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M9550836.TXT
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1995-03-25
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Document 0836
DOCN M9550836
TI Prophylaxis against Pneumocystis carinii pneumonia among children with
perinatally acquired human immunodeficiency virus infection in the
United States. Pneumocystis carinii Pneumonia Prophylaxis Evaluation
Working Group.
DT 9505
AU Simonds RJ; Lindegren ML; Thomas P; Hanson D; Caldwell B; Scott G;
Rogers M; Division of HIV/AIDS, Centers for Disease Control and
Prevention,; Atlanta, GA 30333.
SO N Engl J Med. 1995 Mar 23;332(12):786-90. Unique Identifier : AIDSLINE
MED/95166279
AB BACKGROUND. Pneumocystis carinii pneumonia (PCP) remains a common and
often fatal opportunistic infection among children infected with the
human 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
national surveillance data to estimate the annual incidence of PCP among
children less than one year old. We reviewed the medical records of 300
children given a diagnosis of PCP between January 1991 and June 1993 to
determine why treatment according to the 1991 guidelines for prophylaxis
against PCP either was not given or failed to prevent the disease.
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 1992, PCP
developed in 2.4 percent. Of 300 children with PCP diagnosed from
January 1991 through June 1993, 199 (66 percent) had never received
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
interval, 724 to 1210 cells per cubic millimeter) during the three
months before the diagnosis of PCP. Among infants in whom CD4+ counts
were determined 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 more
children than the guidelines currently recommend.
DE AIDS-Related Opportunistic Infections/DIAGNOSIS/EPIDEMIOLOGY/
IMMUNOLOGY/*PREVENTION & CONTROL Child Child, Preschool CD4
Lymphocyte Count Disease Transmission, Vertical Human HIV
Infections/TRANSMISSION Incidence Infant Pneumonia, Pneumocystis
carinii/DIAGNOSIS/EPIDEMIOLOGY/IMMUNOLOGY/ *PREVENTION & CONTROL
Retrospective Studies United States/EPIDEMIOLOGY JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).