Increasing numbers of children on treatment, despite lack of paediatric drugs

The number of HIV-positive children accessing antiretroviral (ARV) treatment in Malawi is increasing, despite a scarcity of suitable paediatric formulas.

An official in the health ministry, speaking under condition of anonymity, confirmed that adult tablets still had to be cut into smaller doses to treat children, but said this was a minor obstacle.

"In all fairness, it should be noted that there are more children on ARVs in Malawi now than ever before ... the treatment is also yielding positive results among children who would otherwise have died," the official told IRIN/PlusNews.

According to the latest government estimates, children constituted nine percent of the more than 12,000 people who had received ARVs from the government's national treatment programme during the last quarter, up from just five percent two years ago. In total, some 5,906 children are benefiting from the national programme.

The local UN Children's Fund (UNICEF) office supports using reduced doses of adult medication to treat children, because the cost of paediatric tablets is unaffordable to many parents and caregivers. Paediatric formulas also need to be kept in refrigerated storage, and home refrigeration is a luxury for most Malawians, who live far below the poverty line.

"It makes more sense, financially, for the government to use adult ARVs, as syrups cost a great deal more, not only in terms of procurement, but also in terms of storage once they are dispensed to patients," said Dr Miriam Shipimo, UNICEF manager for women, youth and HIV/AIDS.

"Ideally, these children should be using Pedimune, a three-in-one tablet that can be easily stored, but it remains out of reach ... so we still halve Triomune, the widely used adult ARV, and it's proving to be quite effective under the circumstances," she said.

Pedimune, manufactured by the Indian generic drug firm, Cipla, is available in most developed countries and at private clinics in Malawi, but still needs the approval of the World Health Organisation to be rolled out in the public sector.

Medicin Sans Frontieres (MSF), the international medical relief agency, welcomed the "innovative" method of treating the nation's HIV-positive children, but expressed concern over the accuracy of reduced adult dosages.

"We are not exactly pleased with this method, but lives are being saved as we wait for suitable paediatric formulas to made more widely accessible," said Ulrika von Pillar, the Belgian head of mission at MSF in Malawi.

An estimated 80,000 children are living with HIV in this resource-limited country, 24,000 of whom are in urgent need of paediatric ARVs.