Questions & Answers

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Genome layout of human immunodeficiency virus (HIV)–1 and HIV-2.

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Table 1. CDC Immunologic Categories for HIV-Infection in Children Based on Absolute CD4 ⁺ Counts

Category
Category	< 1 y	1-5 y	6-12 y
1 - No suppression	≥1500 (>25)	≥1000 (>25)	≥500 (>25)
2 - Moderate suppression	750-1499 (15-24)	500-999 (15-24)	200-499 (15-24)
3 - Severe suppression	< 750 (< 15)	< 500 (< 15)	< 200 (< 15)

Table 2. Antibiotics for Primary and Secondary Prophylaxis of Opportunistic Infections

Infection	Indication	First-Line Regimen	Alternative Regimen
TB	PPD test result >5 mm	Isoniazid and pyridoxine qd for 9 mo	Rifampin for 4 mo
TB	Exposure	Isoniazid and pyridoxine 3 times/wk for 9 mo, rifampin and pyrazinamide qd for 2 mo	Consult an infectious diseases specialist if the pathogen is multidrug resistant
PCP	CD4⁺ finding*	Trimethoprim-sulfamethoxazole qd	Trimethoprim-sulfamethoxazole 3 times/wk
	Fever of unknown origin for 2 wk, history of infection	Dapsone, pyrimethamine, and leucovorin	Dapsone or aerosolized pentamidine in children >5 y
	---	Atovaquone	Atovaquone
Toxoplasmosis	CD4⁺ count < 100 cells/mL	Trimethoprim-sulfamethoxazole qd	Dapsone, pyrimethamine, and leucovorin
	Positive immunoglobulin G finding	None	Atovaquone
	Previous infection	Sulfadiazine, pyrimethamine, and leucovorin	Clindamycin, pyrimethamine, and leucovorin
MAC infection	CD4⁺ finding^**	Azithromycin qwk	Rifabutin qd or clarithromycin bid
MAC infection	Previous infection	Clarithromycin or azithromycin qd and ethambutol	Clarithromycin or azithromycin qd and ethambutol
Abbreviations: bid = twice daily; PPD = purified protein derivative; qd = every day; qwk = every week. ^* See Table 4 **See Table 5

Table 3. Drugs and Doses for Prophylaxis of Opportunistic Infections

Drug	Dose
Azithromycin	20 mg/kg/dose (1.2 g maximum) PO qwk or 5 mg/kg/dose (250 mg maximum) PO qd
Clarithromycin	7.5 mg/kg/dose (500 mg maximum) PO bid
Clindamycin	20-30 mg/kg/d PO qid
Dapsone	1-2 mg/kg/d (100 mg maximum) PO qd
Ethambutol	15 mg/kg/dose (900 mg maximum) PO qd
Isoniazid	10-15 mg/kg/dose (300 mg maximum) PO/IM qd
Leucovorin	5 mg PO 3 times/wk
Pentamidine	4 mg/kg/dose monthly
Pyrimethamine	15 mg/m²/dose (25 mg maximum) PO qd
Rifabutin	5 mg/kg/dose (300 mg maximum) PO qd
Rifampin	10-20 mg/kg (600 mg maximum) PO/IV qd
Sulfadiazine	85-120 mg/kg/d PO bid
Trimethoprim-sulfamethoxazole	150/750 mg/m²/d PO bid
Abbreviations: bid = twice daily; PO = by mouth; qd = every day; qwk = every week.

Table 4. CD4 ⁺ -Based Indications for Starting PCP Prophylaxis

Age or Status	CD4⁺ Count, cells/mL	CD4⁺ Percentage
6 wk to 1 y	Any	Any
1-2 y	< 750	< 15
2-5 y	< 500	< 15
>5 y	< 200	< 15
Previous PCP infection	Any	Any

Table 5. CD4 ⁺ -Based Indications for MAC Prophylaxis

Age or Status	CD4⁺ Count, Cells/mL
< 1y	< 750
1-2 y	< 500
2-6 y	< 75
> 6 y	< 50
Previous infection	Any

Table 6. Risk Factors for Vertical Transmission

Period	Factors That Increase Risk	Factors That Decrease Risk
Prenatal	Acute HIV infection Viral load >10,000 Cigarette smoking Illicit IV drug use	Viral load < 1000 Zidovudine treatment Neutralizing antibodies
Perinatal	Rupture of membranes for >4 h Chorioamnionitis Emergency cesarean delivery Surgical delivery Episiotomy Use of scalp electrodes	Elective cesarean delivery with zidovudine treatment
Neonatal	Prematurity Low birth weight First-born twin	Full-term Second-born twin
Postdelivery	Breastfeeding	ART

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Author

Delia M Rivera, MD Assistant Professor, Department of Pediatrics, Division of Infectious Disease and Immunology, University of Miami Leonard M Miller School of Medicine

Delia M Rivera, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Richard E Frye, MD, PhD Professor of Child Health, University of Arizona College of Medicine at Phoenix; Chief of Neurodevelopmental Disorders, Director of Autism and Down Syndrome and Fragile X Programs, Barrow Neurological Institute at Phoenix Children's Hospital

Richard E Frye, MD, PhD is a member of the following medical societies: American Academy of Neurology, American Academy of Pediatrics, Child Neurology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Mark Abdelmalek, MD Chief, Division of Laser and Dermatologic Surgery, Assistant Professor, Department of Dermatology, Drexel University College of Medicine

Mark Abdelmalek, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, Pennsylvania Academy of Dermatology, and Pennsylvania Medical Society