Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 1993 Nov;4(6):333-40.
doi: 10.1155/1993/509264.

Pneumocystis prophylaxis for all, some, or no HIV-infected infants less than one year of age: A decision analysis approach

U D Allen  1 , S E Read
Affiliations

Pneumocystis prophylaxis for all, some, or no HIV-infected infants less than one year of age: A decision analysis approach

U D Allen et al. Can J Infect Dis. 1993 Nov.

Abstract
in English, French

Pneumocystis carinii pneumonia (PCP) is associated with significant mortality and morbidity among infants infected with human immunodeficiency virus (HIV). The preferred prophylaxis strategy for such infants is a subject of debate. Medical decision analysis was used to determine the preferred strategy for primary PCP prophylaxis among asymptomatic HIV-infected infants less than one year of age, and to determine the thresholds at which different variables influence decision making. Utility measures (health state preference values) were used to determine whether prophylaxis should be given to all, some or no infants. In this regard, some infants would receive prophylaxis if baseline CD4 counts are fewer than 1500 cells/mm(3). The results suggest that the preferred option is to give prophylaxis to all asymptomatic HIV-infected infants despite CD4 counts, if the risk of PCP is equal to or greater than 25%. However, if the risk of PCP is less than 25%, prophylaxis is recommended for those infants with CD4 counts of fewer than 1500 cells/mm(3). The results complement current guidelines regarding PCP prophylaxis for HIV-infected infants.

La pneumonie à Pneumocystis carinii (PPC) est associée à des taux de mortalité et de morbidité importants chez les nourrissons infectés au virus de l’immunodéficience humaine (VIH). La stratégie prophylactique préférée chez ces nourrissons est sujette à débat. Une approche analytique décisionnelle médicale a été utilisée pour déterminer la meilleure stratégie à adopter en matière de prophylaxie primaire de la PPC chez les nourrissons asymptomatiques infectés au VIH de moins d’un an et pour déterminer les seuils auxquels différentes variables influent sur la prise de décision. Des mesures d’utilité (valeurs relatives à l’état de santé) ont été utilisées pour déterminer si la prophylaxie devrait être administrée à tous les nourrissons, à certains d’entre eux ou à aucun d’entre eux. À cet égard, certains nourrissons recevraient une prophylaxie si leur numération de CD4 de base était inférieure à 1500 cellules/mm3. Les résultats suggèrent que la meilleure option est d’administrer une prophylaxie à tous les nourrissons asymptomatiques infectés au VIH en dépit des numérations de CD4 si le risque de PPC est égal ou supérieur à 25 %. Cependant, si le risque de PPC est inférieur à 25 %, la prophylaxie est recommandée pour les nourrissons dont les numérations de CD4 sont inférieures à 1500 cellules/mm3. Les résultats complètent les directives actuelles au sujet de la prophylaxie de la PPC chez les nourrissons infectés au VIH.

Keywords: Decision analysis; Pneumocystis; Prophylaxis.

PubMed Disclaimer

Figures

Figure 1
Figure 1
All human immunodeficiency virus-infected infants less than one year of age receive Pneumocystis carinii pneumonia (PCP) prophylaxis
Figure 2
Figure 2
Pneumocystis carinii pneumonia (PCP) prophylaxis is not given to any human immunodeficiency virus-infected infants less than one year of age
Figure 3
Figure 3
Human immunodeficiency virus-infected infants less than one year of age who have baseline CD4 counts fewer than 1500 cells/mm3 receive Pneumocystis carinii pneumonia (PCP) prophylaxis. Infants with CD4 counts equal to or greater than 1500 cells/mm3 do not recieve prophylaxis
Figure 4.
Figure 4.
The effect of varying ‘test’ sensitivity and prevalence of Pneumocystis carinii pneumonia (PCP) simultaneously. ‘Test’ refers to a CD4 count of fewer than 1500 cells/mm3 as a predictor of subsequent PCP in a previously asymptomatic human immunodeficiency virus-infected infant. Combinations of values above the curve favour the ‘treat some’ option; combinations below the curve favour the ‘treat all’ option; combinations along the curve represent the indifference points
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Kovacs JA, Masur H. Pneumocystis carinii pneumonia: Therapy and prophylaxis. J Infect Dis. 1988;158:254–9. - PubMed
    1. Centers for Disease Control Update: Acquired immunodeficiency syndrome-United States. MMWR. 1986;35:542.
    1. Scott GB, Hutto C, Makuch RW, et al. Survival in children with perinatally acquired human immunodeficiency virus type 1 infection. N Engl J Med. 1989;321:1–6. - PubMed
    1. Krasinski K, Borkowsky W, Holzman RS. Prognosis of human immunodeficiency virus infection in children and adolescents. Pediatr Infect Dis J. 1989;8:216–20. - PubMed
    1. Bernstein LJ, Bye MR, Rubinstein A. Prognostic factors and life expectancy in children with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. Am J Dis Child. 1989;143:775–8. - PubMed

LinkOut - more resources