Table 3.

Recommendations for PCP Prophylaxis and CD4+ Lymphocyte Monitoring28 for HIV-Exposed Infants* and HIV-Infected Children by Age and HIV Infection Status*

Age and HIV Infection StatusPCP ProphylaxisCD4+ Monitoring
Birth to 4–6 wk, HIV-exposedNo prophylaxis1 mo of age
4–6 wk to 4 mo, HIV-exposedProphylaxis3 mo of age
4–12 mo, HIV-infected or
indeterminate
Prophylaxis6, 9, and 12 mo of age
HIV infection reasonably excludedNo prophylaxisNone
1–2 y, HIV-infectedProphylaxis if CD4+ count <750 cells/μL in first 12 mo orEvery 3–4 mo
 <500 cells/μL at 12–24 mo, or CD4+ percentage <15§
2–5 y, HIV-infectedProphylaxis if CD4+ count <500 cells/μL or CD4+ percentage <15§Every 3–4 mo
6–12 y, HIV-infectedProphylaxis if CD4+ count <200 cells/μL or CD4+ percentage <15§Every 3–4 mo
All ages, HIV-infected, prior PCP
infection
Prophylaxis§Every 3–4 mo
  • * 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.