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close this bookProvisional WHO / UNAIDS Secretariat Recommendations on the Use of Cotrimoxazole Prophylaxis in Adults and Children Living with HIV/AIDS in Africa (UNAIDS, 2000, 4 p.)
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View the documentRECOMMENDATION
View the documentOPERATIONAL ISSUES
View the documentDRUG REGIMENS
View the documentRECRUITMENT
View the documentFOLLOW UP
View the documentDRUG SUPPLY
View the documentTRAINING AND EDUCATION
View the documentMONITORING AND EVALUATION
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OPERATIONAL ISSUES

Selection criteria

Cotrimoxazole prophylaxis should be offered to the following HIV-positive adults (defined as over the age of 13 years):

· all persons with symptomatic HIV disease (Stage 2, 3 or 4 of the provisional WHO classification of HIV infection and disease).

· asymptomatic individuals who have a CD4 count of 500 or less or total lymphocyte count equivalent

· pregnant women after the first trimester

Cotrimoxazole prophylaxis 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 antiretroviral therapy in pregnancy.

· any child who is identified as being HIV infected within the first year of life by PCR, HIV serology or by a clinical diagnosis of HIV infection (according to WHO/national guidelines).

· children older than 15 months who have had a PCP event, have symptomatic HIV disease, an AIDS defining illness, or have CD4 percentage less than 15.

Where PCR or other special diagnostic tests are available, this can be used to confirm the diagnosis in children.

The use of CD4 counts or total lymphocyte counts is not recommended for consideration of the initiation of therapy in infants because these measurements are not predictive of the risk of acquiring PCP in infants less than one year of age.