Primary chemoprophylaxis in children

TMP-SMX should be offered to all HIV-exposed infants from six weeks of age, using the following criteria:

° any child born to an HIV-infected woman irrespective of whether the woman received ART in pregnancy; ° any child who is identified as HIV-infected within the first year of life by PCR (polymerase chain reaction), HIV serology or by a clinical diagnosis of HIV infection (according to WHO or national guidelines) ° children older than 15 months who have had a Pneumocystis carinii event, have symptomatic HIV infection, an AIDS-defining illness or a CD4+ lymphocyte percentage less than 15%.

The dose should be 150 mg TMP/750 mg SMX per m2 three times per week. Cotrimoxazole syrup may not be available: for an infant of 6 weeks, give half of a cotrimoxazole tablet (trimethoprim 80 mg/sulfamethoxazole 400 mg) daily on Monday,Wednesday and Friday.

These are preliminary recommendations, that recognize the need for more research to determine cost-effectiveness in different settings, optimal timing of the start of therapy, duration of prophylaxis and affordable alternatives.

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