As the International AIDS Conference kicks off in Durban, the Drugs for Neglected Diseases initiative (DNDi) has released an update on its efforts to develop optimal child-adapted antiretroviral formulations. This document details some recent progress towards its final goal of developing “4-in-1” fixed-dose combinations using the World Health Organization (WHO) recommended treatment regimen for infants and young children. DNDi’s update also discusses some promising developments for treatment for children living with both HIV and tuberculosis (TB).
The highlights discussed include:
- An implementation study, known as the LIVING study, is being rolled out in several countries for an improved oral pellet formulation of the WHO-recommended treatment lopinavir/ritonavir (LPV/r), an important step towards introducing the 4-in-1s.
- A large study in South Africa with children co-infected with HIV and TB has finished, providing essential evidence and data in support of WHO guidelines on “super-boosting.” This approach can counteract negative drug-drug interactions between LPV/r and the backbone of the regimen used to treat TB in children.
- Formulation work on the 4‑in‑1 fixed-dose combinations is being completed with promising preliminary results, meaning the 4-in-1 treatments could be available by the end of 2018.
While the Durban conference will be an opportunity to review the impressive successes in reaching millions with HIV treatment since the last conference was held in Durban in 2000, children remain a neglected patient population, with treatment coverage lagging behind that of adults. One area where the neglect is particularly acute are current suboptimal paediatric antiretroviral formulations.