* PCP indicates Pneumocystis carinii pneumonia; HIV, human immunodeficiency virus; and PCR, polymerase chain reaction.
↵† HIV infection can be reasonably excluded among children who have had two or more viral diagnostic tests negative for infection (ie, culture or PCR), both of which are performed at 1 month of age or older, and one of which is performed at 4 months of age or older, or two or more negative HIV antibody tests performed at 6 months of age or older among children who have no clinical evidence of HIV infection.
↵‡ More frequent monitoring (eg, monthly) is recommended for children whose CD4+ counts or percentages are approaching the threshold at which prophylaxis is recommended.
↵§ Prophylaxis should be considered on a case-by-case basis for children who may otherwise be at risk for PCP, such as children with rapidly declining CD4+ counts or percentages or children with category C conditions (severely symptomatic). Children who have had PCP should receive lifelong prophylaxis.
Drug Regimens for PCP Prophylaxis for Children 4 Weeks of Age or Older*28
Trimethoprim-sulfamethoxazole, 150 mg/m2/d of trimethoprim with 750 mg/m2/d of sulfamethoxazole (or 5 mg/kg/d of trimethoprim with 25 mg/kg/d of sulfamethoxazole), orally in divided doses two times a day, 3 times per week on consecutive days (eg, Monday, Tuesday, and Wednesday)
Acceptable alternative trimethoprim-sulfamethoxazole dosage schedules
150 mg/m2/d of trimethoprim with 750 mg/m2/d of sulfamethoxazole, orally as a single daily dose, 3 times per week on consecutive days (eg, Monday, Tuesday, and Wednesday)
150 mg/m2/d of trimethoprim with 750 mg/m2/d of sulfamethoxazole, orally in divided doses two times a day, administered 7 days per week
150 mg/m2/d of trimethoprim with 750 mg/m2/d of sulfamethoxazole, orally in divided doses two times a day, 3 times per week on alternate days (eg, Monday, Wednesday, and Friday)
Alternative regimens when therapy with trimethoprim-sulfamethoxazole is not tolerated†
Dapsone, 2 mg/kg (not to exceed 100 mg), orally once a day
Aerosolized pentamidine (for children ≥5 y of age), 300 mg administered via Respirgard II inhaler, once a month
* PCP indicates Pneumocystis carinii pneumonia.
↵† If neither dapsone nor aerosolized pentamidine is tolerated, some clinicians administer 4 mg/kg of pentamidine intravenously every 2 or 4 weeks.
Definition of a Positive Mantoux Skin Test (5TU-PPD) in Children*45
Reaction ≥5 mm
Children in close contact with persons who have known or suspected infectious cases of TB:
Households with active or previously active cases if (1) treatment cannot be verified as adequate before exposure, (2) treatment was initiated after contact with the child occurred, or (3) reactivation is suspected.
Children suspected to have tuberculous disease:
Chest radiograph shows active or previously active TB
Clinical evidence of TB
Children with immunosuppressive conditions† or HIV infection
Reaction ≥10 mm
Children at increased risk of dissemination from:
Young age: <4 y
Other medical risk factors, including Hodgkin's disease, lymphoma, diabetes mellitus, chronic renal failure, and malnutrition
Children with increased environmental exposure:
Born or with parents born in regions of the world where TB is endemic
Frequent exposure to adults who are HIV-infected, homeless, users of intravenous and other street drugs, poor and medically indigent city dwellers, residents of nursing homes, incarcerated or institutionalized persons, or migrant farm workers
Reaction ≥15 mm
Children ≥4 y of age without any risk factors
* The Mantoux skin test contains 5 tuberculin units of purified protein derivative (5TU-PPD). These recommendations should apply regardless of whether bacille Calmette-Guérin (BCG) has been previously administered. TB, tuberculosis; HIV, human immunodeficiency virus.
↵† Including immunosuppressive dose of corticosteroids.
Laboratory Monitoring and Immunization for the HIV-Exposed Infant (Birth to 6 Months of Age)*
* ACTG-076 indicates AIDS (Acquired Immunodeficiency Syndrome) Clinical Trials Group Protocol-076; CBC, complete blood count; PCR, polymerase chain reaction; and HIV, human immunodeficiency virus.
↵† Test mother or neonate if maternal status for other infections has not been assessed (see text).
↵‡ Zidovudine therapy to decrease the risk of HIV infection in the infant is discontinued at 6 weeks of age.
↵§ CBC and differential leukocyte count should continue to be done monthly beyond 4 months of age in the infected child and the child whose infection status is unclear at 4 months.
↵‖ Repeat PCR or viral culture immediately if positive to confirm infection. If initial test is negative, repeat test at 4 weeks to 2 months. If clinical status or other laboratory parameters suggest HIV infection, repeat testing earlier than 4 months. If at 4 months the tests are still negative for infection, ongoing serologic follow-up is indicated.
↵¶ T-cell profile should be repeated at 6 months in infected children and in those whose infection status is unclear at 6 months.
↵#Haemophilus influenzae vaccine schedule may vary depending on which type of vaccine is used.