Pneumocystis carinii pneumonia in children infected with the human immunodeficiency virus

The initial episode of Pneumocystis carinii pneumonia (PCP) in eighteen children with perinatally acquired human immunodeficiency virus (HIV) infects is described. In seven infants PCP was the presenting manifestation of HIV infection. Three children developed Pneumocystis pneumonia while receiving prophylactic therapy, but in two the duration of therapy was suboptimal and the third was not compliant. The Centers for Disease Control and Prevention (CDC) guidelines for PCP prophylaxis would have identified all children except one as requiring PCP prophylaxis based on CD4 T-lymphocyte cell counts. Corticosteroid therapy did appear not to improve survival in this small, nonrandomized cohort of patients. Early detection of HIV infection and the early institution of prophylactic therapy can be expected to improve the survival of HIV-infected children.