       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).

