The failure rate of HIV treatment is higher in children than in adults, researchers warned today.
Dr Ali Judd of the UK Medical Research Council Clinical Trials Unit in London, UK, and colleagues, looked at HIV viral load suppression in children compared with adults.
They used information on 1,007 children taking part in European studies, mostly in the UK, Ireland, Spain, the Netherlands and France. All had contracted HIV from their mother and had started antiretroviral therapy (ART) between 1998 and 2008.
A quarter were exposed to three drugs, and after five years the overall rate of antiretroviral therapy failure was 12 per cent, say the researchers in the Lancet. Failure was more likely when the children started treatment at an older age.
"Of 686 children starting ART with nucleoside reverse transcriptase inhibitors (NRTIs) and either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or ritonavir-boosted protease inhibitor the rate of failure was more than twice as high than in adults with heterosexually transmitted HIV," they report.
This shows the challenge of maintaining lifelong viral suppression in those who start treatment very early in life, the experts say.
"There is continued need for strategies to promote optimum drug adherence in children, caregivers, and young people to minimise the likelihood of triple-class virological failure, and for development of suitable new drugs and formulations to optimise the treatment of children with treatment failure," they conclude.
Commenting on the findings, Dr Alexandra Calmy of Medecins Sans Frontieres, points out the problems of storing these drugs.
"Currently only four quality-assured triple-drug fixed-dose combinations are available in solid and dispersible forms from manufacturers of generic drugs, and less desirable dose formulations continue to dominate," they write.
The Pursuing Later Treatment Options II (PLATO II) project team for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) Risk of triple-class virological failure in children with HIV: a retrospective cohort study. The Lancet, published online April 20, 2011.
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