Lessons From Pediatric HIV: A Case for Curative Intent in Pediatric Cancer in LMICs.

Abstract

* Abbreviations: ALL — : acute lymphoblastic leukemia ARV — : antiretroviral medication BL — : Burkitt lymphoma CLHIV — : children living with HIV HIC — : high-income country LMIC — : low- and middle-income country Antiretroviral medications (ARVs) are now being provided to nearly 50% of children living with HIV (CLHIV) in low- and middle-income countries (LMICs), an increase of 30% in the past 5 years.1 The provision of ARVs in LMICs demonstrates that effective therapy can be delivered to children with complex medical issues. An estimated 96% of CLHIV and 80% of children <15 years of age living with cancer reside in LMICs, where 94 900 pediatric AIDS deaths and 120 000 pediatric cancer deaths occur annually.2,3 The health system infrastructure gains in the fight against HIV and other communicable diseases represent a promising platform for long-overdue, transformational cancer care in LMICs. Similar to combination antiretroviral therapy in the context of pediatric HIV, the advent of combination chemotherapy in the mid-1960s revolutionized pediatric cancer treatment. Before chemotherapy, pediatric cancer was uniformly fatal, and care was focused on palliation. By the 1970s, over half of children diagnosed with cancer in high-income countries (HICs) were cured. … Address correspondence to Henry Miller, Office of HIV/AIDS, United States Agency for International Development, 1300 Pennsylvania Ave, NW, Washington, DC 20523. E-mail: hmiller{at}usaid.gov