Clinical Immunotherapeutics

, Volume 1, Issue 4, pp 258–270 | Cite as

Prevention of Infections in Children with Human Immunodeficiency Virus Infection

Practical Recommendations
  • Lynne M. Mofenson
Practical Therapeutics
  • 4 Downloads

Summary

Infection with HIV in children is superimposed on the immunological naivety inherent to infancy and on an immature immune system undergoing developmental maturation. Therefore, in addition to the opportunistic infections characteristic of HIV infection in adults, severe infections with common bacterial and viral organisms are frequent early manifestations of HIV infection in children. Recurrent serious bacterial infections are the second most frequent AIDS-defining infection in children, with only Pneumocystis carinii pneumonia (PCP) more common. Mycobacterium avium complex infection is also assuming increasing importance as a pathogen in HIV-infected children.

Two randomized placebo-controlled clinical trials of intravenous immunoglobulin (IVIG) prophylaxis of bacterial infections in paediatric HIV infection have recently been completed. The data indicate that IVIG reduces the rate of serious and minor bacterial infections and decreases hospitalizations in HIV-infected children with both mild and advanced HIV disease. In children receiving zidovudine, this effect is independent of CD4+ count at initiation of therapy. In children receiving zidovudine who also receive concomitant prophylaxis with cotrimoxazole (trimethoprim-sulfamethoxazole) for PCP, IVIG may not provide additional benefit for reduction of bacterial infections, although definitive recommendations must await the results of further studies.

Recommendations for prophylaxis of PCP in pediatric HIV infection are complicated by normal age-related changes in CD4+ lymphocyte count. Recent guidelines from the US Public Health Service are reviewed.

Finally, the incidence of Mycobacterium avium complex disease in paediatric HIV infection is examined, and potential prophylactic regimens discussed.

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Copyright information

© Adis International Limited 1994

Authors and Affiliations

  • Lynne M. Mofenson
    • 1
  1. 1.Pediatric, Adolescent and Maternal AIDS Branch, Center for Research for Mothers and ChildrenNational Institute of Child Health and Human Development, National Institutes of HealthBethesda, RockvilleUSA

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