CD4 T-lymphocyte counts and Pneumocystis carinii pneumonia in pediatric HIV infection

Article Abstract:

Pneumocystis carinii pneumonia (PCP) is the primary cause of death in children infected with the human immunodeficiency virus type I (HIV-I). Thirty-nine to 65 percent of HIV-infected infants die during their first bout of PCP. The risk of developing PCP in HIV-infected adults is associated with having fewer than 200 million CD4 T-lymphocytes (a type of immune cell) per liter of blood. PCP prophylaxis, or preventive drug therapy, is recommended for HIV-infected adults with such low numbers of CD4 T-lymphocytes. Because infants have relatively greater numbers of CD4 T-lymphocytes as compared with adults, this recommendation for PCP prophylaxis may not apply to HIV-infected infants. However, PCP prophylaxis should be initiated early in infants, even before a diagnosis of HIV infection is confirmed. The relationship between CD4 T-lymphocyte counts and PCP was assessed in 266 HIV-infected and uninfected children of infected mothers, including 39 children with PCP. CD4 T-lymphocyte counts of less than 500 million cells per liter were detected in only 10 of 21 children with PCP who acquired HIV infection at birth, but all 18 children who were infected by contaminated blood and blood products. Of 68 children aged one year or younger, CD4 T-lymphocyte counts of less than 1,500 million cells per liter were detected in 18 of 20 PCP cases but only five of 48 children who did not have AIDS. Thirty-nine children with PCP had lower CD4 T-lymphocyte counts than 188 children with HIV disease which had not progressed to AIDS. These findings suggest that HIV-infected infants should be identified early and monitored closely. Measurement of CD4 counts may help to determine when to start PCP preventive drug therapy. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Guidelines for prophylaxis against Pneumocystis carinii pneumonia for children infected with human immunodeficiency virus

Article Abstract:

Specialists in the area of human immunodeficiency virus (HIV) infection in children have provided recommendations to the United States Public Health Service for the prophylaxis, or preventive treatment, against Pneumocystis carinii pneumonia (PCP). The incidence of PCP was 39 percent in pediatric AIDS cases reported through 1990. This infection was the initial illness occurring in 8 to 12 percent of children with HIV infection and in more than 50 percent of children whose infection progressed to AIDS in the first year of life. PCP develops in most HIV-exposed children between three and six months of age, and most patients survive only one to four months after the initial diagnosis due to their immature immune systems. PCP prophylaxis is recommended in the first few months of life, and often needs to be initiated before a diagnosis of HIV infection is confirmed (which is difficult to do in infancy). Some factors that may influence the development of PCP include age of less than a year; the development of HIV-related symptoms; and a reduction in the number or function of CD4 cells, a type of immune cell. The observation that infants have higher numbers of CD4 cells than adults should be considered when using CD4 counts as an indicator of PCP risk. The drug regimens used for PCP prophylaxis for HIV-infected or HIV-exposed children include trimethoprim-sulfamethoxazole; pentamidine, which is aerosolized, or given as an inhalant; dapsone; and pentamidine given parenterally, or injected into the bloodstream or muscle. The guidelines to be used regarding PCP prophylaxis for HIV-infected children are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

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HIV transmission through donor artificial insemination

Article Abstract:

Women who were artificially inseminated with donor semen before 1986 may be at risk for HIV infection. HIV testing of semen samples was unavailable before 1986. A study used a look-back strategy to identify HIV-positive semen donors and to trace the number of women infected with HIV through artificial insemination. Five HIV-infected donors were identified. A total of 199 of the 230 women inseminated with semen from an infected donor agreed to HIV testing. Seven women (3.52%) tested positive for HIV infection. All of the infected women were inseminated before 1986.

HIV (Viruses), HIV, Disease transmission, Artificial insemination

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