PROPHYLAXIS AGAINST PNEUMOCYSTIS-CARINII PNEUMONIA AMONG CHILDREN WITH PERINATALLY ACQUIRED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN THE UNITED-STATES
Rj. Simonds et al., PROPHYLAXIS AGAINST PNEUMOCYSTIS-CARINII PNEUMONIA AMONG CHILDREN WITH PERINATALLY ACQUIRED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN THE UNITED-STATES, The New England journal of medicine, 332(12), 1995, pp. 786-790
Background. Pneumocystis carinii pneumonia (PCP) remains a common and
often fatal opportunistic infection among children infected with the h
uman immunodeficiency virus (HIV). HIV-infected infants between three
and six months of age are particularly vulnerable. Current guidelines
recommend prophylaxis in children from birth to 11 months old who have
CD4+ counts below 1500 cells per cubic millimeter. Methods. We used n
ational surveillance data to estimate the annual incidence of PCP amon
g children less than one year old. We reviewed the medical records of
300 children given a diagnosis of PCP between January 1991 and June 19
93 to determine why treatment according to the 1991 guidelines for pro
phylaxis against PCP either was not given or failed to prevent the dis
ease. Results. In our study the incidence of PCP in the first year of
life among infants born to HIV-infected mothers changed little between
1989 and 1992. Among 7080 children born to HIV-infected mothers in 19
92, PCP developed in 2.4 percent. Of 300 children with PCP diagnosed f
rom January 1991 through June 1993, 199 (66 percent) had never receive
d prophylaxis, and for 118 of those children (59 percent) exposure to
HIV was first identified 30 days or less before the diagnosis of PCP,
Among 129 children less than one year old, the CD4+ count declined by
an estimated 967 cells per cubic millimeter (95 percent confidence int
erval, 724 to 1210 cells per cubic millimeter) during the three months
before the diagnosis of PCP, Among infants in whom CD4+ counts were d
etermined within one month of the diagnosis of PCP, 18 percent (20 of
113) had at least 1500 cells per cubic millimeter, a level higher than
the currently recommended threshold for prophylaxis. Conclusions. In
the United States the incidence of PCP among HIV-infected infants has
not declined. If this infection is to be prevented, infants exposed to
HIV must be identified earlier, and prophylaxis must be offered to mo
re children than the guidelines currently recommend.