November 29, 2005
November 29, 2005
A Pediatrician's Perspective: Q & A with Dr. Felipe Garcia de la Vega

Felipe Garcia de la Vega is a pediatrician who first worked with Doctors Without Borders/Médecins Sans Frontières (MSF) in Peru in 1997, followed by missions in Burma and Mozambique. Since May 2005, he has been the HIV/AIDS & TB Advisor to MSF's Campaign for Access to Essential Medicines in Geneva.

What is MSF's position and role regarding pediatric HIV/AIDS?

An MSF doctors examines a child in an HIV/AIDS project in Khayelitsha, South Africa. © Mariella Furrer

Across the globe, MSF currently treats over 57,000 patients with antiretroviral therapy (ART), but only six percent are children. Because we don't have appropriate diagnostic tools and medicines adapted to children's needs, the majority of our patients are over one year of age. Only once we felt confident enough treating adults did we begin to look into the problems of the younger population. It has been a good start but many challenges remain.

You worked as a pediatrician in Mozambique – how was the situation in terms of treating and diagnosing children with HIV/AIDS?

In Mozambique, MSF has two HIV programs. When I arrived in 2003, few children were being offered ART for various reasons: Health staff is generally not confident handling children with suspected or confirmed HIV infection, as they have growth problems and recurring infections, and there are few tools to facilitate the staff's work. As a pediatrician, it was incredibly frustrating not to be able to treat all the children that needed this life-saving treatment. Children's lives change completely once they receive ART: they start to grow, the recurrent infections and skin lesions gradually disappear, and they can return to school and normal life. As our team in Mozambique gained confidence in treating adults, we began to treat more and more children, and the number receiving ART has gradually increased to more than 200 children today.

What other challenges did you face regarding children and HIV/AIDS?

Adherence to treatment is a big problem. As with adults, it is crucial that children take their medicines their whole life without missing a day, in order to delay the onset of resistance. If asking adults to stick to their regimen for life is hard, imagine how hard it is with children and their caregivers. Factors that reduce adherence in children include lack of liquid formulations for some drugs and the large volume of medications they need to take.

Why has it been so hard to put pediatric HIV/AIDS high on the international health agenda?

The answer is simple. There are very few children infected with HIV/AIDS in rich countries, and the millions of children infected with HIV/AIDS in developing countries don't represent a lucrative market for pharmaceutical companies.

What are the new developments regarding pediatric HIV/AIDS?

So far, there have been very few. We have mostly seen adaptations of the tools used for treating adults. Scientists at Cambridge University are currently working on adapting viral load technology to make it available in resource-poor settings, but these projects require strong funding.

UNICEF is launching a campaign to support pediatric HIV/AIDS. What is MSF expecting from this?

Putting children on the agenda is always welcome at MSF. Adequate health care and treatment for children is not only an ethical imperative, but a right recognized by the countries that signed the UN Convention on The Rights of The Child. We want UNICEF to strongly push for the inclusion of more children on ART, and to address the problem of unaffordable pediatric ARV formulations in relation to both originator and generic companies. We want them to be more active in pushing for the prequalification of second-line pediatric formulations, as well as in the development of dosing tables adapted to resource-poor settings.

Pedimune, a new generic pediatric combination, is expected to become available quite soon. How will this change the situation?

Pedimune is a pediatric adaptation of a FDC tablet used in adults. As it will be produced in smaller doses, it will allow doctors to treat more children, starting at three kilogram babies – right now, when FDCs are crushed, it is only possible to treat children that weigh more than 10 kilograms. Adherence will also be made easier, with just two pills or two drinks per day if a dispersible formulation is also developed.