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Optimised paediatric antiretroviral treatment to achieve the 95-95-95 goals

Moherndran Archary1,2, Riana van Zyl3, Nosisa Sipambo4

  • 1Department of Paediatrics and Child Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.

Southern African Journal of HIV Medicine
|October 25, 2021
PubMed

Insights

Paediatric HIV treatment in South Africa lags behind adult progress, with only 13% of children achieving viral suppression due to poor adherence to unpleasant antiretroviral treatments (ART). Expediting child-friendly ART formulations is crucial for improving outcomes.

Area of Science:

  • Public Health
  • Paediatric Infectious Diseases
  • Pharmacology

Background:

  • South Africa's progress towards UNAIDS 95-95-95 targets for HIV is significantly slower in children compared to adults.
  • Current antiretroviral treatment (ART) challenges in children include low rates of diagnosis, treatment initiation, and viral suppression.
  • A critical barrier is the lack of paediatric-friendly ART formulations, particularly the unpalatable Lopinavir/ritonavir syrup, leading to poor adherence.

Purpose of the Study:

  • To highlight the critical gap in paediatric HIV treatment outcomes in South Africa.
  • To identify the limitations of current ART formulations for children.
  • To advocate for the urgent adoption of improved, child-friendly ART formulations.

Main Methods:

  • Analysis of paediatric HIV treatment cascade data in South Africa.
  • Review of challenges associated with existing paediatric ART formulations.
  • Comparison with international and regional availability of simplified paediatric formulations.

Main Results:

  • Only 79% of children living with HIV know their status, with 47% on treatment and only 34% of those virally suppressed, resulting in 13% overall viral suppression.
  • The Lopinavir/ritonavir syrup's poor taste significantly impacts tolerability and adherence.
  • Delays in approving simplified, paediatric-friendly formulations in South Africa contrast with international and regional progress.

Conclusions:

  • Urgent need to address the low viral suppression rates in children living with HIV in South Africa.
  • Transitioning to dispersible paediatric ART tablets can improve administration, adherence, and cost-effectiveness.
  • Expedited approval and implementation of child-friendly ART formulations are essential for saving lives.

Keywords:
95-95-95 goalsARTHIV/AIDSPMTCTpaediatric

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