An estimated 95 000 children died of AIDS-related illnesses in 2019 due to lack of early diagnosis of HIV among infants and children and immediate linkage to optimal HIV treatment regimens.
WHO and its partners have called on national governments to embrace DTG based antiretroviral treatment for infant and children living with AIDS to reduce 95000 preventable death.
The global partners that are committed to ending paediatric AIDS have come together to call on countries to rapidly scale up access to optimal, child-friendly HIV treatment for infants and children. The partners include the United Nations Children’s Fund, the World Health Organization (WHO), UNAIDS, the United States President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, the Elizabeth Glaser Pediatric AIDS Foundation, and the Clinton Health Access Initiative (CHAI).
A joint statement by the global partners said children living with HIV, unlike adults, are being left behind by the global AIDS response. In 2019, only 53% (950 000) of the 1.8 million children living with HIV (aged 0–14 years) globally were diagnosed and on treatment, compared to 68% of adults. The remaining 850 000 children living with HIV have not been diagnosed and are not receiving life-saving HIV treatment.
WHO-recommended, preferred first line DTG-based antiretroviral treatment is now available in more affordable and child-friendly generic formulations for young children and infants as young as four weeks of age and weighing more than 3 kg. According to the statement, rapid transition to this optimal treatment regimen, in combination with improved HIV diagnosis for children and other supportive measures, will help to urgently reduce the 95 000 preventable AIDS-related deaths in children.
WHO said the DTG-based HIV treatment leads to better outcomes for children. DTG is less likely to be affected by drug resistance and achieves viral load suppression sooner; child-friendly dispersible tablets improve adherence due to a lower pill burden and being easier to administer. These factors help children achieve and maintain viral load suppression, the gold standard for measuring the effectiveness of HIV treatment. DTG-based treatment is the standard of care for adults. Starting on this regimen from infancy reduces the need for changes in treatment as they mature through childhood, adolescence and adulthood. Fewer regimens and regimen changes simplifies management of health care, improves stock management and reduces wastage.
WHO has recommended DTG-based HIV treatment for all infants and children since 2018 and provided dosing recommendations for infants and children over four weeks of age and more than 3 kg in July 2020.
The partners are committed to support national governments as they develop rapid transition plans from existing suboptimal HIV treatment to DTG-based treatment for infants and children, including advocacy for political commitment, mobilizing international and domestic resources, new policies and guidelines, managing medicine supply, distribution and stock, training health-care workers and sensitizing and engaging affected communities to ensure demand and treatment literacy for children living with HIV and their caregivers in order to ensure rapid uptake of these new formulations.
Further guidance for national programmes and partners is available from WHO.The CHAI HIV New Product Introduction Toolkit has dedicated resources to help countries transition to paediatric DTG.
Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes at WHO.said DTG treatment has the potential to be a true game-changer for children with HIV, “We must do all in our power to help countries get this new paediatric DTG 10 mg to all the children who need it.”
Shannon Hader, UNAIDS Executive Director for Programme said “National governments, partners on the ground and affected communities need to work together to find and treat the children and infants whose lives can be saved by these new medicines,”. Adding that the new medicines are cheaper, more effective and more child-friendly than current treatments for infants and young children. We need to get them into clinics to save lives now.”
Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. said “Providing antiretroviral drugs to people living with HIV is at the core of our support to national HIV programmes,this new and affordable child-friendly HIV treatment is a tremendous step forward that will improve and save the lives of some of the most vulnerable in society—young children infected with HIV”
While speaking on the DTG, Philippe Duneton, Unitaid Executive Director.said “children in low- and middle-income countries often wait years to access the same medications as adults, hindering their quality of life, or even resulting in preventable deaths. We are proud to have worked with partners on this ground-breaking agreement that will bring quality assured dispersible DTG to children at a record pace,” “Ensuring access to this treatment will transform the lives of children living with HIV, helping them to remain on treatment and saving thousands of lives.”
“For the first time, children living with HIV in low- and middle-income countries will have access to the same first-line antiretroviral medication at the same time as those in high-income countries,” said Iain Barton, Chief Executive Officer of the Clinton Health Action Initiative. “The partnership should serve as a model to remove barriers that hinder development of paediatric formulations to deliver top-line medications quickly and affordably.”
“The persistent treatment gap between adults and children prevents us from achieving an AIDS-free generation,” said Chip Lyons, President and Chief Executive Officer of the Elizabeth Glaser Pediatric AIDS Foundation. “Children living with HIV around the world urgently require age-appropriate, effective and accessible formulations. Approval of dispersible DTG is a momentous step forward, but meaningless if this new formulation doesn’t quickly reach the babies and small children who desperately need it most. The Elizabeth Glaser Pediatric AIDS Foundation is committed to supporting accelerated roll-out, uptake and delivery of new, optimal paediatric antiretroviral medicines in partnership with global, regional and local leaders.”
“The persisting treatment gap between mothers and children is unacceptable with the new scientific breakthroughs that are within our reach to change the trajectory”, said Chewe Luo, Associate Director and Chief of HIV, United Nations Children’s Fund. “The United Nations Children’s Fund welcomes global commitments and progress made in developing better diagnostic approaches and optimal regimens for children to improve their outcomes.”