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

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dc.contributor.authorRabie H.
dc.contributor.authorViolari A.
dc.contributor.authorDuong T.
dc.contributor.authorMadhi S.A.
dc.contributor.authorJosipovic D.
dc.contributor.authorInnes S.
dc.contributor.authorDobbels, Elsen_ZA
dc.contributor.authorLazarus E.
dc.contributor.authorPanchia R.
dc.contributor.authorBabiker A.G.
dc.contributor.authorGibb D.M.
dc.contributor.authorCotton M.F.
dc.date.accessioned2011-10-13T16:58:39Z
dc.date.available2011-10-13T16:58:39Z
dc.date.issued2011
dc.descriptionPlease help us populate SUNScholar with the post print version of this article. It can be e-mailed to: scholar@sun.ac.za
dc.description.abstractSETTING: 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.
dc.description.versionArticle
dc.identifier.citationInternational Journal of Tuberculosis and Lung Disease
dc.identifier.citation15
dc.identifier.citation9
dc.identifier.citationhttp://www.scopus.com/inward/record.url?eid=2-s2.0-80051676494&partnerID=40&md5=6cd568cde5eaff63f01b473bf9c2245f
dc.identifier.issn10273719
dc.identifier.other10.5588/ijtld.10.0721
dc.identifier.urihttp://hdl.handle.net/10019.1/16804
dc.subjectBCG
dc.subjectImmune reconstitution infl ammatory syndrome
dc.subjectPaediatric HIV
dc.subjectantiretrovirus agent
dc.subjectBCG vaccine
dc.subjectvirus RNA
dc.subjectarticle
dc.subjectBCG vaccination
dc.subjectCD4 lymphocyte count
dc.subjectcontrolled study
dc.subjectearly intervention
dc.subjectfemale
dc.subjecthuman
dc.subjectHuman immunodeficiency virus 1
dc.subjectHuman immunodeficiency virus infection
dc.subjectimmune reconstitution inflammatory syndrome
dc.subjectinfant
dc.subjectlymphadenitis
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmulticenter study
dc.subjectoutcome assessment
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectrisk assessment
dc.subjectrisk factor
dc.subjectrisk reduction
dc.subjectSouth Africa
dc.subjecttreatment planning
dc.subjectvirus load
dc.titleEarly antiretroviral treatment reduces risk of bacille Calmette- Guérin immune reconstitution adenitis
dc.typeArticle
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