Looking Forward: How to End Pediatric AIDS in Our Lifetime

It Starts with a Family

Elizabeth Glaser contracted HIV in a blood transfusion in 1981 while giving birth to her daughter, Ariel. Elizabeth had unknowingly passed the virus on to Ariel through breast milk and her son, Jake, had contracted the virus in utero. The Glasers discovered the only drugs on the market were for adults; nothing had been tested or approved for children. Ariel lost her battle with AIDS in 1988. Fearing that Jake’s life was also in danger, Elizabeth rose to action.

She approached her close friends for help in creating a foundation that would raise money for pediatric HIV/AIDS research and later change the course of history for families impacted by HIV around the world. Elizabeth lost her own battle with AIDS in 1994, and to honor her legacy, the Pediatric AIDS Foundation was renamed the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). 

Despite Amazing Progress, the Global AIDS Response is Failing Children

The number of children acquiring HIV has dropped by over 60% since 2010 – a tremendous accomplishment in the fight against HIV. And yet, children who are living with HIV are less likely to know their status, less likely to be on treatment, and less likely to be virally suppressed than adults. These growing inequities result in children bearing a disproportionate share of AIDS-related deaths.

Too many families are still losing far too many children, even when the tools exist today to save these children’s lives. 

Expand Primary Prevention

The best way to keep an infant HIV-free is to prevent the mother from ever becoming HIV-positive.

All women should have access to comprehensive prevention services – including PrEP and other new prevention technologies– before, during, and after pregnancy.  

Increase ART Coverage

The percentage of pregnant women on ART has not meaningfully increased in over a decade.

Linking all women with lifelong treatment is critical for the health of mother and baby.  

Ensure Retention Through Breastfeeding Period

Preventing vertical transmission doesn’t end at birth.

Treatment adherence and ongoing retention in care can decrease the substantial portion of new infections that occur during breastfeeding. 

Point-of-care early infant diagnosis

POC diagnostics speed up the time from when an HIV-exposed infant is tested and when their caregiver receives the result. This allows faster initiation of ART for HIV-positive children, therefore reducing severe illness and death.  

Index testing

60% of children living with HIV who are not on treatment are over the age of 5, and therefore won’t be reached through early diagnosis. Testing all children of people living with HIV is a key tactic for finding older children with HIV who have not yet learned their status.  

Reduce Drug Development Delays

It takes years before new drugs approved for adults are available for children, often resulting in sub-standard pediatric care. Clear regulatory guidance and innovative trial design combined with incentives for drug developers can help to shrink these time delays.   

Develop Child-friendly Formulations

Pediatric antiretrovirals are often bitter, hard for children to swallow, and difficult for caregivers to correctly dose. The recent rollout of pediatric dolutegravir has the potential to improve treatment outcomes.

Additional palatable fixed-dose formulations that are easy to crush, chew, or sprinkle into food help ensure children living with HIV are getting the medications they need.  

Improving Adherence

It’s not enough for children to start treatment, they must stay on treatment to remain healthy. Patient and caregiver education, psychosocial support, and differentiated service delivery – like dispensing multiple months of medication at once or having a special day for children to come to a health facility – can help.  

Expanding Viral Load Testing

HIV viral load testing is a critical tool for antiretroviral treatment (ART) monitoring and optimization and can serve as a necessary signal for the need for a patient to transition to a better regimen. Viral load data also can be used to improve programming, therefore improving viral suppression. 

Ensuring Social Protection and Quality of Life

HIV status is only one facet of a person’s life. Advancing quality of life through access to education, nutrition support, gender equity, comprehensive health care, and child protection is essential to ensure mothers and children can thrive.  

Preventing Mortality

A lack of access to optimized treatment puts children at an increased risk of death. In 2023, children accounted for only 3% of all people living with HIV but comprised 12% of all AIDS-related deaths. Improving antenatal and pediatric care can decrease preventable deaths from all causes – not just HIV.