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Patient needs driven Research and Development Agenda in HIV

Patient needs driven Research and Development Agenda in HIV. Dr. Felipe Garcia de la Vega MSF Campaign for Access to Essential Medicines. HIV in Mozambique. Mozambique is one of the poorest countries in the world. Today 1.3 m people live with HIV in Mozambique. 99,000 children

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Patient needs driven Research and Development Agenda in HIV

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  1. Patient needs driven Research and Development Agendain HIV Dr. Felipe Garcia de la Vega MSF Campaign for Access to Essential Medicines

  2. HIV in Mozambique • Mozambique is one of the poorest countries in the world. Today 1.3 m people live with HIV in Mozambique. • 99,000 children • In 2001 MSF started HIV treatment projects in Maputo and Lichinga.

  3. The problem of HIV diagnosis in children • Most common presentation is failure-to-thrive • One of the most difficult diagnostic challenges in pediatrics even in western setting • HIV diagnosis particularly important in <18 months because most children die during infancy

  4. Diagnosis HIV Paediatric Diagnostics • Viral Load, not used routinely • Impossible to detect infection <12-18 m. with serologic tests 50% of children die before 2 years

  5. Paediatric Formulations • More expensive than adult formulations • Almost all available formulations: liquids • No fixed dose combinations • Complex dosing schedules mg/kg or mg/m2 • Some need cold storage, shipment • Distributing/dispensing glass bottles • Taste of formulations

  6. ART IN FIXED DOSE COMBINATIONS: ADULT AND PAEDIATRIC FORMULATIONS Adult Tablet Children Tablets d4T + 3TC + NVP FORMULATIONS Adult: d4T (30 mg or 40mg) + 3TC 150mg + NVP 200 mg "Junior" (10-30 Kg):d4T 12mg + 3TC 60mg + NVP 100 mg Children Adult Tablet Children Tablets "Baby" (3-10 Kg): d4T 6mg + 3TC 30mg + NVP 50mg

  7. Conclusions • Children with AIDS have been neglected • In addition to diagnostic tools and formulations other gaps exist in HIV R&D (HIV/TB, PMCT, 2nd line…) • Simply relying on the market for filling these gaps is not a strategy in itself • Who will take the lead in addressing these challenges and fund and manage the R&D of needed tools  R& D has to be driven by patient needs

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