Opportunistic Infections

Friday, December 07, 2007

Uganda: Aluvia to treat HIV positive children

By, Jane Nafula, The Monitor (Kampala), December 5, 2007

Uganda is the first African country to use the Aluvia paediatric drug that improves the health of children whose bodies are resistant to the first line of ARVs treatment.

8-year-old Tim (not real name) was born with HIV/Aids. He survived on Antiretroviral Drugs for six years after which the virus became resistant to the drugs. And for the last two years, Tim's life has been hanging in balance because there was no alternative drug that would reduce the viral load (the level of the virus in the blood).

"We have been giving him septrin tablets to treat the opportunistic infections like cough but his health has been deteriorating every other day. I really don't know why he became resistant to ARVs," said Tim's mother who prefers to be identified as Namubiru.

As Tim's parents were still searching for a way to prolong their son's life, the government through the Joint Clinical Research Centre (JCRC) contacted Abbott Laboratories in the United States to supply Uganda with Aluvia, a paediatric Aids drug that improves the health of children whose bodies are resistant to the first line of ARVs treatment.

The World Health Organisation recommends use of Aluvia (lopinavir/ritonavir) as options for the treatment of children who no longer respond to the first line of HIV medicines. The US department of Health and Human Medicine also recommends the same medicine for initial treatment of children with HIV.

Abbott is a global health care company involved in the discovery, development, manufacture and marketing of pharmaceuticals and medical products.

Uganda is the first African country to use the Aluvia paediatric drug and Tim was privileged to be the first child living with Aids in Africa to receive the drug.

President Yoweri Museveni handed over a packet of Aluvia to Tim after launching it at JCRC on December 1.

Parents thronged to JCRC on World Aids day to register their children for this medication. About 60 children will be the first people to benefit and there after, the drug will be distributed countrywide. More than 2 million children living with HIV in the endemic countries stand to benefit from the drug.

Better option

The Director of JCRC, Dr Peter Mugyenyi said the introduction of the second line treatment for children living with HIV/Aids will help restore hope for millions of parents and children who would otherwise face a bleak future, adding that the new drug will enforce compliance because it is easy to swallow, doesn't need to be refrigerated, and one doesn't have to take a meal before taking it as is the case with other medicines.

"Adherence to ARVs has been difficult especially among children because of lack of paediatric formulation," he said.

According to him, JCRC will get a grant of $1m (about Shs1.8b) from President Bush's Emergency Plan for Aids Relief (PEPFA) to restock all their branches with life saving drugs and also establish new ones to reach out to more people.

The Regional Director of Abbott International, Mr Angelo Kondes said Abbott's effort to provide for African children is part of its five point global strategy to expand access to HIV treatment around the world.

"We developed Aluvia with distinct needs of children in the developing world in mind," Kondes said, explaining that nine of every 10 children with HIV live in Sub-Saharan Africa where Uganda falls.

According to the Joint United Nations Programme on HIV/Aids (UNAIDS) and the World Health Organisation (WHO), in 2006, an estimated 2.5 million children under the age of 15 were living with HIV/Aids worldwide.

Last year alone, an estimated 530,000 children were infected with HIV, and 380,000 others died of Aids.

Kondes also said that HIV/Aids is a global problem that demands shared commitment and responsibility, adding that Abbott and Abbott Fund are investing more than $100m (about Shs180b) in developing countries through their global Aids care programmes focusing on strengthening health care systems, helping children affected by HIV/Aids, preventing mother to child transmission of HIV, and expanding access to counselling and testing.

According to Mr Dirk Van Eeden, The director of HIV/Aids communication and policy at Abbott international, it took them seven years to develop this drug, which is being supplied to Uganda at a cheaper price. "The government will spend about $250 per child per year. Aluvia is cheaper than any other generics. We are giving a bigger discount to African countries than to Europe," he added.

Statistics indicate that about 110,000 children who are less than 15 years in Uganda are living with HIV/Aids and of these, 47,000 have advanced Aids and are in need of antiretroviral therapy.

Only 9,500 children were accessing treatment by the end of September 2007.

President Museveni said children who are well treated can live a pain free life, grow normally, and become responsible adults.

"Children should not lose hope. We are going to protect them so they can grow up, study and exploit their talents."

Protecting the children

He believes poor adherence to antiretroviral drugs is one of the factors responsible for drug resistance.

Health experts say patients are not adhering to treatment due to stigma associated with the disease, drug exhaustion and lack of defined formulations especially for children.

Mr Museveni also says the management of paediatric Aids in Uganda has lagged behind that of the adults and that it should be given the necessary attention, adding that prevention of mother to child transmission of HIV/Aids is an important intervention in preventing the spread of the virus among children.

"We should stop children from contracting the disease than waiting for them to get infected to seek treatment. Supposing all Ugandans become infected, will we manage the burden of treating them?"

Mother to child transmission of Aids is the second largest mode of transmitting the virus and it accounts for about 21 percent of the new infections while sexual transmission accounts for 76 percent and the 3 percent is through other modes including blood transfusion. Every year, about 250,000 children are born with HIV in Uganda.

A mother who is HIV positive can transmit the virus to her baby during pregnancy, labour and delivery, or breastfeeding.

Women who have reached the advanced stages of the disease require a combination of ARVs for their own health.

Doctors say ARVs reduce the risk of mother-to-child transmission by 50- 60 percent. The Director General of Uganda Aids Commission, Dr Kihumuro Apuuli says currently, mothers are being encouraged to test for HIV whenever they go for routine antenatal care at health centres and that those found with HIV are given treatment to improve their health and also avoid passing on the virus to their unborn babies.

The First Lady, Ms Janet Museveni said Ugandans have become complacent due to availability of ARVs, cautioning that these drugs are not a cure but they simply reduce the viral load and that preventive strategies should be re-activated instead of relying on the drugs.

"Relying of treatment alone is negligence. These drugs simply treat opportunistic infections but they don't cure Aids," she said, adding that although more children get the virus from their mothers, very few HIV-positive pregnant women have access to drugs that reduce the risk of mother to child infection like Neverapin.

"We need to do more even if Uganda has been applauded as a success story in the fight against HIV/Aids. "The prevalence rate that has stagnated at 6.4 percent is bad enough and we should not allow this to continue," she advised.

Source: http://allafrica.com/stories/200712060372.html


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