Neena Bhandari
SYDNEY, Jul 25 2007 (IPS) – The 4th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention concluded here Wednesday with a call for antiretroviral drugs developed specifically for HIV-infected children.
A Lesotho woman holds HIV medication for her granddaughter. Credit: Eva-Lotta Jansson/IRIN
We must do more to protect our future, finding better ways to treat the youngest among us and pursuing integrated prevention strategies grounded in behaviour change and biomedical science, said IAS president Dr Pedro Cahn, conference co-chair and director of Fundación Huesped in Argentina.
As many as 2.3 million children are living with HIV (human immunodeficiency virus), with around 600,000 new infections each year. As many as 780,000 children need antiretroviral (ARV) drugs, but only 15 percent of the global need is being met. In sub-Saharan Africa, children represent 14 percent of people who need antiretroviral treatment, but only six percent of those receive it.
Without treatment half of all infants infected will die before their second birthday. There is shocking failure of the global community on drugs for children. What we urgently need is more and better generic paediatric ARV formulations a wider range of drugs; dual and triple combinations; scored, crushable, dispensable tablets; granules or sachets, said Dr Annette Sohn, an expert from the paediatric infectious diseases division at the University of California in San Francisco.
Most of the world has been forced to split adult tablets into child-size pieces, she said. However, splitting tablets into anything less than one half risks under- or over-dosing. It means children who require smaller sized pieces may be under-dosed, leading to inadequate drug levels and risk of treatment failure.
The goal of treatment in children must be balanced between halting the effects of the HIV disease and the long-term effects of antiretroviral on a developing child, Sohn added.
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Promoting adherence and providing social support for the family are additional ways to help delay treatment failure and secure a future for children as they grow toward adulthood, she said.
She explained that HIV-infected children on antiretroviral drugs risk HIV encephalopathy, where the brain swells and damages tissue over time, resulting in reduced neurocognitive development and lower bone density.
While early treatment of children was said to increase survival rates, some children on early treatment have been forced onto second- and third-line ARV drugs because the virus quickly builds resistance. It s clear that response to treatment is better when children are started before they develop severe immune deficiency, Sohn added.
The four-day conference opened with the Sydney Declaration urging governments to allocate 10 percent of HIV funding to research, both medical and operational, to ensure treatment reached those in the world s poorest nations. By the close of the conference, nearly 1,600 scientists, clinicians, policy-makers and community leaders from around the world had signed it.
HIV presents one of the greatest and most complex scientific challenges of our time. Confronting this challenge will require sustained political will and increased resources dedicated to AIDS research, said David Cooper, co-chair of the 2007 IAS conference and professor of medicine and director of the national HIV centre at the University of New South Wales in Sydney.
New, less toxic ARVs are being developed to overcome resistance, and although millions of people in the developing world who need the drugs don t receive them, access to ARVs has steadily improved. In sub-Saharan Africa more than a million people were getting the drugs by June 2006, a 10-fold increase since December 2003, according to UNAIDS (Joint United Nations Programme on HIV/AIDS).
Cooper said, In the developing world we are giving out the most toxic combinations of drugs, which are not being used in the developed world. We are rolling out these bad regimens, because they are cheap. The major challenge facing the scientific community is to develop second- and third-line treatment in developing countries, critical for those who develop resistance to first-line drugs.
The closing day plenary session focused on the promise and challenges associated with biomedical prevention strategies and the obstacles posed by the adaptive capacity of HIV.
Dr Ben Berkhout s experimental virology laboratory at the University of Amsterdam has demonstrated for the first time that HIV-1 can not only become resistant to drugs, but also become dependent on certain antiviral drugs. He said the HIV-1 strain has an enormous adaptive capacity, which hampers therapeutic intervention because the virus can become resistant to antiviral drugs used in the clinic.
Delegates also heard about current and promising prevention technologies, including the use of drugs to suppress genital herpes, microbicides, pre-exposure prophylaxis, and cervical barriers by Dr Nancy Padian, director of international programmes at the University of California at San Francisco s AIDS Research Institute.
According to Padian, researchers encounter a number of challenges when evaluating these methods, including the effect of comparison groups and the measurement of self-reported behaviours and adherence to drug regimens.
More than quarter of a century into the AIDS epidemic, as many as 25 million people have died of the disease and an estimated 40 million people are living with HIV/AIDS, according to the UN. Despite AIDS being preventable through safe-sex practices, 11,000 more people contract HIV each day; despite it being treatable, more than three million people die from AIDS-related causes each year.
An AIDS vaccine is still several years away, say scientists. New research is being done on a vaccine that helps delay disease progression if a vaccinated person does become infected with HIV. The current global spending on vaccine development is about 650 million U.S. dollars, compared to the five billion dollars spent on HIV prevention.
According to the United Nations, HIV/AIDS treatment dramatically expanded from 240,000 people in 2001 to 1.3 million by 2005.
Scientists emphasised the urgent need to increase HIV testing. Early diagnosis is important so people can begin life-extending treatment. The World Health Organisation estimates that 80 percent of people living with HIV in low- and middle-income countries do not know that they are HIV-positive. Recent surveys in sub-Saharan Africa showed just 12 percent of men and 10 percent of women have been tested for HIV.
However, treatment must be shown to be cost-effective, as there is already fatigue in the donor community with regard to funding for HIV. There is also the criticism that AIDS has taken away resources and manpower from other public health issues, said Debrework Zewdie, director of the global HIV/AIDS programme at the World Bank.
During the conference, the Australian government committed one billion dollars over the next three years to address the pandemic.
More than 5,000 delegates from 133 countries participated in the conference, hosted by IAS, the world s leading independent association of HIV professionals, with more than 1,000 members from 174 countries, and the Australasian Society for HIV Medicine, one of the first HIV medicine societies in the world.
The next IAS conference will be held in Cape Town, South Africa, in 2009.
