E-DRUG: MSF Releases New Data on Paediatric AIDS
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New MSF Data Shows Treatment of Children Works in Resource Poor Settings
But Scale-up Is Hampered by Ill-adapted Tools and Exorbitant Costs
Toronto, 15 August 2006: Two new studies released by Medecins Sans
Frontieres (MSF) at the XVI International AIDS Conference in Toronto
demonstrate good outcomes in antiretroviral treatment of children living
with HIV and AIDS across a wide array of resource-poor settings, but that
paediatric drug formulations are excessively overpriced, costing up to six
times more than adult equivalents.
Globally, an estimated 2.3 million children are living with HIV, the vast
majority in sub-Saharan Africa. Nine out of ten newly infected children
acquire the virus through mother-to-child transmission, largely because
efforts to prevent this are insufficient. Far too few children receive
treatment - only 5% of the 660,000 in urgent need - and there are no
appropriate tests for diagnosing infants and very few adapted tools to
treat children.
MSF stated that international organizations have been late
to respond to the needs of an increasing number of children living with
HIV and AIDS and warned that scaling-up treatment of children will be
impossible without immediate action.
MSF presented clinical data on outcomes of treating children in
resource-poor settings. Data released on 3,754 children under 13 in MSF
treatment programmes in 14 countries showed that children can be treated
effectively: 80% were alive and continuing therapy after 24 months on
treatment, with few adverse side effects. Significant gains in CD4 count
and weight were observed. In the absence of suitable paediatric
formulations, most children were treated with broken adult tablets.
'We know that treating children works, but with better tools we could be
treating so many more,' said Dr Moses Masaquoi, of MSF in Malawi. 'And we
see the number of children born with HIV constantly growing in Africa,
because expecting mothers don't have access to antenatal care and children
born to HIV positive mothers are largely lost to follow-up.' This partly
explains the worrying fact that infants under a year represented only 2% of
children on ART in MSF projects. Without treatment, half of children who
acquire HIV through mother-to-child transmission die before the age of two.
Diagnosing and treating children remains a major challenge. Diagnosis is
difficult in resource-poor settings because antibody-detection tests
commonly used in adults are not accurate for that age group. Treatment is
difficult because there are very few appropriate paediatric dosages of
antiretroviral drugs, forcing caregivers to split adult tablets that are
not designed for partial intake - an option that is far from ideal. For
children weighing less than 10 kg, even this strategy is impossible, as the
only treatment options are syrups that are difficult to measure, bitter
tasting, often need refrigeration, and are overpriced.
Because the vast majority of infected children live in poor countries, most pharmaceutical
companies are hardly investing in developing paediatric formulations.
MSF data presented on pricing showed that pharmaceutical companies are
charging excessively marked up prices in resource-poor countries for
paediatric formulations of ARVs. These prices are not justified by the
amount of active pharmaceutical ingredient (API). API is the main driver of
the cost of drug production and therefore of the final price - it typically
accounts for more than half of what it costs to produce a drug.
As an example, the dose of zidovudine required to treat an adult costs
US$175 per year. The amount of API in the adult dose is more than a third
of that contained in a dose of zidovidune syrup for treating a child under
10 kg. Logically, the syrup should cost US$40. However, the drug is
marketed for US$215, over 5 times more than that.
WHO and UNICEF need to issue a strong call for urgently needed formulations
to serve as clear guidance to manufacturers. Because such guidance was
lacking, two companies have started producing a long-awaited
fixed-dose-combination, but in different dosages.
'Lack of guidance from WHO is making the treatment of children even more
confusing, and some clear indications three years ago could have really
helped avoid this,' said Fernando Pascual, pharmacist with MSF's Campaign
for Access to Essential Medicines.
MSF provides antiretroviral treatment to more than 60,000 patients spread
across 65 projects in 32 countries, including to over 4,000 children. MSF
has been caring for people living with HIV and AIDS in developing countries
since the mid 1990s, and first began providing antiretroviral treatment in
2000 (in Thailand and South Africa).
MSF Briefing Document for the XVI International AIDS Conference
'TOO LITTLE FOR TOO FEW: Challenges for effective and accessible antiretroviral therapy'
available at www.accessmed-msf.org and www.msf.ca/aids2006
For more information, contact:
Sheila Shettle: +1.416.455.7916
Lorna Chiu: +1.416.892.1496
at Toronto AIDS Conference: +1.416.455.7916
Sheila Shettle
Communications Officer
Medecins Sans Frontieres
Campaign for Access to Essential Medicines
Rue de Lausanne 78
1211 Geneva
Switzerland
+ 41.22.849.8403
sheila.shettle@geneva.msf.org
www.accessmed-msf.org