A New Hope for Children Living with HIV

In 2021, approximately 1.7 million children aged 0–14 years were living with HIV globally (1). In total, an estimated 110,000 children died from preventable AIDS-related causes in 2021, attributed mostly to inadequate access to HIV prevention, treatment, and care, with 75% occurring in children under 10 years of age (2). Among these 1.7 million children worldwide aged 0­–14 years living with HIV, only slightly more than half are on treatment. This is significantly lower than adults, with approximately 76% receiving antiretroviral treatment (ART). Without timely treatment, evidence shows that one third of children infected with HIV at birth will die by age one, and half by age two (3).

Age-appropriate treatment options are becoming increasingly important, as evidence shows that progress towards viral suppression among children receiving ART is much slower than that of adults receiving ART (4). In Europe, a step is being taken towards increasing the amount of treatment options for children with the European Union marketing authorization of Triumeq, a dispersable, single tablet formulation of the fixed-dose combination of abacavir, dolutegravir, and lamivudine (5). The treatment is from ViiV Healthcare, a company that specializes in HIV treatments.

“Triumeq … is now approved for the treatment of children living with HIV, weighing 14 kg to <25 kg,” explains Ana Puga, global paediatrics lead, ViiV Healthcare. “Dolutegravir prevents HIV viral DNA from integrating into the genetic material of human host cells by inhibiting the activity of the enzyme integrase, while abacavir and lamivudine interfere with reverse transcriptase, an enzyme needed for the virus to replicate” (6–8).

Targeting children within this weight range could be paramount, as very young children face a large number of obstacles regarding treatment options. “We know that children and young people living with HIV have specific treatment needs, and options that work for them can be limited. This treatment provides an age-appropriate formulation of the single-tablet regimen to a younger population, making it easier to administer to young children who may find it difficult to swallow a tablet,” says Puga. “Furthermore, by successfully initiating young children onto age-appropriate treatments, it may help them foster a positive relationship with their lifelong treatment regimen early on.” HIV treatment is a lifelong commitment, and can help people living with HIV lead longer, healthier lives. HIV treatments also reduce the risk of the transmission of HIV (9).

Early testing and treatment for HIV is also essential in decreasing the mortality and morbidity of children with the disease. The World Health Organization (WHO) recommends that infants who are born to mothers living with HIV should be tested for HIV by two months of age, during the duration of breastfeeding, and when breastfeeding ends, due to the continued risk of transmission during this period. Infants or children who test positive for HIV should be started on ARV immediately in order to suppress the HIV virus. This continues to be a serious obstacle due to how the newest and most effective ARVs are designed for adults, lacking child-friendly formulations (10).

The accessibility of child-friendly HIV treatments has come a long way in recent years. “Since the approval of Triumeq in 2014, ViiV Healthcare has worked to accelerate the development, registration, and ultimately access to optimized pediatric antiretrovirals,” says Puga. “The EU’s Marketing Authorization marks a step forward in paediatric HIV care and means further treatment options should soon be available for young children living with HIV in Europe.”

The future looks hopeful for the improvement of treatment accessibility for children, with organizations like WHO, UNAIDS, and UNICEF partnering to bring together a new alliance aiming to eliminate AIDS in children by 2030. The new Global Alliance for Ending AIDS in Children by 2030 was announced at the International AIDS Conference in Montreal, Canada, in 2022. The aim of the alliance is to ensure that no child living with HIV is denied treatment by 2030, as well as to prevent new infant HIV infections. The alliance has put forth four major points of action, which are, “closing the treatment gap for pregnant and breastfeeding adolescent girls and women living with HIV and optimizing continuity of treatment; preventing and detecting new HIV infections among pregnant and breastfeeding adolescent girls and women; accessible testing, optimized treatment, and comprehensive care for infants, children, and adolescents exposed to and living with HIV; and addressing rights, gender equality, and the social and structural barriers that hinder access to services” (11). With new child-friendly treatment options becoming available, and global organizations taking a stand to ensure children are able to access these treatments, there is hope for further improving the mortality rate and morbidity of children living with HIV in the future.

References

1. UNAIDS. Global HIV & AIDS Statistics–2022 Fact Sheet. 2022. https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf

2. Unicef. Global and Regional Trends. July 2022. https://data.unicef.org/topic/hivaids/global-regional-trends/

3. Children & AIDS. Treatment in Children Living with HIV. https://www.childrenandaids.org/paediatric_treatment (accessed 7 March 2023).

4. Min Han, W.; et al. Global Estimates of Viral Suppression in Children and Adolescents and Adults on Antiretroviral Therapy Adjusted for Missing Viral Load Measurements: A Multiregional, Retrospective Cohort Study in 31 Countries. The Lancet HIV. 2021; 8(12) E766-E775.

5. Viiv Healthcare. ViiV Healthcare Receives EU Marketing Authorisation for Triumeq PD, the First Dispersible Single Tablet Regimen Containing Dolutegravir, a Once-daily Treatment for Children Living with HIV in Europe. Press release. 22 Feb. 2023.

6. National Institute for Health and Care Excellence. British National Formulary–Dolutegravir. https://bnf.nice.org.uk/drugs/dolutegravir/ (accessed February 2023).

7. National Institute for Health and Care Excellence. British National Formulary–Abacavir.https://bnf.nice.org.uk/drugs/abacavir/(accessed February 2023).

8. National Institute for Health and Care Excellence. British National Formulary – Lamivudine. https://bnf.nice.org.uk/drugs/lamivudine/ (accessed February 2023).

9. National Institutes of Health. HIV Treatment Adherence. US Department of Health and Human Services https://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-treatment-adherence (accessed 7 March 2023).

10. WHO. Treatment and Care in Children and Adolescents https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/treatment/treatment-and-care-in-
children-and-adolescents (accessed 17 March 2023).

11. WHO. New Global Alliance Launched to End AIDS in Children by 2030. News release. 2 Aug. 2022.

About the author

Alivia Leon is assistant editor for Pharmaceutical Technology.

Article details

Pharmaceutical Technology Europe
Vol. 35, No. 4
April 2023
Pages: 30-31

Citation

When referring to this article, please cite it as A. Leon. A New Hope for Children Living with HIV. Pharmaceutical Technology Europe 2023 35 (4).