       Document 0043
 DOCN  M9640043
 TI    Benefit of primary prophylaxis before 18 months of age in reducing the
       incidence of Pneumocystis carinii pneumonia and early death in a cohort
       of 112 human immunodeficiency virus-infected infants. New York City
       Perinatal HIV Transmission Collaborative Study Group.
 DT    9604
 AU    Thea DM; Lambert G; Weedon J; Matheson PB; Abrams EJ; Bamji M; Straus
       WL; Thomas PA; Krasinski K; Heagarty M; Medical and Health Research
       Association, New York, USA.
 SO    Pediatrics. 1996 Jan;97(1):59-64. Unique Identifier : AIDSLINE
       MED/96133793
 AB    OBJECTIVE. To determine the effectiveness of primary prophylaxis in
       preventing Pneumocystis carinii pneumonia (PCP) in children with
       perinatally acquired human immunodeficiency virus 1 (HIV-1) infection.
       METHODS. We conducted a retrospective analysis of a cohort of infants
       followed from birth at six metropolitan hospitals and one outpatient
       clinic for pregnant, drug-using women in New York City. Outcomes
       measured were histologically confirmed PCP and/or death. The potential
       confounding effect of the infant's stage of illness, as determined by
       CD4 count, was controlled by including all CD4 determinations as
       time-dependant covariates in a Cox proportional hazards analysis. Cases
       were censored at PCP onset, death, loss to follow-up, and 18 months of
       age. RESULTS. One hundred twelve HIV-infected children were enrolled at
       birth between 1986 and 1993. Sixty of these were tracked beyond 18
       months of age; of the others, 21 died before this age, 4 were considered
       lost to follow-up, and 27 had not reached 18 months of age at the last
       visit. Only 3 cases (4%) of confirmed PCP occurred among the 70 children
       who received primary PCP prophylaxis before 18 months of age, compared
       with 12 cases (28%) among 42 children not receiving PCP prophylaxis at
       any point before 18 months of age. The Kaplan-Meier estimated incidence
       of PCP in the first year among children not receiving prophylaxis was
       25% (95% confidence interval [CI], 12 to 39). Using Cox methods, the
       unadjusted risk of PCP among infants not receiving prophylaxis, relative
       to those receiving it, was 4.1 (95% CI, 1.1 to 15); the relative risk
       was 4.4 (95% CI, 1.2 to 17) adjusting for the percentage of CD4-positive
       lymphocytes and 5.1 (95% CI, 1.3 to 20) adjusting for the absolute
       number of CD4-positive cells. Eight of 26 deaths were caused by PCP, and
       the likelihood of early death was significantly diminished if PCP
       prophylaxis was given (relative risk controlling for absolute CD4 cells,
       2.57; 95% CI, 1.1 to 6.1). CONCLUSIONS. We report evidence that primary
       antimicrobial PCP prophylaxis is highly effective in decreasing the
       frequency of PCP and early death in infants with perinatal HIV
       infection. These findings support the revised National Pediatric HIV
       Resource Center and Centers for Disease Control and Prevention
       guidelines for PCP prophylaxis in children.
 DE    Acquired Immunodeficiency Syndrome/DIAGNOSIS  Age Factors  AIDS-Related
       Opportunistic Infections/IMMUNOLOGY/MORTALITY/  *PREVENTION & CONTROL
       CD4 Lymphocyte Count  Female  Follow-Up Studies  Human  Incidence
       Infant  Pneumonia, Pneumocystis carinii/IMMUNOLOGY/MORTALITY/*PREVENTION
       & CONTROL  Pregnancy  Primary Prevention/*METHODS  Proportional Hazards
       Models  Retrospective Studies  Support, Non-U.S. Gov't  Support, U.S.
       Gov't, P.H.S.  Trimethoprim-Sulfamethoxazole Combination/THERAPEUTIC USE
       JOURNAL ARTICLE  MULTICENTER STUDY

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

