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

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: