Preventing opportunistic infections in children
Due to their weak immune systems, children living with HIV are very vulnerable to opportunistic infections, and need to be provided with drug prophylaxis to prevent such illnesses. For example, prophylaxis against PCP (one of the most common opportunistic infections in children living with HIV) is recommended for all children born to HIV-positive mothers, starting from about one month after birth.43 For children who have no access to ARVs, treatment for opportunistic infections may delay the need for antiretroviral treatment.
Co-trimoxazole, an antibiotic that is included in PCP prophylaxis and can help to prevent other infections such as TB, was shown to reduce AIDS-related mortality by 43% and hospital admission rates by 28% among children with HIV in a major trial in Zambia.44 Based on this trial and other evidence, experts agree that co-trimoxazole should be widely provided to all children living with HIV, especially where ARVs are not available. It is also recommended that all children born to HIV-positive mothers should be provided with co-trimoxazole until tests confirm that they are HIV-negative. Co-trimoxazole prophylaxis can be given to a child from 4 to 6 weeks of age.45 As well as being effective, co-trimoxazole is cheap, costing as little as US$0.03 a day to provide. However, provision is extremely low; in 2009, only 14 percent of infants in low and middle-income countries in need of co-trimoxazole received it.46
Another important intervention is vaccination or immunisation against common infections. There are some risks associated with providing routine vaccines to children living with HIV, but these risks are far outweighed by the benefits of immunisation. In general, routine vaccines are safe to administer in HIV-positive children, and are recommended.47 48 However, it should be noted that ‘live vaccines’ are often not considered safe for use in HIV-positive children.
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