Details

Autor(en) / Beteiligte

• Rabie, H
• Violari, A
• Duong, T
• Madhi, S A
• Josipovic, D
• Innes, S
• Dobbels, E
• Lazarus, E
• Panchia, R
• Babiker, A G
• Gibb, D M
• Cotton, M F

Titel

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

Ist Teil von

• The international journal of tuberculosis and lung disease, 2011-09, Vol.15 (9), p.1194-1200

Ort / Verlag

France

Erscheinungsjahr

2011

Quelle

MEDLINE

Beschreibungen/Notizen

• Two centres in Soweto and Cape Town, South Africa. 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 inflammatory syndrome (BCG-IRIS) in human immunodeficiency virus (HIV) infected infants. 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. 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 > 750 000 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. Early ART initiation before immunological and/or clinical progression substantially reduces the risk of BCG-IRIS regional adenitis.