HIV: why are so many mothers and children still dying?

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Last year we published an Editorial arguing that the time had come to integrate prevention and treatment of HIV into maternal and child health care programs. Today at the IAS2011 conference in Rome, Dr Philippa Musoke, of Makerere University in Uganda, pointed out that we’re unlikely to meet MDG4 and MDG5 by 2015. Currently she said that every second 3 children die and every minute 1 woman dies and that HIV is a large contributor to the toll of maternal and child deaths in sub-Saharan Africa. To put this another way there are 2.5million HIV-infected children of whom 30% will die by 1 if untreated. It seems that the improvements made to date in rolling out PMTCT (preventing mother-to-child transmission) programs are having an impact (most optimistic estimates are 43% of those in need are actually getting PMTCT) but we have a lot further to go yet to reduce this shocking burden of mortality.

One pressing problem with treating infant HIV infection is that the drugs might work, but they aren’t tailored for the specific needs of infants: a typical regime for a newborn is 3 different syrups (one for each drug), given in three different doses (with dosage dependent on weight). As if this isn’t difficult enough for caregivers to administer, the drugs taste vile and need refrigeration — hardly ideal for child or indeed mother. Recognising the need for new formulations, DnDi yesterday launched a new initiative for an R&D agenda to develope pediatric formulations of antiretrovirals. According to Shing Chang, Director of R&D at DNDi, the goal is a fixed dose combination treatment to treat HIV and HIV/TB coinfection in infants under 3.

DNDi might seem an unusual partner for drugs that are needed by so many, but Marc Lallemant, Head of the HIV Programme at DNDi, noted that ‘children living with HIV/AIDS are a neglected population and pediatric AIDS can be considered a neglected disease’. Certainly it would seem Pharma are neglecting this in-need group, perhaps because the introduction of treatment for mothers means the number of babies born infected with HIV represents a shrinking market.

I spoke to Rachel Cohen, Regional Executvie Director for DNDi, North America, and asked whether there was any attempt to link care of infants to PMTCT programs, and she agreed this would be ideal. But sadly, access to PMTCT and uptake of PMTCT services still needs massively improving, and linkage to care of both mothers and children is far less than ideal.

As Dr. Musoke concluded, we must continue to improve maternal and child health through scale-up of PMTCT programmes, strengthening integrated approaches to maternal and child health (including HIV care) and providing integrated family planning services.

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