Prevention of opportunistic infections and other infectious complications of HIV in children

doi:10.1017/CBO9780511544798.014

11 - Prevention of opportunistic infections and other infectious complications of HIV in children

from Part II - General issues in the care of pediatric HIV patients

Published online by Cambridge University Press: 03 February 2010

Russell B. Van Dyke

Edited by

Steven L. Zeichner and

Jennifer S. Read

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Russell B. Van Dyke: Affiliation:
Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, LA
Steven L. Zeichner: Affiliation:
National Cancer Institute, Bethesda, Maryland
Jennifer S. Read: Affiliation:
National Cancer Institute, Bethesda, Maryland

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Summary

Introduction

AIDS was first recognized in 1981 when an unusual clustering of cases of Pneumocystis carinii pneumonia (PCP) occurred among young homosexual men in Southern California, USA. Subsequently, other opportunistic infections were identified in this population, including disseminated mycobacterial infections, toxoplasmosis, and cytomegalovirus retinitis. Soon thereafter, these same opportunistic infections were identified in children. The occurrence of this group of distinctive opportunistic infections remains central to the definition of AIDS. The recognition that HIV-infected individuals are at increased risk for certain specific opportunistic pathogens has stimulated the development of strategies to prevent these infections.

For most HIV-associated opportunistic infections, the risk of infection is correlated with the patient's degree of immunosuppression. Thus, guidelines for initiating prophylaxis are generally based upon the number of circulating CD4+ lymphocytes in the peripheral blood. The normal CD4+ lymphocyte count is substantially higher in infants than in older children and adults, with normal values decreasing over the first few years of life. However, the normal percentage of CD4+ lymphocyte is relatively independent of age. This is reflected in the immune categories of the CDC classification system for HIV infections in children [1] (Table 11.1). Thus, a child of any age with a percentage of CD4+ lymphocytes of less than 15% is considered severely immunosuppressed and a candidate for PCP prophylaxis. In addition, infants have a less effective cellular immune response than do older children (see Chapter 1).

Type: Chapter
Information: Textbook of Pediatric HIV Care , pp. 153 - 167

DOI: https://doi.org/10.1017/CBO9780511544798.014 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2005

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