PRIMARY PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS IN HIV INFECTED CHILDREN

There are

various opportunistic infections

that can occur in HIV infected children such as:

• PCP pneumonia
• Recurrent Bacterial Infections
• Mycobacterium Tuberculosis
• Mycobacterium avium complex
• Toxoplasmosis
• Chronic diarrhea due to amoebiasis, giardiasis, Cryptosporidium, Microsporidia, Isospora Belli & Cyclospora
• Cryptococcal meningitis
• Candidiasis
• Cytomegalovirus (CMV)
• Herpes simplex
• Chickenpox
• Herpes zoster

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 :

1. -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


2. 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