Evaluating a new strategy for prophylaxis to prevent Pneumocystis carinii pneumonia in HIV-exposed infants in Thailand

Objective: To evaluate a strategy for prophylaxis against Pneumocystis cari nii pneumonia (PCP) for infants in Thailand. Methods: HIV-infected women were offered trimethoprim-sulfamethoxazole for PCP prophylaxis for their children at 1-2 months of age. When the children reached 6 months of age, investigators simulated a decision to continue or stop prophylaxis on the basis of clinical criteria, and compared their deci sions with results of polymerase chain reaction (PCR) testing for HIV. We c alculated the proportions of children who received and completed prophylaxi s, and compared the rates of pneumonia and death from pneumonia with rates from an earlier prospective cohort. Results: Of 395 eligible infants, 383 (97%) started prophylaxis. By 6 month s of age, 10 (2.6%) were lost to follow-up, three (0.8%) were non-adherent, seven (2%) had stopped because of adverse events, four (1%) had died, and 359 (94%) still received prophylaxis. At 6 months of age, 30 (70%) of 43 HI V-infected children and 16 (5%) of 316 uninfected children met the clinical criteria to continue prophylaxis. The incidence of pneumonia at 1 to 6 mon ths of age was 22% (15/68) in the earlier cohort, and 13% (6/46) in the rec ent cohort [relative risk (RR) 0.6, 95% confidence interval (CI) 0.3-1.4; P = 0.22]; mortality rates were 9% and 4%, respectively (RR 0.5; 95% CI 0.1- 2.3; P = 0.47). Conclusion: This PCP prophylaxis strategy appeared to be acceptable and saf e, may have reduced morbidity and mortality from pneumonia, and should be c onsidered in developing countries where early laboratory diagnosis of perin atal HIV infection is unavailable. (C) 2000 Lippincott Williams & Wilkins.