Bacillus Calmette–Guérin (BCG) vaccine-induced complications in children treated with highly active antiretroviral therapy
Received 26 February 2008; received in revised form 28 May 2008; accepted 10 June 2008. published online 17 September 2008.
Summary
Objective
To describe the frequency, risk factors, and clinical features of bacillus Calmette-Guérin (BCG) complications in HIV-infected children treated with highly active antiretroviral therapy (HAART).
Methods
A retrospective study of children started on HAART between August 2002 and November 2004 was completed.
Results
Six percent (21/352; 95% CI 3.7–8.0%) developed BCG complications. All developed ipsilateral axillary lymphadenitis; one child had suspected disseminated BCG infection. There were 14 females; median age at start of HAART was 5 months. BCG disease developed a median of 34 days after starting HAART. At baseline and 6 months into HAART, the median CD4 percentage and log10 viral load were 12.3/6.1 and 23.9/4.5, respectively. Seventeen (81%) of the patients were treated with either zidovudine or stavudine combined with lamivudine and ritonavir. Young age and high baseline viral load were independent risk factors for development of BCG complications. Mycobacterium bovis BCG was isolated in 70% of patients who underwent incision and drainage of abscesses at the vaccination site or regional lymph nodes.
Conclusions
This study identified a high prevalence of BCG complications in children on HAART. A clinical case definition of BCG immune reconstitution syndrome independent of laboratory parameters for use in resource-limited settings should be developed.
Corresponding Editor: William Cameron, Ottawa, Canada
aPaediatric Infectious Diseases Unit, Red Cross Children's Hospital, School of Child and Adolescent Health, University of Cape Town, Rondebosch, 7700, Cape Town, South Africa
bInfectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa
cSouth African Tuberculosis Vaccine Institute, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
ABSTRACT