Factors impacting on drug choices. Issues for developing countries.

Abstract

In considering factors that impact on drug choices for children in developing countries, it is important to learn from the advances in antiretroviral therapy that have been made in the United States and other developed countries. Abundant clinical data indicate that monotherapy with antiretroviral agents, no matter how potent, is inadequate and the children should be treated with three or more drugs. When treatment regimens are changed, at least two new drugs should be started simultaneouly to avoid the rapid development of resistance. Understanding the impact of host and viral genotypes may provide information as to how best to treat the individual child. However, at present, I believe that with limited resources, the best use of antiretrovirals for children is in disease prevention. Thus, antiretrovirals to prevent mother-to-infant transmission should be given the highest priority. Second, children in the first year of life are at highest risk of progression and should be treated with trimethoprim-sulfamethoxazole to prevent Pneumocystis carinii pneumonia, and targeted for receiving antiretrovirals. Moreover, treating children without an overall plan is unacceptable. Treatment with drugs because they are available will have little impact on the quality of life or disease progression unless they are used in combination. There should be no reason for children, no matter where they might live, to receive suboptimal antiretroviral therapy. For this reason, I call upon industrialized countries and the World Bank to help provide resources for the care and treatment of HIV-infected children. Additionally, I would propose that pharmaceutical companies provide support for the care and treatment of HIV-infected children. The drugs and financial support provided by pharmaceutical companies should go to a central foundation or group that will optimize the use of these resources for children in developing countries. I would also propose that in the United States, Europe, and other industrialized countries the patents on antiretroviral drugs be extended according to a formula based on the donation of a pharmaceutical company. It is only through a unified effort that we will be able to adequately treat all children infected with HIV regardless of where they might live.