New ARV pellets could be a game changer for young children with HIV
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Cape Town - SOUTH Africa is failing its children with HIV, and needs to urgently focus on finding and treating the thousands who are HIV-positive but not on lifesaving treatment.
However, a new drug formulation may be the game-changer that mothers of HIV-positive children have been desperate for.
There are currently an estimated 331 000 children living with HIV in the country, but only 63% of those are on treatment, according to data from April.
Dr Lesley Bamford, acting chief director of Child, Youth and School Health for the Department of Health, said only 77% of HIV-positive children under the age of 15 are aware of their status.
A particularly concerning group is adolescents who are old enough to know their status, are becoming sexually active, but are not on treatment.
“The number of children not on treatment is high in our adolescent population.
“Why is our progress lower in children compared to adults?
“There are difficulties in identifying (HIV-positive) children, particularly the slightly older children who are well and don't gain access to health facilities,” Bamford said this week at the SA National Aids Council (Sanac) webinar on paediatric HIV progress.
“The most important reason why children are lagging behind is that we have failed to focus adequately on children.
“We need to find those children, we need to initiate them and we need to make sure they are retained on treatment.”
For younger children, a massive factor in sticking to a treatment regimen is the medicine itself: it’s either an extremely bitter syrup, or a big pill that has to be swallowed whole.
“These are extremely unpalatable.
“We are very pleased that we now have Lopinavir/Ritonavir oral pellets that can be used as an alternative.
“We hope that this is something that will contribute to improved adherence amongst children,” Bamford said.
Mother Sinethemba Jali, whose young child is HIV-positive, knows all too well how hard it is to get a toddler to swallow his medication.
She described her struggle through a translator: “It’s difficult because the child is always complaining and he even cries when he is about to take the Kaletra (a combination ARV).
“A four year old might not understand why he must take this medication.
“But the child has to adhere, so I end up forcing the child to take the medication.”
The new oral pellets, called Lopimune, are like miniature pills that come in a capsule.
The caregiver can twist open the capsule, mix the pellets into a spoonful of food like porridge or yoghurt, and sneak it into the child’s mouth without any foul taste.
CIPLA’s medical advisor for infectious diseases and vaccines, Dr Precious Garnett, said the new product could be a game changer for children who need antiretroviral therapy.
“Sub-optimal formulations are likely a contributing factor to why only 63% of paediatric patients currently have a suppressed viral load,” she said.
“Convincing babies to take Kaletra is hard.
“Baby spits it out or vomits it out.
“This formulation is trying to solve the syrup/tablet problem.”
Referencing UNAIDS data for SA last year, Garnett said only 47% of children with HIV were on antiretroviral therapy in SA at the time.
“That means there’s 53% of children walking around with HIV (without treatment), when we have life saving medicine.
“We ought to be doing better.”
The Sanac Trust’s Coceka Nogoduka said the data shows we desperately need to focus on paediatric HIV treatment to have any hope of hitting the UNAIDS targets by 2030.
“Data has shown us that we are not doing well in tracking our children, in ensuring that our children that are born with HIV are well protected,” she said.
Nogoduka added that sharply rising sexual violence in SA means the number of children who become infected with HIV after birth has increased.
“We need to be able to track those children and link them to care.”
The National Strategic Plan (NSP) that governs the HIV/Aids response in SA is coming to an end next year, and stakeholders are currently busy writing a new one.
“The next NSP is critical for us as a country.
“It will be the last NSP for us before 2030, and it will really determine our contribution as a country and if we are going to be able to mitigate the HIV and reach the targets.
“The world is looking at us in South Africa to sort out our HIV incidence.”