Opinion Paper - Special Collection: UNAIDS Targets for 2030

Optimised paediatric antiretroviral treatment to achieve the 95-95-95 goals

Moherndran Archary, Riana van Zyl, Nosisa Sipambo, Gillian Sorour
Southern African Journal of HIV Medicine | Vol 22, No 1 | a1278 | DOI: https://doi.org/10.4102/sajhivmed.v22i1.1278 | © 2021 Mohandran Archary | This work is licensed under CC Attribution 4.0
Submitted: 21 June 2021 | Published: 01 September 2021

About the author(s)

Moherndran Archary, Department of Paediatrics and Child Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and, Department of Paediatrics, King Edward VIII Hospital, Durban, South Africa
Riana van Zyl, Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, South Africa
Nosisa Sipambo, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
Gillian Sorour, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa


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Abstract

While the progress towards reaching the UNAIDS 95-95-95 targets in South African adults seems promising, the progress in the paediatric population is lagging far behind; only 79% percent of children living with HIV know their status. Of these, only 47% are on treatment, and a mere 34% of those are virally suppressed. Thus, virological suppression has been attained in only 13% of children living with HIV in South Africa. Multiple factors contribute to the high treatment failure rate, one of them being a lack of paediatric-friendly antiretroviral treatment (ART) formulations. For example, the Lopinavir/ritonavir syrup, which is the current mainstay of ART for young children, has an extremely unpleasant taste, contributing to the poor tolerability and lack of adherence by children using the formulation. Furthermore, the lack of appropriate formulations limits the optimisation of regimens, especially for young children and those who cannot swallow tablets. Switching from syrups to dispersible tablets will improve ease of administration and adherence and result in cost-saving. Despite the approval of simplified paediatric-friendly formulations internationally, including other sub-Saharan African countries, unnecessary delays are experienced in South Africa. Clinician groups and community organisations must speak up and demand that approvals be expedited to ensure the delivery of life-changing and life-saving formulations to our patients as a matter of urgency.

Keywords

paediatric; HIV/AIDS; ART; 95-95-95 goals; PMTCT

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