Page 73 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 5 Opinion Paper

Current perspectives on paediatric HIV

management from the Mexico International

Aids Society Conference, 2019

Authors: While acknowledging the great achievements in getting 23 million people living with HIV to
Mohendran Archary access antiretroviral treatment (ART) globally, there is still more to do in order to close the
1,2
Lee Fairlie
3
Amy Slogrove 4 HIV treatment gap between the paediatric and adult ART programmes, with only 54% of
children accessing ART compared to 62% of adults. Furthermore, while tremendous global
Affiliations: gains have been made in preventing perinatal and postnatal HIV acquisition, HIV-exposed
1 Department of Infectious
Diseases, University of and uninfected children are still not achieving early childhood developmental outcomes
KwaZulu-Natal, Durban, comparable to HIV-unexposed children. In this article, we present highlights from two pre-
South Africa conference meetings (11th International Workshop on HIV Pediatrics and 5th Workshop on
Children and Adolescents HIV Exposed and Uninfected) and the International Aids Society
2 Department of Paediatrics & (IAS) meeting held in Mexico in July 2019.
Child Health, University of
KwaZulu-Natal, Durban, Keywords: 2019 Paediatric ART Conferences; International Aids Society; management of
South Africa
pregnant and breastfeeding women; paediatric/adolescent HIV; treatment update.
3 Wits Reproductive
Health and HIV Institute
(WRHI), University of International paediatric HIV workshop
the Witwatersrand,
Johannesburg, South Africa The global scale-up of antiretroviral treatment (ART) and prevention of mother-to-child
transmission (PMTCT) strategies has resulted in a dramatic reduction in new paediatric
4 Department of Paediatrics infections. Despite this, globally there were 160 000 new paediatric infections in 2018. This annual
and Child Health,
Stellenbosch University, meeting provides a good summary of the current and future directions in the prevention and
Cape Town, South Africa treatment of paediatric and adolescent HIV and co-infections. The key findings presented at this
meeting can be categorised into the following: (1) treatment and management of paediatric and
Corresponding author: adolescent HIV; and (2) management of pregnant and breastfeeding women and PMTCT.
Mohendran Archary,
[email protected]
Treatment and management of paediatric/adolescent HIV
Dates:
Received: 30 Aug. 2019 Difficulties in administering medication to children and attendant adherence issues have resulted in
Accepted: 11 Sept. 2019 1
Published: 31 Oct. 2019 poorer virological suppression rates in children than adults. Several advances in drug formulations
and delivery methods were presented at the meeting. Two of the notable new molecules with a
How to cite this article: potential impact on management of children in the future are GS-6207 and MK-8591.
Archary M, Fairlie L,
Slogrove A. Current
perspectives on paediatric HIV GS-6207 is the first in the class of capsid inhibitors and is unique in that it acts on various sites of
management from the Mexico the HIV lifecycle including capsid disassembly on viral entry and capsid assembly and maturation
International Aids Society during production of new viral particles. Initial data on subcutaneous administration in adults
Conference, 2019. S Afr J HIV
Med. 2019;20(1), a1027. support 3-monthly administration. No paediatric studies have been conducted. 2
https://doi.org/10.4102/
sajhivmed.v20i1.1027 The second (MK-8591) also has an unique mechanism of action as a nucleoside reverse transcriptase
Copyright: translocation inhibitor that lacks cross-resistance with other nucleoside reverse transcriptase
© 2019. The Authors. inhibitors (NRTIs). In addition, the formulation has a very long intracellular half-life that
Licensee: AOSIS. This work potentially allows for administration of very low dosages and the possibility of being given once
is licensed under the weekly. Adult data from a fixed-dose combination of MK-8591/doravirine were presented at the
Creative Commons
Attribution License. main conference. Animal studies suggest that an implantable formulation may support once-a-
year administration. No paediatric data are available on these new formulations.
3
Read online: Other notable new treatment options included cabotegravir/rilpivirine and extended release
Read online:
Scan this QR broadly neutralising antibodies. 4
Scan this QR
code with your
code with your
smart phone or
smart phone or
mobile device Tenofovir alafenamide (TAF) as the optimal background regimen in children was discussed. The
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to read online.
advantage of TAF compared to tenofovir diproxil fumarate (TDF) in paediatrics is the potentially
http://www.sajhivmed.org.za 66 Open Access