No treatment available for 85 per cent HIV-positive children

By Anindita Ramaswamy Jul 25, 2007, 7:20 GMT

Sydney - An estimated 85 per cent of HIV-positive children globally who need critical, life-extending treatment and care don't have access to it, according to data revealed Wednesday at the largest scientific AIDS conference.

An estimated 2.3 million children are HIV-positive, according to reports from the World Health Organisation (WHO) and UNICEF. At least 780,000 of them need to get on to antiretrovirals. In sub-Saharan Africa, children represent 14 per cent of those who need anti-AIDS drugs, but only 6 per cent receive them.

'We need to expand treatment coverage, and to do that, it is essential to have more and better paediatric antiretroviral formulations,' said Annette Sohn, professor of Paediatric Infectious Diseases at the University of California, San Francisco. 'We urgently need drugs for children that have limited long-term metabolic side-effects.'

Paediatric AIDS is largely under control in wealthy nations. Children are dying in the developing world because they have no access to treatment, without which, half of all babies infected with HIV die before their second birthday, according to the international medical humanitarian organisation Médecins Sans Frontières (MSF).

It isn't easy to diagnose HIV infection in infants, which is done in adults through an antibody test. Babies born to HIV-positive women acquire their mother's antibodies, and these can remain in the blood as long as 18 months, making it hard to tell if they have been infected. A critical issue is how early treatment should start.

As infants' immune systems are not fully developed in the first year of life, and they are especially susceptible to rapid HIV progression and death, as well as other serious infections. Currently, the world over, infants are treated with antiretrovirals only after they show signs of illness or a weakened immune system.

However, the initial results of a path-breaking clinical trial released Wednesday at the 4th International AIDS Society Conference on Pathogenesis, Treatment and Prevention, has revealed that more HIV-infants survive if they are given therapy early on, regardless of their apparent state of health.

The trial, called the Children With HIV Early Antiretroviral Therapy or CHER study, is in phase III in South Africa, and is sponsored by the US National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institute of Health (NIH).

'This is the first randomised clinical trial that shows infants treated before three months of age will do better than infants who have delayed treatment,' said NIH director Elias Zerhouni.

The initial results underline the importance of diagnosing HIV infections early, within the first 6-12 weeks of life.

NIAID director and White House adviser Anthony Fauci said, 'The results of this trial could have significant public health implications worldwide because these findings will cause experts to consider changes in standards of care in many parts of the world.'

The CHER study cannot, however, be generalised to adults or older children, because infants have very different immune function. CHER began 2 years back to evaluate whether early antiretroviral therapy given over a limited period would delay disease progression. It was hoped that this would allow the immune system to develop and possibly allow the child to stop treatment for a while, avoiding continuous therapy from an early age.

The trial started in July 2005 and is designed to continue through 2011. But a review of early trial data on June 20, 2007 revealed a significant increase in survival among infants who received immediate antiretroviral therapy - 96 per cent of the children were alive, compared to only 84 per cent of children in the control group.

Avy Violari, of the University of Witwatersrand in South Africa who led the trial, said starting antiretroviral therapy before 12 weeks of age reduced early mortality by 75 per cent. 'These results support the need for enhanced mother-to-child prevention programmes, early infant diagnosis and effective transition to care.'

This is important because nine times out of 10, children become infected with HIV through mother-to-child transmission - during pregnancy, child birth or while breastfeeding. Yet, this 'vertical' transmission is easily preventable by giving pregnant women antiretrovirals.