There are various opportunistic infections
that can occur in HIV infected children such as:
Primary prophylaxis to prevent these infections is not regularly recommended in these children due to drug interactions, toxicity of the drugs and formation of drug resistant organisms. Hence for primary prophylaxis very few agents are recommended.
When an HIV infected child presents, following prophylaxis is recommended :
- -SMX prophylaxis (for PCP, recurrent bacterial infections, chronic diarrhea and toxoplasmosis)
Indications:
- All HIV infected asymptomatic infants till 1 year of age
- All symptomatic HIV infected children (WHO Stage 2 and above)
- All HIV infected children with CD4 % less than 15% irrespective of symptoms
Dosage:
- TMP/SMX- 5 mg/kg of TMP/day PO daily
- or Clarithromycin prophylaxis for mycobacterium avium
Indications:
- Any child in CDC Class C or WHO Stage IV
- In patients with very low CD4 count such as
Age |
CD 4 count (cells/cumm) |
< 12 months |
< 750 |
1-2 years |
< 500 |
2-6 years |
< 75 |
> 6 years |
< 50 |
Prophylaxis may be stopped if CD4 percent is more than the threshold for 6 months and ART has been continued for more than 12 months and child is asymptomatic.
Dosage:
Drugs |
Dosage |
Clarithromycin |
15 mg/kg/day PO BD (max 500 mg/day) |
Azithromycin |
20 mg/kg/day PO weekly (max 1.25 gm/day |