Pursuing use of optimal formulations for paediatric HIV epidemic control - a look at the use of LPV/r oral pellets and oral granules
Pursuing use of optimal formulations for paediatric HIV epidemic control - a look at the use of LPV/r oral pellets and oral granules
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DOI：
10.1002/jia2.25267
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发表时间：
2019-04-01
影响因子：
6
通讯作者：
Phelps, Benjamin R.
中科院分区：
文献类型：
--
作者：
Malati, Christine Y.;Golin, Rachel;Phelps, Benjamin R.
简介：尽管艾滋病毒母婴传播显著减少，但2017年估计有18万儿童感染艾滋病毒，只有52%的15岁以下艾滋病毒感染儿童（CLHIV）正在接受挽救生命的抗逆转录病毒治疗（ART）。如果没有有效的治疗，一半的CLHIV在两岁之前死亡，只有五分之一的人能存活到五岁。讨论：在过去的四年里，美国食品和药物管理局暂时批准了口服小丸和口服颗粒形式的洛匹那韦/利托那韦（LPV/R）的新制剂。然而，在儿童艾滋病毒负担最重的低收入和中等收入国家，上述制剂的采用缓慢，主要是由于三个挑战：有限的生产能力;目前丸粒和颗粒剂的单位成本;以及决策者和保健工作者对这些新制剂的采用缓慢。克服这些障碍的解决方案包括确保LPV/r口服丸剂和口服颗粒剂的充足供应，在选择儿科ART制剂时考虑所有方案和临床因素，并利用现有资源降低儿科艾滋病毒发病率和死亡率。
Introduction: Despite a significant reduction in mother-to-child transmission of HIV, an estimated 180,000 children were infected with HIV in 2017, and only 52% of children under 15 years of age living with HIV (CLHIV) are on life-saving antiretroviral therapy (ART). Without effective treatment, half of CLHIV die before the age of two years and only one in five survives to five years of age.Discussion: Over the past four years, the United States Food and Drug Administration tentatively approved new formulations of lopinavir/ritonavir (LPV/r) in the form of oral pellets and oral granules. However, the slow uptake of the aforementioned formulations in the low- and middle-income countries with the highest paediatric HIV burden is largely due to three challenges: limited manufacturing capacity; current unit cost of the pellets and granules; and slow uptake of these new formulations by policy makers and health care workers.Conclusions: Solutions to overcome these barriers include ensuring availability of an adequate supply of LPV/r oral pellets and oral granules, considering all programmatic and clinical factors when selecting paediatric ART formulations, and leveraging current resources to decrease paediatric HIV morbidity and mortality.