Improving the health of children living HIV with pDTG
Caption: The paediatric formulation of dolutegravir is being praised as a game changer in managing HIV in children as it makes treatment easier and cheaper. PHOTO | CHAI
DOLUTEGRAVIR in paediatric formulation (pDTG) – a drug recommended as first-line anti-retroviral for HIV treatment, is being hailed as a game changer in managing the virus in children as it makes treatment easier and cheaper.
The new drug is a strawberry-flavoured tablet that can be dissolved in clean water, making it easier to give to children too young to swallow tablets.
An estimated 1.8 million children worldwide live with HIV, but only half are receiving treatment, due to the complexities of being hard to administer due to the bitter taste or incorrectly dosed by crushing adult pills (UNAIDS, 2021).
UNAIDS notes that treatment coverage among children living with HIV in 2020 was just 54 percent, representing a global failure to provide life-sustaining care to almost 800,000 of the 1.8 million children living with HIV.
According to UNAIDS, treatment coverage among children living with HIV lags adult treatment coverage in most of the sub-Saharan African countries with large HIV epidemics. And about 100,000 children die from AIDS-related causes annually.
HIV/AIDS is a leading cause of child mortality contributing about 21 percent of deaths, followed by pneumonia, diarrhoea, measles, and malaria in Zimbabwe (ZDHS, 2015). And approximately two thirds of childhood deaths occur during infancy, with more than one third taking place during the first month of life (MICS, 2019). In the year 2020, 79 000 children (0-14 years) were living with HIV and 3 500 succumbed to the disease in Zimbabwe (UNAIDS, 2021).
Data shows that the lowest suppression is amongst the younger children. The lack of options when it comes to effective drugs and formulations has made treating paediatric HIV challenging. The current choices include syrups that are unpalatable and require cold chain storage, and solid formulations that are extremely bitter, hard to swallow and must be taken multiple times per day.
These barriers have compromised adherence to treatment, resulting in poor outcomes in children and significant premature death.
Paediatric dolutegravir is now the first-line HIV treatment that is recommended by the World Health Organisation (WHO) from the age of four weeks and three kilogrammes, but it had been out of reach for babies because of the lack of appropriate formulations.
pDTG belongs to a class of ARVs called HIV integrase inhibitors and is the WHO’s recommended first-line drug to treat HIV. It is said to be more effective, easier to take, has fewer side effects than alternatives, and has a low chance of one developing drug resistance when taken correctly and consistently.
The flavouring renders the drug more palatable to children compared with current options, paediatric HIV experts attest. The availability of pDTG film-coated tablets will foster improved adherence among the children living with HIV thereby improving treatment outcomes in children and adolescents.
The pDTG 10mg dispersible tablet is targeted for children between three kilogrammes and 20kg. Thereafter, children above 20kg are treated with DTG 50mg. The new pDTG 10mg dispersible formulation – when coupled with other available dispersible ART treatments – provides treatment that is easy to administer, has better taste and can ultimately improve viral suppression for the youngest and most vulnerable children.
In Zimbabwe, the phased transition from the use of Nevirapine and Efavirenz then to (DTG) 50 mg and now to pDTG 10mg kicked off in June 2021.
Dosing for pDTG is determined by the weight of the child, caregivers are therefore encouraged to bring the child is weighing at all clinic/hospital visits and medicine dioses are adjusted as the child grows.
Zimbabwe Association of Church-Related Hospitals (ZACH) with funding from the U.S President’s Emergency Plan for AIDS Relief (PEPFAR) through Centres for Disease Control and Prevention in Zimbabwe (CDC), is supporting Ministry of Health and Child Care efforts to fight HIV/AIDS in children in ensuring that pDTG reaches every child who needs it.
The organisation ensures that children who are HIV positive are put on treatment early and health care workers are being regularly trained, followed by a mentoring system to increase confidence and ensuring access to paediatric treatment including adequate formulations for children.
Every child living with HIV deserves treatment for their own health!
- The paediatric formulation of dolutegravir has been hailed as a game changer in managing the virus in children.
- The new drug comes as a tablet that can be dissolved in water, making it easier to give to children too young to swallow tablets.
- DTG belongs to a class of ARVs called HIV integrase inhibitors and is the WHO’s recommended first-line drug to treat HIV.
- Works fast to suppress the virus and has fewer side effects than other ARVs.
- Dolutegravir (DTG) should not be taken alone. DTG should be taken with two other anti-retroviral medications
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