Opportunistic Infections, Prophylaxis in Children

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Click here to access the Primary Health Care - PHC Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV and AIDS) - 26 February 2026

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Z29.2 + (B24)

Cotrimoxazole prophylaxis

Initiation

• All HIV-infected infants (< 1 year), starting from 6 weeks of age.
• Any child 1–5 years of age with CD4 < 25%, or WHO stage 3 and 4.
• Any child > 5 years of age with CD4 count < 200 cells/mm³, or WHO stage 3 and 4.

LoE:IIIb⁵⁴

• Cotrimoxazole (sulfamethoxazole/trimethoprim), oral, once daily.

Click on image to enlarge.

Table 1: Dose bands for cotrimoxazole

Discontinuation

Prophylaxis may be discontinued if the immune system is fully reconstituted on ART, i.e.,

• Child > 1 year of age, AND immune system shows signs of full reconstitution on two CD4 tests at least 3-6 months apart (regardless of clinical stage), i.e.:
  • Child 1-5 years of age: CD4 > 25%
  • Child > 5 years of age: CD4 > 200 cells/mm³

TB prophylaxis

See TB chemoprophylaxis/Isoniazid Preventive Therapy (IPT) in Children.

Immunisation

Continue immunisation as per the SA-EPI (See Vaccines for Routine Administration). If signs of HIV infection present, defer the BCG vaccination.

Click here to access the pdf.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 2.1_09 December 2024

Chapter 11: Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (HIV AND AIDS)_ 11.7 Opportunistic Infections, Prophylaxis in Children