The Indian pharmaceutical company, Cipla has announced their commitment to price the ground-breaking new product Quadrimune, a “4 in 1” treatment for young children with HIV at below a US Dollar a day.

Quadrimune is currently under review by the US Food and Drug Administration (FDA) for use in children between three and 25 kg bodyweight.

This pleasant tasting, heat-stable fixed-dose combination of four antiretrovirals (ARVs) for infants and young children with HIV was developed in partnership by Cipla and the not-for-profit Drugs for Neglected Diseases initiative (DNDi) with financial support from Unitaid and other donors.

If it receives tentative approval by the FDA in 2020, the 4-in-1 will represent a major improvement in the treatment of HIV in very young children and will replace older, bitter-tasting medicines, medicines requiring refrigeration, or regimens that are no longer recommended by the World Health Organization (WHO).

‘Cipla is happy that over the past 20 years it has contributed to making adult antiretroviral drugs available at affordable prices for patients throughout the developing world, in particular Africa, and has pioneered the development of paediatric fixed-dose combinations of ARVs for children,’ says Dr Yusuf K Hamied, Chairman of Cipla.

‘Over the years, the treatment of children with HIV has been neglected. In order to ensure faster access, particularly in sub-Saharan Africa, our product Quadrimune, once approved, will be offered for less than one dollar a day for children, he said in a statement copied to the Ghana News Agency (GNA).

“Children living with HIV have been neglected for too long, with the recommended treatment for years consisting of bitter-tasting syrup with 40 per cent alcohol content,’ said Dr Bernard Pécoul, Executive Director of DNDi.

Mothers were often forced to bury the syrup in the sand to keep it cool, because it required refrigeration. The new Quadrimune is pleasant-tasting, heat-stable and easy-to-use. We will finally have a treatment designed specifically for infants and young children, who are at the highest risk of dying if they do not receive treatment.’

It is estimated that 1.8 million children are living with HIV, almost 90 per cent of whom live in sub-Saharan Africa. Only an estimated 54 per cent of these children have access to HIV treatment and over 300 children still die from the disease every day. Inappropriate, suboptimal treatment options have contributed to low treatment coverage.

Quadrimune contains the WHO-recommended ARVs abacavir, lamivudine, lopinavir and ritonavir, in the form of granules filled in capsules.

If approved, parents and caretakers will be able to administer the drugs to children by sprinkling the granules with soft food, water, or milk. The 4-in-1 does not require refrigeration and is easy to administer to infants and children of different weights and ages.

Cipla will provide Quadrimune at an ex-factory cost of US$ 15 per pack of 120 capsules, giving a price of $1 per day ($360 per year) for children in the medium weight bracket of 10 to 13.9 kg, with prices lower, at 50 US cents per day for younger children and infants.

“This optimal child-adapted all-in-one ARV regimen, that meets WHO recommendations, will be a game-changer for millions of infants and young children,” Unitaid Executive Director Lelio Marmora said.

“Unitaid is proud to have supported from day one the development of this new 4-in-1 treatment that is safe and effective, adapted and palatable, easy-to-use and with no requirement for refrigeration. Once adopted, this innovative formulation will enable great advances in the treatment of the youngest kids.”

Since 2013, WHO has recommended regimens that include a class of ARVs called protease inhibitors, which includes lopinavir/ritonavir (LPV/r), for infants and young children.

Cipla and DNDi worked closely to develop Quadrimune, testing over 30 formulations of abacavir, lamivudine, and LPV/r, ensuring good taste-masking and selecting one which met the standards required for enable regulatory submission.

The 4-in-1 could be the first of several new treatment options for young children with HIV that are now on the horizon.

DNDi is a not-for-profit research and development organization working to deliver new treatments for neglected diseases – notably leishmaniasis, sleeping sickness, Chagas disease, specific filarial infections and mycetoma – as well as treatments for neglected patients, particularly those living with paediatric HIV and hepatitis C.

Since its inception in 2003, DNDi and its partners have already delivered eight innovative treatments to improve the quality of life and health of patients.

Unitaid also brings the power of new medical discoveries to the people who most need them and helps set the stage for large-scale introduction of new health products by collaborating with governments and partners such as PEPFAR, the Global Fund and WHO.

It invests in new ways to prevent, diagnose and treat diseases including HIV/AIDS, hepatitis C, tuberculosis and malaria more quickly, affordably and effectively.