One out of 10 mothers passing HIV to newborn, data shows

Kenya has been ranked the best country in Africa as far as prevention of mother-to-child transmission is concerned, with Cameroon doing badly at 40 per cent.

Whereas one child is born with HIV in Kenya today, six children in Cameroon are born daily with HIV.

However, the bigger challenge is keeping those who are born with HIV on treatment and suppressing the virus in their bodies.

The data shows that out of 10 HIV-positive children, only five children attain viral suppression, as more develop resistance to some of the HIV drugs they are taking.

This means the remaining 45 per cent are not responding to their treatment, leading to low or no viral suppression.

“We know the dangers of low viral suppression, as these children are on lifelong ARTs,” says Dr Ruth Masha, the chief executive officer of NACC.

Mother-to-child transmission has reduced significantly in the country, from 17 per cent in 2014 to 10 per cent.

Fight fallen behind

“Despite the progress, the HIV fight in children has fallen behind as compared to the response in adults. The children are at 70 cent identification of HIV cases, 67 per cent are on treatment and a paltry 55 per cent have recorded viral suppression,” she said.

This means out of 10 HIV-positive children, only seven have been identified and only six are on treatment.

From the data, out of the 106,807 HIV-positive children aged less than 15 years, only 72,241 are on treatment, which means about 35,000 children are not on treatment.

“It is sad that in this era we have children who are not on treatment and that we still see instances of mothers transmitting the disease to their children. This is unacceptable. We know that this population is vulnerable HIV acquisition and further transmission of HIV to their children,” Dr Masha said.

As the children grow into adolescence, they become a major concern in the fight against HIV.

Viral suppression

Of the adolescents living with HIV, only 77 per cent of those on treatment have recorded viral suppression.

“There is a need to ensure maximal viral suppression to reduce resistance to life-saving ARVs and provide options for the children to have normal growth and development,” she said.

But even as the government plans for more HIV-friendly regimens for the children to boost the viral suppression rate, a report released yesterday by the World Health Organization shows that 10 per cent of children in Kenya have developed resistance to nucleoside reverse transcriptase inhibitors (NRTIs).

NRTIs-based antiretroviral regimens are second-generation treatments that include doravirine, etravirine and rilpivirine.

These drugs interfere with the ability of HIV to multiply or reproduce by blocking an enzyme that the virus needs to make copies of itself.

Drug resistance

HIV drug resistance occurs when disease-causing germs such as bacteria or viruses continue multiplying despite the presence of drugs that noramally kill them.

The resistance is caused by mutations (changes) in the virus's genetic structure, sub-optimal treatment adherence, treatment interruptions or the use of suboptimal drugs and combinations.

The WHO data shows eight per cent of Kenyan children on treatment have developed resistance to Abacavir (ABC), seven per cent to Emtricitabire (FTC) - Lamivudine (3TC), five per cent to Zidovudine (ZDV) and three per cent to Tenofovir disoproxil fumarate (TDF).

This means that infants from whom these specimens were obtained unlikely to respond to treatment.

Overall, the prevalence of pretreatment resistance to Efavirenz (EFV) or Nevirapine (NVP) was high, with a pooled prevalence of 46 per cent ranging from 34 per cent in Eswatini to 68 per cent in Malawi.

Specifically, ABC resistance levels ranged from 1.5 per cent in Eswatini in 2011 to 20 per cent in Malawi.

Pre-treatment resistance to abacavir (ABC) and 3TC (the preferred NRTIs for infants) had exceeded 10 per cent in five of the 10 countries in Sub-Saharan Africa, Kenya included.

The report indicates most countries are moving away from NNRTI-based ARTs for infants, in accordance with WHO recommendations.

“The relatively high levels of NRTI resistance in some countries suggest caution when initiating regimens containing drugs with a low genetic barrier to resistance (including raltegravir in neonates), and findings highlight the importance of using DTG-containing regimens in young children as early as possible,” the WHO said.

Regimen for infants

As a first-line regimen for infants younger than one, WHO recommends raltegravir + Zidovudine (ZDV) or Abacavir (ABC) + Lamivudine (3TC). Only when children attain three kilogrammes and four weeks of age is DTG + ABC + 3TC recommended (32).

“Observed levels of ABC resistance emphasized on the need to accelerate access to new ARV drugs in this population, such as tenofovir alafenamide and drugs from new classes such as islatravir or lenacapavir,” the WHO report notes.

WHO encourages countries to change the first-line HIV treatment to a more robust dolutegravir-containing regimen.

Based on the most recent findings from surveys conducted in 10 countries in sub-Saharan Africa, nearly half of newly diagnosed infants have drug-resistant HIV.

The WHO has recommended dolutegravir as a first and second line of treatment for all population groups since 2019, arguing that it is more effective, easier to take and has relatively fewer side effects.

Dolutegravir also has a high genetic barrier to developing drug resistance.

To keep infected children on drugs, the national government is revising its national ART guidelines to adopt pediatric Dolutegravir (Ped DTG) in an effort to roll out pediatric-friendly regimens.

“By next year, we’ll be having Dolutegravir drug for our young girls and boys,” Dr Masha said.