Drugs to treat HIV so foul-tasting, many kids refuse to take them: study

TORONTO (CP) - Children infected with the AIDS virus need something to help make the medicine go down, since many find the liquid drugs so nasty-tasting they refuse to take them, researchers say.

A study of almost 120 Canadian children being treated for HIV found that more than one-third of them found the drugs needed to keep the infection in check were so unpalatable that they refused to swallow them.

"We found that of these kids being treated that it was really common that children had to have their therapy changed because they couldn't tolerate the medications' taste," said Dr. Michael Rieder, a pediatrician at the Children's Hospital of Western Ontario and the study's lead investigator.

For kids on the worst-tasting drug of all, Ritonavir, half the children had to have their prescriptions changed because they couldn't stomach the medication, said Rieder, calling it "extremely bitter."

Having children turn up their noses at the nasty-tasting drugs can have serious consequences, he said Tuesday from London, Ont. "Some of them didn't get an adequate number of courses, because you have to take 90 per cent of your drug for it to work with HIV infection.

"Some of them had their medications changed to one of the others, and in rare cases, some of them had to have feeding tubes put in to be treated that way, which is a bit extreme, but sometimes you have to do it."

In Canada, there are about a dozen liquid antiretroviral drugs that can be prescribed for HIV-infected children, said Dr. Stanley Read, head of the HIV clinic at the Hospital for Sick Children in Toronto. Liquids must be used because many kids, the youngest ones in particular, are unable to swallow tablets.

The drugs work by interfering with HIV's reproductive cycle, stopping the virus from making copies of itself that can cripple the immune system and lead to the deadly infections and cancers associated with AIDS.

While medicines for children, such as cough syrups and even some antibiotics, are made more palatable with sugar, sweeteners or other taste-altering ingredients pose a challenge for drug companies because the additions could cause a chemical interaction with the drugs, Rieder said.

And in fairness to pharmaceutical companies, he said, palatability in prescription drugs is an issue that has only recently become a consideration.

But with inadequate dosing of the drugs, there's a danger that drug-resistant mutations of the virus will develop or the virus will replicate and begin destroying the immune system, Read said.

At the Sick Kids clinic, Read said health providers teach parents of HIV-positive children how to administer a cocktail of the drugs, which are loaded in a syringe and squirted into the mouth twice daily.

Trying to mask the taste of the medicines by putting them in orange juice or milk won't work because the result is bad-tasting orange juice or milk that turns the child off drinking liquids, Read said. "So it's best just to give it straight and chase it with something that will help to wash out the bad taste."

Rieder, whose study looked at the pharmacology records of 119 HIV-infected children treated at Sick Kids between 1987 and 2003, is urging drug manufacturers to develop HIV drugs that are easier for children to take.

Sylvie Legre, a spokeswoman for Montreal-based Abbott Laboratories Ltd. of Canada, agreed its product Ritonavir "tastes bad." While the company is not specifically trying to alter the drug's taste, she said it continuously looks for ways to improve the palatability and effectiveness of all its products.

Read said getting kids to take their medicine is part of the complex psychosocial issues surrounding HIV-AIDS.

"In most cases you've got an HIV-positive mom who feels guilty about passing the virus onto her child, trying to give this child medication that she knows is going to help them, but the child fights her and gets upset every time she has to give it," he said.

"It gets to be a very complex interaction. But with a lot of support and encouragement, most of them do a good job."