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


Rabie, H; Violari, A; Duong, T; Madhi, SA; Josipovic, D; Innes, S; Dobbels, E; Lazarus, E; Panchia, R; Babiker, AG; Gibb, DM; Cotton, MF; Team, C; (2011) Early antiretroviral treatment reduces risk of bacille Calmette-Guerin immune reconstitution adenitis. [Conference or Workshop Item]

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Abstract

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-Guerin (BCG) related regional adenitis due to immune reconstitution inflammatory syndrome (BCG-IRIS) in human immunodeficiency 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 BCG-IRIS 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 >750000 copies/ml at initiation. Incidence of BCG-IRIS was 10.9 and 54.3 per 100 person-years (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.

Item Type: Conference or Workshop Item
Keywords: BCG, immune reconstitution inflammatory syndrome, paediatric HIV, hiv-infected children, therapy, infants, vaccine, tuberculosis, bcg, disease
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: TB Centre
Tropical Epidemiology Group
Web of Science ID: 294520900012
URI: http://researchonline.lshtm.ac.uk/id/eprint/102

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