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Title: Evaluating a new strategy for prophylaxis to prevent Pneumocystis carinii pneumonia in HIV-exposed infants in Thailand
Authors: Kulkanya Chokephaibulkit
Rutt Chuachoowong
Tawee Chotpitayasunondh
Sanay Chearskul
Nirun Vanprapar
Naris Waranawat
Philip Mock
Nathan Shaffer
R. J. Simonds
Mahidol University
HIV/AIDS Collaboration
Thailand Ministry of Public Health
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Faculty of Medicine, Siriraj Hospital, Mahidol University
Keywords: Immunology and Microbiology;Medicine
Issue Date: 23-Sep-2000
Citation: AIDS. Vol.14, No.11 (2000), 1563-1569
Abstract: Objective: To evaluate a strategy for prophylaxis against Pneumocystis carinii pneumonia (PCP) for infants in Thailand. Methods: HIV-infected women were offered trimethoprim-sulfamethoxazole for PCP prophylaxis for their children at 1-2 months of age. When the children reached 6 months of age, investigators simulated a decision to continue or stop prophylaxis on the basis of clinical criteria, and compared their decisions with results of polymerase chain reaction (PCR) testing for HIV. We calculated the proportions of children who received and completed prophylaxis, and compared the rates of pneumonia and death from pneumonia with rates from an earlier prospective cohort. Results: Of 395 eligible infants, 383 (97%) started prophylaxis. By 6 months of age, 10 (2.6%) were lost to follow-up, three (0.8%) were non-adherent, seven (2%) had stopped because of adverse events, four (1%) had died, and 359 (94%) still received prophylaxis. At 6 months of age, 30 (70%) of 43 HIV-infected children and 16 (5%) of 316 uninfected children met the clinical criteria to continue prophylaxis. The incidence of pneumonia at 1 to 6 months of age was 22% (15/68) in the earlier cohort, and 13% (6/46) in the recent cohort [relative risk (RR) 0.6, 95% confidence interval (Cl) 0.3-1.4; P = 0.22]; mortality rates were 9% and 4%, respectively (RR 0.5; 95% Cl 0.1-2.3; P= 0.47). Conclusion: This PCP prophylaxis strategy appeared to be acceptable and safe, may have reduced morbidity and mortality from pneumonia, and should be considered in developing countries where early laboratory diagnosis of perinatal HIV infection is unavailable. (C) 2000 Lippincott Williams and Wilkins.
ISSN: 02699370
Appears in Collections:Scopus 1991-2000

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