Target product profile for a ‘4-in-1’ for paediatric HIV

DNDi aims to develop a once-daily, pleasant-tasting 4-in-1 fixed-dose antiretroviral treatment for HIV in all children under three years, including neonates, that is easily swallowed and does not require a cold-chain.

IdealAcceptable
Target populationBoth nevirapine (NVP)-exposed and non-exposed HIV+ and HIV-exposed children under 3 years of age, including neonates Both NVP-exposed and non-exposed HIV+ children under 3 years of age and above 3 months of age
Treatment regimenOnce-daily
Dosing based on weight band
Twice-daily
Dosing based on weight band
FormulationFixed-dose formulation of abacavir, lamivudine, lopinavir, and ritonavir.
Dosage form suitable for sprinkling on age-appropriate food or liquid, suitable for infants and young children, with very small particle sizes enabling easy swallowing by very young infants and neonates.
Fixed-dose formulation of abacavir, lamivudine, lopinavir, and ritonavir.
Dosage form suitable for sprinkling on age-appropriate food or liquid, suitable for infants and young children.
DurabilityHigh genetic barrier, protease inhibitor-like. Long plasma half-life.High genetic barrier, protease inhibitor-like. Long plasma half-life.
EfficacySame as for adultsSame as for adults
Safety/tolerabilityWell tolerated and no laboratory monitoring neededNo laboratory monitoring needed
PalatabilityNo taste or pleasant taste for childrenAcceptable taste for children
Drug-drug interactionsNo drug-drug interaction with TB medicines, particularly rifampicin or rifabutinSome drug-drug interaction with TB medicines, but can be used with proper dose adjustments
StabilityNo cold chain requirement, minimum 2 years shelf life in Zone IVb conditionsNo cold chain requirement, minimum 18 months shelf life in Zone IVb conditions
CostSimilar to average public cost of an adult antiretroviral therapyNot more expensive than the public cost of the paediatric formulations of the separate drugs