Symptoms, transmission, and current treatments for paediatric HIV
What is HIV?
The human immunodeficiency virus (HIV) is a virus that weakens the immune system, making the body less able to fight infections and cancers. Without treatment, HIV continues replicating within the body leading to an advanced stage of HIV infection called Acquired Immunodeficiency Syndrome (AIDS). At this stage, the body is very vulnerable to infections and cancers that can typically be fought by a healthy immune system, leading to chronic illness and death.
However, antiretroviral drugs are generally expensive, and there is not enough access to diagnostic tests and treatments in low- and middle-income countries.
Babies and young children with HIV are particularly vulnerable, with most not surviving to the age of five without treatment. Transmission of the HIV virus from a pregnant mother to a child can be easily prevented with current treatments, but a high number of paediatric infections still occur in some developing countries despite global progress in the prevention of mother-to-child transmission.
What is the impact of paediatric HIV?
- 1.7 million children living with HIV
- 160,000 new HIV cases in children in 2021
- 83% of children diagnosed with HIV in 2021 live in sub-Saharan Africa
- Only 52% of children with HIV receive treatment – compared to 74% of adults with HIV
- Without treatment, half of children with HIV will die before turning two
- Children comprised 4% of people living with HIV in 2021 but 15% of AIDS-related deaths
How is HIV in children treated?
At present, HIV cannot be cured, but it can be managed with combinations of antiretroviral drugs. However, due to the relatively low number of children living with HIV compared to adults, research on new HIV medicines specifically for children has been neglected.
The World Health Organization (WHO) recommends first-line treatment for babies and children of a boosted protease inhibitor with two nucleoside reverse transcriptase inhibitors in a combination of ABC + 3TC or ZDV + 3TC. Until recently, the only protease inhibitor available for young children was LPV/r, available in a form that was:
- not child-friendly (the syrup tastes terrible and contains 42% alcohol)
- not suitable for poor communities because it needs to be stored in a fridge
- difficult to store and transport.
Together with our partner Cipla, we have developed sweet-tasting, heat-stable, ‘4-in-1’ granules to treat young children, which were approved by the South African Health Products Regulatory Authority (SAHPRA) in 2022. Carers can give the medicine to children by sprinkling the granules over soft food like porridge or dissolving it in water or milk.
Multiple new child-friendly formulations of WHO-recommended regimens are now being introduced – including paediatric formulations of dolutegravir-containing regimens – representing a long-awaited and long overdue treatment revolution for children with HIV.
For children with both HIV and TB, WHO guidelines now recommend a ‘superbooster’ therapy we developed that has improved treatment results.
UNAIDS targets state that 95% of children should be on treatment by 2025. More child-friendly medicines are needed to roll-out treatment to more babies and young children, who are either receiving no treatment or suboptimal treatments. Access is also a problem: only 52% of children with HIV received antiretroviral treatment in 2021.
What new treatments for paediatric HIV are needed?
A better treatment for babies and young children would ideally be safe, easy to give, well-tolerated and palatable, heat-stable, and readily dispersible in commonly used food and liquids. It must also carry minimal risk for developing resistance, be compatible with drugs against tuberculosis, and affordable.
What paediatric HIV treatments are we working on?
We aim to help end the neglect of paediatric HIV by developing optimal child-friendly antiretroviral formulations for children living with HIV, with a special focus on babies and young children who are at the highest risk of dying without treatment.
Find out more about our work developing treatments for paediatric HIV
How do children get HIV?
- 90% of babies with HIV acquired the virus from their HIV-positive mothers during pregnancy, delivery, or through breast-feeding.
- Effective treatment can prevent HIV transmission from a mother to her child, but not all HIV-infected pregnant women have access to these treatments.
What is the effect of HIV on children?
Babies with HIV develop the same symptoms as adults, but the disease progresses faster. Symptoms include:
- slow growth and weight gain
- severe wasting
- diarrhoea and upper respiratory tract infections that cause increased medical problems and death
- infections such as tuberculosis
How is HIV in children diagnosed?
Rapid HIV-antibody tests have made field diagnosis of HIV inexpensive and technically feasible in poor communities.
Last updated: July 2022
Read about how Uganda is rolling out better ‘point-of-care’ early infant diagnostics
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