17th International AIDS Conference Mexico City, Mexico - August 13 - 18, 2008

BCG ADVERSE EVENTS IN PERINATALLY HIV-INFECTED CHILDREN

Int Conf AIDS. 2008 Aug 13-18;17 Abstract No. MOAB0302

V. Uriarte ¹, M.R. Agosti¹, M.K. Garcia¹, J.C. Morales¹, A. Aguirre², S. González Ayala^1
1Department of Infectious Diseases, Sor Maria Ludovica Children´s Hospital, La Plata, Argentina, ²Reference Laboratory for Mycobacteriaceae, San Juan de Dios Hospital, La Plata, Argentina

BACKGROUND: BCG vaccination by intradermal injection is included in the National Immunization Calendar for newborns with weight >2000g during the first week (since 2003)/four weeks of life (1978-2002). The objective of this study is to report the BCG complications in perinatally HIV-infected children.

METHODS: Retrospective study of localized and disseminated adverse events in BCG-vaccinated perinatally-infected HIV- positive children. Blood, gastric wash, bone marrow, and lymph nodes samples were cultured. Biochemical identification of M. bovis BCG, and susceptibility tests were performed at a National Reference Laboratory for Mycobacteriaceae.

RESULTS: Of 487 BCG-vaccinated perinatally HIV-infected children, 31(6.4%) had BCG-related adverse events. BCG disseminated infection (multiple lymph nodes, pneumonitis, caseum areas in spleen, liver and bones) was detected in 4 infants (0.8%) and 3 died at 1 year of age despite specific treatment and initiation of HAART. In these patients, viral load was >500,000 copies/mL and CD4 T-cell count <8%. HIV-infection was suspected and diagnosed because of BCG disseminated infection in all of them, as their mothers had no antenatal or delivery HIV screening. The localized BCG-related adverse event found in our population was axillar or supraclavicular adenitis ipsilateral to the vaccination site and was observed in 26 (5.3%) children. One patient (0.2%) had a chronic suppurative axillary adenitis as manifestation of immune reconstitution syndrome after the initiation of HAART.

CONCLUSIONS: For general population, the incidence of localized and disseminated BCG adverse events is <0.04% and <0.0002%, respectively. In HIV-infected children, we observed 5.3% and 0.8% for each one: a several hundreds-fold increase. Argentinean authors previously reported 7.8%, and 1.3-1.8% for local and disseminated adverse events, respectively. The international reported range for local events is 0-30.7%. Efficacy of BCG in children living with HIV is unknown. Risks and efficacy of BCG vaccination in HIV-infected children must be assessed by controlled population-based studies.

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2008-08-13
MOAB0302

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