing with HIV alongside their own sexual development. Fear of stigma increases their isolation and tendency towards denial, all of which might adversely affect drug adherence."