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November 29, 2011

For Children with AIDS, a Tolerable Regimen

For most of his short life, 14-year-old Lazarus has been on a strict drug regimen he calls "easy and hard."

"Like, in the morning, they are easy, and then they are hard," he says. "In the morning I take only four tablets and in the evening I take six, actually, the evening one, when I take [the tablets], I feel like I am a little bit dizzy. When I take all of them I hurt my neck."

Lazarus lives in Nyumbani, a home on the outskirts of Nairobi for orphaned children living with HIV/AIDS. He began his treatment a decade ago and developed resistance to some of the drugs during the process.

His situation reflects what children living with HIV/AIDS typically experience when receiving treatment. They often have to take many pills or bitter syrups and, commonly, adult dosages are divided into smaller parts for children, which can be dangerous if portions aren't properly sized.

But for many children just beginning their regimens, all that is changing. At the end of 2006, UNITAID, a global health initiative to increase access to medicine in developing countries established by Brazil, France, Norway, Chile and Britain, started a project to spur demand for child-friendly AIDS medicines.

The result is one pill, designed to be taken twice daily, that combines up to 16 different medicines. The special fixed-dose combination is a first-line treatment primarily meant for children starting their regimen, and for roughly 26 of 114 AIDS orphans living at Nyumbani, the pill provides welcome relief.

The home's executive director, Sister Mary Owens, says she is seeing a big difference.

"They had to take five, six, seven tablets - we had to break tablets, we had to open capsules," she says, describing a typical daily regimen before the pill's 2009 introduction. "Some of our children who went on anti-retroviral treatment after [the two-dose combination] became available are on one pill in the morning and one pill in the evening, so we’re very, very grateful for that."

She's also grateful for the international lobbyists who approached the large pharmaceutical companies that, in her opinion, should be motivated by more than just profits.

"[When] you think of a child inheriting the HIV virus and having to live their life with that virus, taking medication every day, all the other restrictions that affect the child’s life as the child grows up: this is totally unjust," she says.

Creating incentive


UNITAID spokesperson Daniela Bagozzi says virtually no children are born with HIV in the developing world, as measures have been taken to prevent HIV transmission during pregnancy. According to UNITAID estimates, of the developing world's 2.5 million children now living with HIV, nine out of 10 are in Sub-Saharan Africa.

She says pharmaceuticals initially did not see a viable market for children’s AIDS drugs, but now, after international lobbying efforts, companies are developing the medicines. Funded by government contributions and a tax on airline tickets, the UNITAID program, in partnership with the Clinton Health Access Initiative, now provides medicines to about 360,000 children worldwide.

"We approached the Indian generic manufacturers and basically we put the money on the table saying, 'Okay, we have these funds which are predictable and long-term, and we will be buying the medicines for the next three to four years.'" she says. "So this gave them the incentive to actually create medicines that were tailored to children’s needs."

According to United Nations AIDS agency estimates, out of the 1.8 million people who died of AIDS in 2009, one in seven were children, with an estimated 400,000 children becoming newly infected the same year.