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

H Rabie, A Violari, T Duong, SA Madhi… - … of tuberculosis and …, 2011 - ingentaconnect.com
H Rabie, A Violari, T Duong, SA Madhi, D Josipovic, S Innes, E Dobbels, E Lazarus…
The International journal of tuberculosis and lung disease, 2011ingentaconnect.com
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
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) …
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 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 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 > 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 CONCLUSIONS: Early ART initiation before immunological and/or clinical progression substantially reduces the risk of BCG-IRIS regional adenitis.
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