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CDC Recommendations for PCP Prophylaxis and CD4+ Monitoring for HIV-exposed Infants and HIV-infected Children, by Age and HIV-infection Status

April 28, 1995

Age/HIV-infection StatusPCP ProphylaxisCD4 Monitoring
Birth to 4-6 weeks, HIV exposedNo prophylaxis1 month
4-6 weeks to 4 months, HIV-exposedProphylaxis3 months
4-12 months
HIV-infected or indeterminate
HIV infection reasonably excluded*
No prophylaxis
6, 9 and 12 months
1-5 years, HIV-infectedProphylaxis if:
CD4 count is <500 cells/ l or
CD4 percentage is < 15%§
Every 3-4 months
6-12 years, HIV-infectedProphylaxis if:
CD4 count is <200 cells/ l or
CD4 percentage is <15%
Every 3-4 months

* HIV infection can be reasonably excluded among children who have had two or more negative HIV diagnostic tests (i.e., HIV culture or PCR), both of which are performed at one month of age or later and one of which is performed at four months of age or later, or two or more negative HIV antibody tests performed at more than six months of age among children who have no clinical evidence of HIV disease.

† More frequent monitoring (e.g., monthly) is recommended for children whose CD4 counts or percentages are approaching the threshold at which prophylaxis is recommended.

§ Children 1-2 years of age who were receiving PCP prophylaxis and had a CD4 count of below 750 cells/ l or percentage of below 15 percent at below twelve months of age should continue prophylaxis.

¶ Prophylaxis should be considered on a case-by-case basis for children who might otherwise be at risk for PCP, such as children with rapidly declining CD4 counts or percentages or children with "Category C" conditions. Children who have had PCP should receive lifelong PCP prophylaxis.

Source: Morbidity and Mortality Weekly Report, April 28, 1995, vol. 44, no. RR-4.

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