title: Optimizing drugs to reach treatment targets for children and adolescents living with HIV.
abstract: BACKGROUND
  As the global community makes progress towards the 90-90-90 targets by 2020, a key challenge is ensuring that antiretroviral drugs for children and adolescents are suitable to the context of resource-limited settings. Drug optimization aims to support the expanded use of more simplified, less toxic drug regimens with high barriers to drug resistance that require minimal clinical monitoring while maintaining therapeutic efficacy. This manuscript summarizes the progress made and outlines further critical steps required to ensure that the right drugs are available to start children and adolescents on treatment and to keep them virologically suppressed.
  
  
  CONCLUSIONS
  Building upon previous work in drug optimization, several important steps were taken in 2014 to ensure alignment between WHO dosing recommendations and the requirements of regulatory bodies, to accelerate drug development, to reduce intellectual property barriers to generic production of combined formulations and rationalize drug selection in countries. The priority for the future is to improve access to antiretroviral therapy (ART) at the two ends of the paediatric age spectrum--infants and adolescents--where the treatment gap is greatest, and optimize drug sequencing with better use of available medicines for second- and third-line ART. Future efforts in this area will require continuous collaboration and coordination, and the promotion of innovative approaches to accelerate access to new drugs and formulations.
  
  
  CONCLUSIONS
  While significant progress has been made, additional efforts are needed to ensure that treatment targets are reached by 2020.
authors.affiliation: HIV Department, World Health Organization, Geneva, Switzerland; penazzatom@who.int.
authors.forename: Martina
authors.initials: M
authors.lastname: Penazzato
authors.affiliation: Drugs for Neglected Diseases Initiative, Geneva, Switzerland.
authors.forename: Janice
authors.initials: J
authors.lastname: Lee
authors.affiliation: Clinical pharmacology, University of California, San Diego, CA, USA.
authors.forename: Edmund
authors.initials: E
authors.lastname: Capparelli
authors.affiliation: HIV Department, World Health Organization, Geneva, Switzerland.
authors.forename: Shaffiq
authors.initials: S
authors.lastname: Essajee
authors.affiliation: HIV Department, World Health Organization, Geneva, Switzerland.
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
authors.affiliation: UNICEF, Copenhagen, Denmark.
authors.forename: Atieno
authors.initials: A
authors.lastname: Ojoo
authors.affiliation: Medicine Patent Pool, Geneva, Switzerland.
authors.forename: Fernando
authors.initials: F
authors.lastname: Pascual
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Sugandhi
authors.affiliation: Drugs for Neglected Diseases Initiative, Geneva, Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Lallemant
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015658:HIV Infections / Q000188:drug therapy*; D006285:Health Planning; D006801:Humans; D007223:Infant
chemical_list: D019380:Anti-HIV Agents
keywords: ART; HIV; antiretrovirals; children; formulations; optimization; treatment