CD4 T cell count, P carirui pneumonia and children born to HIV infected mothers

475 CD4 T cell count, Pcatinii to HIV infected mothers

pneumonia

and children

born

P~~~fzoc~.stic ccoinii pneumonia (PCP) is a common affliction in children infected with HIV. The Centers for Disease Control recommends that the CD4 T cell counts of children born to infected mothers should be closely monitored and that prophylaxis be started when the count falls below a critical value. This paper questions the usefulness of CD4 T cell count as a predictor of PCP, using data from a large, prospective study of children born to mothers known to be HIV-infected. Of 14 children diagnosed with PCP only three clearly fulfilled the criteria for prophylaxis; most infected children be-

came eligible for prophylaxis after the age of high risk of PCP: had the guidelines been followed, at least 10% of uninfected children would have been treated. It is concluded that, rather than modifying the guidelines, a better strategy might be to start prophylaxis in all infants as soon as HIV infection is diagnosed. As the peak incidence of PCP is between 3 and 6 months of age, this approach hinges upon an early diagnostic test for HIV infection being routinely available. D Dunn (7) Institute of Child Health, London WClN IEH, UK (7)

EMJ

(1994)

308.

437-40