CDC and WHO recommendations for PCP prophylaxis for HIV-exposed infants
state that co-trimoxazole is indicated for HIV-exposed infants at 4-6
weeks and it needs to be continued till HIV PCR DNA tests on the infant
on 2 occasions are negative; one done after 1 month of age and second
after 4 months of age(1). With introduction of PACTG 076 protocol, risk
of perinatal transmission of HIV infection has shown a dramatic decline
from 24 to <5%(2). This implies that out of 100 mothers who are
HIV-positive and on PACTG 076 management, only 5 unlucky infants will
develop HIV infection. If above WHO PCP prophylaxis recommendations are
followed, 95% of infants would have unnecessarily received PCP
prophylaxis when in fact they are not infected with this deadly virus.
Such a mass usage of co-trimoxazole carries with it risk of causing
bacterial and malarial resistance. Besides, co-trimoxazole is not devoid
of adverse-effects. I personally feel that some sort of a risk scoring
should be done and co-trimoxazole prophylaxis offered only to those with
high risk of acquiring the vertical infection. What is the recent
opinion on it?
Sukhbir Kaur Shahid,
Consultant Pediatrician and Neonatologist,
1. Revised guidelines for prophylaxis against
Pneumocystis carinii pneumonia for children infected with or
perinatally exposed to human immunodeficiency virus. MMWR
Recommen-dations and Reports, 1995; 44(RR-4): 1-11.
2. Conner EM, Sperling RS, Gelber R, Kiselev P, Scott G, O’Sullivan
MJ, et al. Reduction of maternal-infant transmission of human
immunodeficiency virus type 1 with zidovudine treatment. N Engl J Med
1994; 331: 1173-1180.