April 25, 2011
A significant proportion of children infected with HIV at birth and now receiving antiretroviral therapy are experiencing virological failure, according to a new report. The retrospective European cohort study, which involved 1,007 children, found the risk of triple-class virological failure within five years was 12 percent.
One of the problems is that antiretroviral drugs are not tested on children or formulated for children to take easily, Nathan Ford and Alexandra Calmy, of Doctors Without Borders, wrote in an article accompanying the study. DWB treats many children with HIV/AIDS. Without treatment, about half would die before their second birthday.
"Of the 22 antiretroviral drugs approved by the U.S. Food and Drug Administration, five are not approved for children and six are not available in pediatric formulations," Ford and Calmy wrote. Some "are extremely unpalatable," they added. Pediatric HIV drugs should be a priority for drug developers, clinical trial investigators, and regulators, the two said.
The European children studied were all under age 16 and began treatment with three or more drugs between 1998 and 2008. While the failure rate was problematic for young children, it was even higher among older children, the study found.
"Drug adherence is a challenge for children and young people with any chronic disease," the study noted. "For those with HIV ... fear of stigma increases their isolation and tendency towards denial, all of which might adversely affect drug adherence."
The study and commentary, "Risk of Triple-Class Virological Failure in Children With HIV: A Retrospective Cohort Study" and "Improving Treatment Outcome for Children With HIV," were published ahead of the print edition of Lancet (2011;doi:10.1016/S0140-6736(11)60208-0 and doi:10.1016/S0140-6736(11)60363-2).
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