Document 0963
 DOCN  M94A0963
 TI    The impact of prophylaxis guidelines on Pneumocystis carinii pneumonia
       (PCP) in infants, U.S.A.
 DT    9412
 AU    Simonds RJ; Lindegren M; Thomas P; Scott G; Connolly G; Laraque F;
       Hanson D; Div HIV/AIDS, CDC, Atlanta, GA 30333.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(2):24 (abstract no. 389B). Unique
       Identifier : AIDSLINE ICA10/94371612
 AB    OBJECTIVE: PCP in HIV-infected children occurs most often in infants (<
       1 year old) and can be prevented by chemoprophylaxis. However, although
       prophylaxis guidelines were published in 1991, no decline in PCP cases
       among infants has been detected. We evaluated the guidelines to
       determine why prevention efforts may have failed. METHODS: We calculated
       PCP incidence among infants using national data from AIDS surveillance
       of children and HIV serosurveillance of childbearing women; we
       determined the timing of HIV and PCP prophylaxis evaluations by
       reviewing medical records of infants with PCP from 11 U.S. sites.
       RESULTS: The incidence of PCP among infants born to HIV-infected women
       in 1989, 1990, 1991, and Jan-Jun 1992 was 2.7%, 2.7%, 2.1%, and 2.2%,
       respectively. We reviewed records of 223 infants (median age 4 mos) with
       PCP diagnosed 1/91-6/93. Of these infants, 169 (76%) had not received
       prophylaxis before PCP. Of the 169 non-prophylaxed infants, 105 (62%)
       had not been evaluated for HIV infection > 30 days before PCP. Of the 64
       infants who had been evaluated, 45 (70%) did not have CD4 counts
       measured. Fifteen (79%) of the 19 non-prophylaxed infants who had CD4
       counts measured did not qualify for prophylaxis by the guidelines (no
       counts < 1500 cells/microliters). For 42 infants (including 26 on
       prophylaxis) who had > or = 2 CD4 counts before PCP diagnosis, the
       estimated decline in CD4 count during the 3 months before PCP was 937
       cells/microliters (95% CI 653-1221 cells/microliters). CONCLUSIONS: The
       incidence of PCP among infants has not declined substantially since
       prophylaxis guidelines were published. Most recent cases can be
       attributed to lack of timely evaluation for HIV. Using CD4 counts as
       criteria for prophylaxis may be impractical for infants because counts
       may be difficult to obtain before the age of peak PCP risk (3-6 mos),
       and may decline rapidly before PCP. HIV screening and PCP prophylaxis
       strategies must be improved to maximally prevent PCP in infants.
 DE    AIDS-Related Opportunistic Infections/EPIDEMIOLOGY/*PREVENTION &
       CONTROL  Centers for Disease Control and Prevention (U.S.)  *Guidelines
       Human  HIV Infections/BLOOD/CONGENITAL  Incidence  Infant  Infant,
       Newborn  Leukocyte Count  Pneumonia, Pneumocystis
       carinii/EPIDEMIOLOGY/*PREVENTION &  CONTROL  Retrospective Studies  T4
       Lymphocytes  United States/EPIDEMIOLOGY  MEETING ABSTRACT

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).