BMJ 1994;308:437-40 (12 February)

Papers

CD4 T cell count as predictor of Pneumocystis carinii pneumonia in children born to mothers infected with HIV

D Dunn, M L Newell, T Ades, C Peckham, A D Maria,  for the European Collaborative Study Group

Department of Epidemiology and Biostatistics, Institute of Child Health, London WC1N 1EH. Correspondence to: Dr M-L Newell,.

Abstract

Objective : To assess the value of CD4 T cell count in predicting Pneumocystis carinii pneumonia in infants born to mothers infected with HIV, with reference to the guidelines from the Centers for Disease Control on prophylaxis against pneumocystis.
Design : Prospective birth cohort study.
Setting : Hospitals in 10 European cities participating in the European collaborative study.
Subjects : 924 children born to mothers known to be infected with HIV at or before delivery. Main outcome measures - The incidence of P carinii pneumonia. CD4 T cell counts in children before diagnosis of the pneumonia. The proportions of children infected and uninfected with HIV who fulfilled the criteria for primary prophylaxis.
Results : Fourteen children were diagnosed with P carinii pneumonia. The cumulative incidence by the age of 6 years was 2% (95% confidence interval 0.9 to 3.0%). Of the 11 children with a CD4 T cell count predating diagnosis, only three fulfilled the criteria from the Centers for Disease Control for prophylaxis. Prophylaxis was indicated by 1 year of age for 62% of infected children who had not developed P carinii pneumonia and for at least 10% of uninfected children.
Conclusions : Monitoring CD4 T cell count seems to be of limited value in deciding when to start prophylaxis against P carinii pneumonia in children born to mothers infected with HIV. The alternative approach of giving prophylaxis to all children born to infected mothers would be difficult to justify given the low incidence of the pneumonia.

Clinical implications

  • Clinical implications

  • The Centers for Disease Control recommend prophylaxis against Pneumocystis carinii pneumonia when CD4 T cell count falls below a critical level

  • In this study of children born to mothers infected with HIV the cumulative incidence of Pneumocystis pneumonia was 16% by 6 years of age in children who had HIV infection

  • If the guidelines were to be followed prophylaxis would be indicated for at least 10% of uninfected children by 1 year of age

  • Monitoring CD4 T cell count was of limited value in deciding when to start prophylaxis in children born to mothers infected with HIV

  • A better strategy would be to start prophylaxis in infants under 6 months of age as soon as HIV infection is diagnosed


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This article has been cited by other articles:

  • The European Collaborative Study, (2001). Fluctuations in Symptoms in Human Immunodeficiency Virus-Infected Children: The First 10 Years of Life. Pediatrics 108: 116-122 [Abstract] [Full text]  
  • Helbert, M., Breuer, J. (2000). Monitoring patients with HIV disease. J. Clin. Pathol. 53: 266-272 [Full text]  
  • Peckham, C., Gibb, D. (1995). Mother-to-Child Transmission of the Human Immunodeficiency Virus. NEJM 333: 298-303 [Full text]  
  • Simonds, R.J., Lindegren, M. L., Thomas, P., Hanson, D., Caldwell, B., Scott, G., Rogers, M., The Pneumocystis carinii Pneumonia Prophylaxis Eva, (1995). Prophylaxis against Pneumocystis carinii Pneumonia among Children with Perinatally Acquired Human Immunodeficiency Virus Infection in the United States. NEJM 332: 786-790 [Abstract] [Full text]  
  • Jones, P (1994). HIV in childhood. BMJ 308: 425-426 [Full text]  
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