Pneumocystis carinii pneumonia prophylaxis and early clinical manifestations of severe perinatal human immunodeficiency virus type 1 infection. Northern California Pediatric HIV Consortium.
BACKGROUND
Some children with perinatal HIV infection develop early progression to severe symptoms (Category C) within the first 4 years of life. Prophylactic therapy with trimethoprim-sulfamethoxazole (TMP/SMX) may affect progression by decreasing the incidence of Pneumocystis carinii pneumonia (PCP).


METHODS
HIV progression to Category C in the first 3 years of life was retrospectively analyzed in a population-based cohort of children with perinatal HIV infection followed for > or = 3 years from birth. Time to development of Category C and clinical patterns of new Category C diagnoses were examined in relation to patterns of PCP prophylaxis before diagnosis.


RESULTS
Fifty-eight of 147 children developed 67 initial category C diseases by 3 years of age: PCP (n=24), encephalopathy (n=22), other opportunistic infections (n=19) and wasting (n=2). Before diagnosis therapy included TMP/ SMX and zidovudine (ZDV) (n=11), TMP/SMX alone (n=7), ZDV alone (n=1) and neither (n= 39). The probability of developing a Category C diagnosis after 2 years was significantly lower among children who received TMP/SMX compared with those who did not (29%, TMP/SMX vs. 45%, no TMP/SMX; 30%, TMP and ZDV vs. 45%, no therapy; P < 0.01). The frequency of PCP was significantly lower and that of HIV encephalopathy was significantly higher among children receiving TMP/SMX +/- ZDV before Category C diagnosis than among children receiving neither.


CONCLUSIONS
In this study PCP prophylaxis was associated with longer time to Category C diagnoses in the first 3 years of life. This association was related to a decreased incidence of PCP and an increased incidence of encephalopathy as the first Category C diagnosis among children who received TMP/SMX.
Maldonado
Y A
YA
Department of Pediatrics, Stanford University School of Medicine, CA 94305, USA. mn.yam@forsythe.stanford.edu
Araneta
R G
RG
Hersh
A L
AL
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000401:mortality; D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage; D000890:Anti-Infective Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D015497:HIV-1; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D011020:Pneumonia, Pneumocystis / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D015215:Zidovudine / Q000008:administration & dosage
D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D015215:Zidovudine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination