HIV in Children

PRIMARY PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS IN HIV INFECTED CHILDREN

Dr. Ira Shah
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Last Updated : 1st September 2012
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 :
  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

  2. Dosage:



    • TMP/SMX- 5 mg/kg of TMP/day PO daily

  3. 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
PRIMARY PROPHYLAXIS OF OPPORTUNISTIC INFECTIONS IN HIV INFECTED CHILDREN
Dr. Ira Shah
Incharge Pediatric HIV and TB Clinic, B.J.Wadia Hospital for Children, Mumbai, India Consultant in Pediatric Infectious Diseases, Nanavati Hospital, Mumbai, India.