Despite much greater coverage for adults with HIV/AIDS, less than a quarter of children who need treatment for the disease are getting it, according to the World Health Organisation.

According to data from its progress report for 2011, the WHO notes that the number of children in low- and middle income countries receiving antiretroviral (ARV) therapy increased from 354,600 in 2009 to 456,000 in 2010, but the coverage for the estimated 2,020,000 children in need is only 23%, much lower than the 51% coverage of ARVs among adults.

The figures prompted a response from Bernard Pecoul, executive director of the Drugs for Neglected Diseases initiative (DNDi), a non-profit R&D organisation that has recently launched a new paediatric HIV drug development programme. He noted that "children with HIV/AIDS are falling through the cracks" and 250,000 children died of disease-related complications in 2010 – "that’s nearly 700 each day. This is simply unacceptable".

There are several reasons for this, DNDi said, including lack of access for pregnant women to antenatal care, HIV testing and ARVs to prevent mother-to-child transmission and treat expecting mothers. However, it adds that "one of the most important, and overlooked, is the lack of suitable formulations of ARVs adapted for children, particularly babies and toddlers".

DNDi claims that "the reason for this neglect lies, ironically, with the success of the virtual elimination of HIV among newborns in wealthy countries". Dr Pecoul argues that "there's little profit to be made from developing treatments for the millions of children with HIV/AIDS, 90% of whom are the poorest of the poor in sub-Saharan Africa, and the lack of market incentive means pharmaceutical companies do not develop ARVs adapted to their needs". Without treatment, he concluded, "half of the children born with HIV die before their second birthday".