Emerging Concepts in the Treatment of HIV Infection in Children

SELECTED CASE A 16-MONTH-OLD child was considered to have human immunodeficiency virus (HIV) infection at 4 months of age when she developed acute interstitial pneumonia that was documented by open lung biopsy to be caused byPneumocystis carinii. The patient's mother was known to be HIV seropositive, having presumably acquired the infection from sexual intercourse with the child's father, a known intravenous drug user. The patient's episode withP cariniiwas stormy, requiring first sulfamethoxazole and trimethoprim and, later, pentamidine isethionate and ventilatory support to reverse the pneumonic process. Following this episode of pneumonia, the child's subsequent course was characterized by recurrent episodes of otitis media and thrush, failure to thrive, hepatosplenomegaly, and a slowed acquisition of normal developmental milestones. At the time of her referral to the Pediatric Branch, National Cancer Institute, for antiretroviral therapy, her CD4 lymphocyte count was 0.115 × 103/L and the CD4/CD8 lymphocyte