How pills beat potions for HIV positive babies ​

When Dr Fatima Mir, the head of paediatric infectious diseases at AKU, started treating children with HIV in 2006, you treated the virus with three medicines, called combination therapy.

This was difficult for the parents, who had to give three separate syrups to their screaming, crying, kicking child. “It didn’t even taste good,” she recalls. “The child took the medicine and vomited it out. We had to tell parents that if they vomit within 30 minutes, you have to give the medicine again. Parents, poor things, suffered.” And as with all long-term illnesses that come from germs, you have to give treatment over a longer period of time. 

HIV needs combination therapy. You don't prescribe one medicine; there are three types of medicines. Together they work on the virus's birth, growth, and development into an adult virus by reducing it at different stages. One medicine will interrupt the HIV virus at one stage, another at another stage. Even Malaria and TB are treated with combination therapy. 

The good news is that HIV treatment for children in Pakistan has come a long way.  Caregivers like Dr Fatima Mir can now explain to parents that they don’t need to give their child three syrups. The combination therapy now comes in one dispersible tablet.

“You just dissolve it in a teaspoon of water and make the child drink it,” she says. “Even that doesn't taste amazing, but because it dissolves in a little bit of water, the child will still be able to swallow it.”

And so now, healthcare practitioners are tending to give less syrups and suspensions because they require refrigeration. “But now the WHO and governments around the world are going towards child-friendly medicines for chronic infections such as HIV, TB, where you have to give medicines for a longer time than usual,” she says. 

Dr Fatima Mir​ reassures parents that HIV does not mean their child has AIDS. HIV is just an infection and they have to take a certain number of medicines. “But of course, other than HIV, we have to do all the things which we have to do for children,” she adds. “Your HIV-positive child will get pneumonia, your HIV child will get gastroenteritis, your HIV child will get the flu, will get colds. All of those have to be dealt with like they're dealt with in other children.” The only difference is that the child has to be administered HIV medicine their entire life.