HIV 4 – Administering HIV medicines in children

UNDERSTANDING THE CHALLENGES OF MEDICATION

Taking any medicine is tricky. Adherence to HIV treatment among children is a crucial part of managing HIV and extending the life and health of infected children.^2a,b
“Children living with HIV have been neglected for too long, with the recommended treatment for years consisting of a bitter-tasting syrup with high alcohol content.”^3b
Dr Bernard Pécoul, Executive Director of Drugs for Neglected Diseases initiative (DNDi).
Some antiretrovirals (ARVs) for children require refrigeration, making storage of these medicines difficult for families without the necessary living conditions suited to this.^3b
Infants and young children are at the highest risk of dying if they do not receive treatment.^3b

It is estimated that:

When treatment options are limited or difficult to take, this can lead to low treatment coverage.^3c

THE NEED FOR ADAPTED AND BETTER TASTING FORMULATIONS

Medicines that are designed specifically for infants and young children should encourage adherence.^3b
There have been major improvements in the types of medicines available for treatment of HIV in very young children.^4a Medicines are more pleasant tasting, heat-stable and easier-to-use. There are also now fixed-dose combinations (up to 4 medicines in one formulation) which will replace older medicines.^3a

Examples of how medicines can be offered are:

GRANULE-FILLED CAPSULES

Combines 4 medicines in 1
Strawberry flavoured granules
Parents and caretakers are able to administer the medicine to children by sprinkling the granules on soft food or milk
Does not require refrigeration therefore provides convenient transport and storage
Easy to administer to infants and children of different weights and ages

PELLETS

Combines 2 medicines in 1
Can be mixed into foods such as porridge or milk
Easier to administer to children than liquids
Improved adherence to treatment
No refrigeration required

WHAT ARE THE CAUSES OF POOR ADHERENCE (BARRIERS) TO TREATMENT AMONG CHILDREN?

The goal of treatment is to maintain successful therapy for as long as possible during a child’s lifelong treatment.^2d Barriers to this do unfortunately exist:^2b

HIV regimens for infants and young children often require taking multiple daily doses of multiple pills or liquids, some of which are extremely unpalatable.^5a
A struggle when administering medicine adds to the burden that caregivers experience when providing care to their HIV-infected children.^2e

The lack of child-friendly formulations seems to be the biggest contributing factor in poor adherence among children.^2b

The main obstacles preventing good adherence to treatment in children are:

All these factors influence adherence and, therefore, survival of children with HIV.^2b
The development of child-friendly formulations makes it easier for caregivers to administer HIV medications and easier for children to take medications.^2f
↑ ADHERENCE ↑ SUCCESSFUL LONG-TERM THERAPY ↑EXTENDED LIFE^2d

Improved formulations can lead to better treatment outcomes.^4cMany children have to take three or more pills or a combination of pills and liquids, every day, twice a day.^2c Fixed-dose combinations improve treatment adherence by lessening the pill (or liquid) burden.^4d

The main message here is: the easier the medicine is to give to a child, the better the chances of that child taking the medicine properly and therefore resulting in better control of HIV.^4c

Speak to your doctor or pharmacist for further advice on your child’s condition and the best treatment options for you.