PORTLAND, Oregon — In 2019, Ugandan children suffering from human immunodeficiency virus (HIV) were admitted to Mbarara Regional Referral Hospital as part of an emergent study. The study sought to test the effectiveness of a new drug, Quadrimune, for treating children suffering from HIV. In Uganda, children younger than 15 account for 11% of the nation’s HIV cases. Because children can be particularly hard to treat for the disease, this problem remains particularly urgent. However, Quadrimune, produced by the pharmaceutical company Cipla and the nonprofit Drugs for Neglected Diseases Initiative, could be the solution to treating children with HIV in Uganda and across the globe.
Childhood HIV in Uganda
In the past, Uganda has had success in addressing its HIV epidemic. In 1986, Uganda passed one of the continent’s first national AIDS control plans. Because of national and local efforts, “HIV prevalence [reduced]threefold to 5.7% among people ages 15 to 49 in 2018.” Nevertheless, the virus, and particularly its prevalence among children, still poses a significant risk to Uganda.
Mothers living with HIV/AIDS risk transmitting the disease to their children through pregnancy, childbirth and breastfeeding. Referred to as mother-to-child transmission (MTCT), wealthier nations have widely eliminated this phenomenon due to ARV access. While there is no cure for HIV, ARVs are a class of drugs that suppress the multiplication of the virus within an individual, thereby preventing the spread of the disease between a mother and child.
Such drugs are less widely available in lower-income countries, meaning that MTCT continues to pose a threat. In Uganda, MTCT accounts for an HIV case rate of 466 cases per 100,000 births. That is still much higher than Uganda’s target of 50 cases per 100,000 births.
Struggles with ARVs in Uganda
In addition to high rates of MTCT, Uganda has low rates of treating children suffering from HIV. In Uganda, only about 49% of babies born to mothers who have HIV receive the necessary ARVs in the first six weeks. Such low rates of treatment can be attributed to limited medical infrastructure, cultural stigma and the financial burden of ARV treatment. Even when the drugs themselves come at no cost to the patient, travel and other expenses can be a serious financial investment in low-income countries. Furthermore, if parents do gain access to ARVs, they can still face difficulties in administering the medication to their children.
Traditionally, the ARVs used with children in low-income countries like Uganda have often come in liquid form. These liquid formulas are undesirable for the difficulty with which they are administered. To deliver the medication to their child throughout the day, a parent must have access to numerous clean syringes. Additionally, these liquid medications need to be kept refrigerated, a requirement that is often hard for people to meet in low-income settings. Quadrimune, the new ARV drug, promises to deal with the issues associated with liquid formulas.
The New Drug Quadrimune
Quadrimune is not actually a single new drug, but a combination of four previously existing drugs. These component drugs are abacavir, lamivudine, lopinavir and ritonavir, all of which are ARVs. However, it is the way in which the drugs are administered, rather than the chemical components themselves, that is new. Quadrimune addresses all of the inadequacies of traditional, liquid ARVs.
- The new drug has a sweet, strawberry flavor instead of the more traditional bitter taste.
- Quadrimune comes in “granule-filled capsules”, the contents of which can be mixed into a child’s food or drink, thereby removing the need for clean syringes.
- It does not need to be refrigerated.
- Quadrimune is cost-effective. The drug’s manufacturer, an Indian pharmaceutical company called Cipla, has said that Quadrimune will be available for less than $1 a day on average. Dr. K. A. Hamied founded Cipla in 1935, and the company has a long history of providing life-saving drugs at affordable prices. In 2001, the company supplied another ARV medication to African countries suffering from an HIV epidemic. Doctors Without Borders noted that Cipla sold the drugs in a significantly cost-effective manner.
Allocation and Approval
For the release of Quadrimune, Cipal is once again working with an affiliate of Doctors Without Borders. Cipla has partnered with the Drugs for Neglected Diseases Initiative (DNDI) to develop Quadrimune and ensure its equitable and affordable distribution. Doctors Without Borders founded DNDI in 2003 to advocate for the victims of non-prioritized diseases. Children in particular face significant hurdles to receive adequate care in resource-poor environments. DNDI is hoping to assist these children through its partnership with Cipla to create and distribute Quadrimune.
Quadrimune is still awaiting approval from the Food and Drug Administration. Yet, its potential to treat underserved communities at an affordable price could save thousands of lives in Uganda and around the globe. Hopefully, the joint efforts of Cipla and DNDI signal a wider shift toward the pharmaceutical industry and other global business leaders embracing humanitarian projects.
– Joseph Cavanagh