Early antiretroviral treatment reduces risk of bacille Calmette- Guérin immune reconstitution adenitis

SETTING: Two centres in Soweto and Cape Town, South Africa. OBJECTIVE: To assess the effects of timing of initiation of antiretroviral treatment (ART) and other factors on the risk of bacille Calmette-Guérin (BCG) related regional adenitis due to immune reconstitution infl ammatory syndrome (BCG-IRIS) in human immunodefi ciency virus (HIV) infected infants. DESIGN: HIV-infected infants aged 6-12 weeks with CD4 count ≥25% enrolled in the Children with HIV Early Antiretroviral Therapy (CHER) Trial received early (before 12 weeks) or deferred (after immunological or clinical progression) ART; infants with CD4 count <25% all received early ART. All received BCG vaccination after birth. Reactogenicity to BCG was assessed prospectively during routine study follow-up. RESULTS: Of 369 infants, 32 (8.7%) developed BCGIRIS within 6 months of starting ART, 28 (88%) within 2 months after ART initiation. Of the 32 cases, 30 (93.8%) had HIV-1 RNA > 750 000 copies/ml at initiation. Incidence of BCG-IRIS was 10.9 and 54.3 per 100 personyears (py) among infants with CD4 count ≥25% at enrolment receiving early (at median age 7.4 weeks) vs. deferred (23.2 weeks) ART, respectively (HR 0.24, 95%CI 0.11-0.53, P < 0.001). Infants with CD4 count <25% receiving early ART had intermediate incidence (41.7/ 100 py). Low CD4 counts and high HIV-1 RNA at initiation were the strongest independent risk factors for BCG-IRIS. CONCLUSIONS: Early ART initiation before immunological and/or clinical progression substantially reduces the risk of BCG-IRIS regional adenitis. © 2011 The Union.

Description

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Keywords

BCG, Immune reconstitution infl ammatory syndrome, Paediatric HIV, antiretrovirus agent, BCG vaccine, virus RNA, article, BCG vaccination, CD4 lymphocyte count, controlled study, early intervention, female, human, Human immunodeficiency virus 1, Human immunodeficiency virus infection, immune reconstitution inflammatory syndrome, infant, lymphadenitis, major clinical study, male, multicenter study, outcome assessment, priority journal, prospective study, risk assessment, risk factor, risk reduction, South Africa, treatment planning, virus load

Citation

International Journal of Tuberculosis and Lung Disease
15
9
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