Of the estimated 2.2 million children worldwide who are infected with HIV, less than 1 percent are receiving antiretroviral (ARV) therapy. Without the medicine, most will die before their fifth birthday. Particularly in sub-Saharan Africa -- home to more than 85 percent of all HIV-infected children under age 15 -- pediatric ARV treatment remains out of reach.

Botswana, the first African country to provide free ARV treatment to all who need it, is one of the few treating HIV-positive children through its public health system. The country boasts the continent's first facility devoted to pediatric AIDS. Operated by the Houston, Texas-based Baylor College of Medicine and financed by Bristol-Myers Squibb, the Botswana-Baylor Children's Clinical Center of Excellence (BBCCCE) treats some 1,400 African children.

But even in Botswana, where an estimated 5,000 children are on treatment, only five of the 32 sites dispensing free ARVs will treat children.

Pediatrics professor Gabriel Anabwani, who runs BBCCCE, said the challenges in treating children are numerous. Because there has been such little research on pediatric treatment, options are limited, and dosing guidelines are less precise than for adults. The youngest children cannot swallow pills and require liquid formulations, which are not always available.

According to the US-based Elizabeth Glaser Pediatric AIDS Foundation, only 12 of the 20 AIDS drugs developed so far are labeled for pediatric use; just seven are labeled for children under two. Though adult AIDS drug prices have dropped significantly, pediatric formations cost up to eight times more, the foundation said.

Some countries cannot afford to add children's AIDS medicines to their formularies. In countries like Malawi, clinicians grind up adult pills to approximate a pediatric dose, said Anabwani.

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