108 Antiretroviral Therapy for HIV-infected Children in Resource-limited Settings Diana Gibb Med Res Council, London, UK

The most efficient and cost effective way to reduce paediatric HIV globally is to reduce mother-to child transmission. However, in resource-limited settings, only 10% of pregnant HIV infected women access antenatal services, and single dose nevirapine used in women who subsequently breastfeed has limited efficacy. Even if coverage were 80% today, over 300,000 new paediatric infections would still occur annually. The necessity for treatment alongside prevention is therefore increasingly recognized, the goal being family-based therapy for practical (to avoid pill sharing) and ethical reasons. Nevertheless, the current reality is that even successful programmes struggle to include children – in 2004, only 7% of 25,000 patients on HAART in MSF projects were children. Barriers include difficulties with early diagnosis; procurement, high cost and inadequate availability of appropriate paediatric expertise. In addition, data required for forecasting children’s needs, such as numbers of infected children, natural history and predictors of progression, are lacking. To address these challenges a number of parallel initiatives are urgently needed. Incentives for pharmaceutical companies to produce and rapidly register high quality fixed-dose combination crushable pills need to be found. Paediatric ART access needs to be scaled up and incorporated into large ART programs and success stories publicized. Global and local research collaboration is urgently needed to provide answers to questions about ART which cannot be answered from adult data or in industrialized settings. These include the timing of ART initiation, strategies to minimize long-term toxicity while maintaining efficacy, and research on cost-effective monitoring tools for children. Galvanized action is required to realize the WHO 3x5 goal of starting 10-15% children out of a total 3 million persons on ART by the end of 2005. This talk will overview what is known about paediatric HIV in Africa and discuss operational and research aspects of Paediatric ART management relevant to resource poor settings.