Thursday, August 18, 2011
It's interesting to compare the hype surrounding strategies such as 'treatment as prevention', pre-exposure prophylaxis, vaginal microbicide and the like with the relative silence surrounding pediatric HIV. Marc Lallemant calls it a 'neglected disease'.
Pediatric HIV has been almost eliminated in rich countries. Hundreds of thousands of infants are infected every year and hundreds of thousands more die of AIDS. Only one third of infants who need antiretroviral treatment are receiving it. Without treatment, a third will die before they are one year old and even more will die in the following year or two.
Versions of antiretroviral drugs suitable for children are not seen as a tempting proposition for pharmaceutical companies, it appears. Not only do they want vast profits, they want easy profits and pediatric formulations are just not easy enough.
So it could be asked why anyone would consider a strategy such as 'treatment as prevention', which involves testing everyone for HIV regularly, perhaps once a year, and treating anyone found HIV positive immediately. Currently, people need to reach a specific stage in HIV progression to receive treatment.
Yet in developing countries, many pregnant women don't have access to antenatal care, about three quarters are not tested for HIV, many don't have access to the drugs needed for prevention of mother to child transmission. Even accurate information and adequate support for preventing transmission after delivery is not available to most women.
Developing countries just don't have the equipment, personnel, facilities or even the training to prevent the majority of pediatric HIV transmissions. They don't even have the capacity to diagnose HIV in most infants until it is too late for them to benefit from treatment. It's too expensive. And the all the noise we hear about 'treatment as prevention' is absent when it comes to infants, or even mothers with HIV.
One of the shocking features of diseases that are referred to as 'neglected' is that most of them are easily prevented and treated; most of them are not even expensive to address.
As with pregnant mothers, it would be far better to find out how people are being infected and develop a strategy to prevent infection, insofar as it's possible. But failing that, there is no justification for providing treatment for adults and denying it to infants, just because the former makes the pharmaceutical industry vast and easy profits and the latter does not.
Treat everyone who is infected with HIV, regardless of their demographic. But do not mistake that for prevention. We have failed to prevent millions of HIV infections over many years because we have refused to establish how people are becoming infected. We will continue to fail as long as we fool ourselves into thinking that 'treatment is prevention'. It is not, and it never will be. Nor is it a substitute for prevention.