Pneumocystis jirovecii pneumonia prophylaxis for HIV-exposed neonates

Pneumocystis pneumonia (PCP) is a common, usually fatal opportunistic infection of HIV-infected infants. This review summarizes the current knowledge and recommended practices regarding PCP prophylaxis in HIV-exposed infants. The incidence of PCP has dropped dramatically in areas of the world where widespread testing for HIV and empiric prophylaxis for PCP in HIV-exposed neonates have been adopted. The recommended drug for PCP prophylaxis is trimethoprim-sulfamethoxazole (TMP-SMX), and all HIV-infected infants under a year of age should receive PCP prophylaxis as well as combination anti-retroviral therapy. With the advent of accurate, timely testing that can reliably rule out infection with HIV at an early age, PCP prophylaxis can be safely avoided in the majority of HIV-exposed infants. Resource-poor settings should employ universal PCP prophylaxis for HIV-exposed infants and have a need for rapid, accurate, molecular testing approaches to diagnose HIV infection in exposed neonates.