Big Pharma Ignoring AIDS Children

by Moyiga Nduru

(IPS) BANGKOK -- More than 2.5 million children living with HIV/AIDS have been neglected by pharmaceutical companies that produce life-prolonging drugs, such as antiretroviral drugs (ARVs), for adults, says the leading humanitarian agency Medecins Sans Frontieres (MSF).

HIV treatment for adults is slowly becoming easier, with increasing availability in developing countries of a three-drug cocktail in one tablet.

But children who need treatment still have to drink large amounts of foul-tasting syrup or swallow large tablets " that is, if they can actually access treatment at all," Dr David Wilson, the medical coordinator of MSF, who is based in Thailand, told reporters.

ARVs are substances used to kill or inhibit the multiplication of retroviruses such as HIV.

Wilson, who is attending the ongoing 15th International AIDS Conference, in the Thai capital Bangkok, said: "Children with HIV are generally not interesting for pharmaceutical companies, but some generic companies are developing more child-friendly ARV treatments."

"International agencies need to push this issue up the agenda and governments will need to remove barriers to the use of generic products," he said at a press conference Tuesday.

Worldwide, the estimated number of children with HIV/AIDS was over 2.5 million in 2003, according to the Joint United Nations Programme on HIV-AIDS (UNAIDS).

In the same year, 700,000 children under the age of 15 were newly infected with HIV/AIDS, 88.6 percent of whom live in sub- Saharan Africa.

"Efforts to prevent transmission of the virus from mother-to- child have been largely successful in industrialised countries meaning there are relatively few children being born with HIV," Wilson said.

The resulting lack of a profitable market for children drugs in developed countries means that these medicines are in short supply despite the growing need for them.

As a result, children with HIV/AIDS are neglected, and doctors treating them have very limited choices of drugs at their disposal, Wilson explained.

But pharmaceutical firms, attending the gathering and contacted by IPS declined to respond to the MSF claims. Most of them have opposed sale of generic AIDS drugs in the Third World

MSF, which is currently treating 13,000 children worldwide, says it began treating children with the ARVs in early 2002. However, in March 2004 only 5 percent of MSF patients were children under 13.

"In South Africa, we started with 13 children last year. We hope to expand the treatment to the many children who need it," Nozia Ntuli, a nurse with MSF in South Africa, told IPS.

South Africa, where 10 percent of its population is living with HIV/ AIDS, has around one million AIDS orphans, latest figures from the South African government say.

According to the MSF, most methods used to diagnose HIV are not reliable for children under 18 months.

Monitoring blood count, known as CD4, is also difficult, since most of the commercially available CD4 count machines are not adaptable by the lack of proper tools.

The other challenge is the lack of paediatric formulations of ARVs, which makes determining and administering doses complex and burdensome. Currently, doses are determined according to weight or body surface, so doses must be adjusted as the child grows.

In developing countries, says MSF, there are no standardised dosing schedules, and doctors and other health professionals have no simple guidelines for treatment of HIV in children.

In most cases, bad-tasting, difficult to measure syrups are used for children under 10 kilogrammes. For older children, a dosing chart is used to calculate dose by weight.

MSF says syrups and oral solutions are not suitable for use in older children because of the large volumes needed, but low dosage tablets and capsules are not produced for most ARVs. In practice, this means that caregivers are forced to measure syrups and cut and crush adult formulations.

"This will not be possible for a grandmother, living in rural area with four children, to handle," Fernando Pascual, a pharmacist, with MSF's 'Campaign for Access to Medicines', told the press conference.

But others disagree.

They argue that people living in rural areas, especially in Africa, have a higher drugs-compliant rate.

"I don't think grandparents have problems delivering drugs to children living with HIV/AIDS. If you give them the right information, they will stick to it and deliver the drugs correctly," Ludfine Anyango, of Action Aid, an international charity, told IPS.

The other challenge facing AIDS campaigners is that drugs for children come at a high price.

ARV treatment for children costs several times more than for adults. While the cheapest fixed-dose drug for adults is available for about $200 per patient for a year.

The best price for the same drugs in paediatric formulations is around $1,300 (oral solutions and syrups), according to MSF. There are no paediatric fixed-dose combinations, it says.

For the other life-prolonging drug, known commonly as AZT, the adult yearly price is from $1,200 but for paediatric dosages, the same regimen in power and syrup formulations costs from $2,846 per person for a year, according to MSF.

In a bid to move into mass production, Dr. Omokhudu Idogho, of the Action Aid, who is based in Nigeria, urged African countries to formulate a policy whereby 30 percent of pharmaceutical companies' budgets are set aside for producing drugs for children.

"Apart from South Africa, most African countries do not have the capacity for mass production. Therefore, we must move fast because European and American pharmacies do not feel the pressure to produce the drugs for us," he told IPS. "If we don't produce them fast enough, then we're going to lose more lives."

Meanwhile about 50 protestors forced Hank McKinnel, the chairman of U.S. pharmaceutical giant Pfizer, to abandon his speech at a session on ARVs at the conference. The protestors accused Pfizer of creating barriers to patients' access to low- cost ARV drugs. They also protested the speech of the U.S. AIDS czar Randall Tobias, a former chief of Eli Lilly, another major drug maker.

Chanting "Let Us Free" the protestors said the pharmaceutical firms were more interested in profits than saving lives of people living with HIV/AIDS.

Defending his company, McKinnel said Pfizer was willing to cooperate with any governments in need of making quality drugs available to people living with the disease.