[19] BCG-INDUCED DISEASE IN HIV-INFECTED CHILDREN

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] BCG-INDUCED DISEASE IN HIV-INFECTED CHILDREN

[AUTHOR(S):] AC Hesseling¹, HS Schaaf¹, N Beyers¹, MF Cotton¹, RP Gie¹, BJ Marais¹, P van Helden², WA Hanekom³ and R Warren¹^,³
¹Department of Paediatrics and Child Health, Tygerberg Children’s Hospital; ²Department of Medical Biochemistry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa; and ³Infectious Diseases and Immunology, Department of Paediatrics, School of Medicine, University of Miami, USA

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 19
Antiviral Therapy 2003; 8(Suppl. 1):S189

[ABSTRACT:] BCG, a live attenuated strain of Mycobacterium bovis, is widely given but may be associated with adverse events. Disseminated BCG disease is rare and seen predominantly in immunocompromised patients. Routine identification of mycobacterial isolates involves isolation of M. tuberculosis complex and does not differentiate between M. tuberculosis and the vaccine strain M. bovis BCG. PCR-based methodologies can rapidly and accurate differentiate M. tuberculosis complex. The study aims were to retrospectively determine the proportion of BCG-related culture-confirmed mycobacterial disease in hospitalized HIV-infected children aged 0–13 years through speciation with a PCR-based algorithm targeting the TBD1 and RD 10 regions and the ESAT-6 gene. Clinical features of BCG disease were also described. 183 mycobacterial samples from 49 HIV-infected patients were analyzed. Danish strain M. bovis BCG was isolated from 15 specimens from 5 patients (10%). All cases were asymptomatic at birth, younger than 12 months and severely immunodeficient at presentation. Two patients had probable disseminated BCG disease, two localized extraregional disease and one adenitis. One patient presented with BCG disease related to immune reconstitution after HAART and two patients were co-infected with M. tuberculosis. The clinical picture was similar to tuberculosis, although right axillary adenitis is more common. Young symptomatic HIV-infected infants are at risk for BCG-related complications. Clinical features do not adequately distinguish between BCG and M. tuberculosis. Coinfection with M. tuberculosis can occur. Due to study limitations, we are unable to recommend a change in current vaccination policy. Population-based controlled studies are necessary to assess the risk of BCG in HIV-infected children.

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