Ineffectiveness of Trimethoprim‐Sulfamethoxazole Prophylaxis and the Importance of Bacterial and Viral Coinfections in African Children withPneumocystis cariniiPneumonia

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Abstract
African human immunodeficiency virus type 1 (HIV-1)–infected children were evaluated to define the burden of Pneumocystis carinii pneumonia (PCP) and its interaction with bacterial and viral pathogens. P. carinii was identified in 101 (43.7%) of 231 episodes of pneumonia among 185 HIV-1–infected children (median age, 4.5 months; range, 1.7–27.3 months). Receipt of trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis was not associated with a significant reduction (36%; 95% confidence interval [CI], -15.4% to 64.5%) in isolation of P. carinii among children considered to have received adequate prophylaxis (37.7% of children) compared with children who had never received any prophylaxis (48.5% of children). However, deaths among children with PCP who had been taking TMP-SMX prophylaxis were markedly reduced (98.6%; 95% CI, 89.1%–99.8%) compared with children who were not taking prophylaxis. Concurrent P. carinii infection was observed in 6 of 18, 11 of 26, and 4 of 6 HIV-1–infected children who had bacteremia, a respiratory virus isolated, or Mycobacterium species isolated, respectively.